Giving 25mg IM injection with 50mg prefilled syringe

[jeddyl]

Hello! I am a nursing student in my first semester so I do not have very much experience yet. Today, we had a question on our exam that went something like

"A nursing student is giving a 25mg IM injection with a 50mg prefilled syringe. When should the clinical instructor step in?"

Answers included:

1. Student wastes the first 25mg in the syringe

2. Student re-caps needle when finished injecting

3. Student places needle in trash can

4. (Don't remember full answer) Student was or was not using some sort of machine or technique that started with a C or Ch

I picked 2 because you should never recap a needle.....what are your thoughts? What are the complete steps to using a prefilled syringe with more medication than you are administering? What are you not supposed to do? All of the answers seemed to need instructor intervention!

[Meriwhen, ASN, BSN, MSN, RN]

1. Student wastes the first 25mg in the syringe

Considering they're only meant to be giving 25mg, there's nothing wrong with that. Though IMO, if you're going to waste the 25mg before injecting, please change out the needle before administering, as a fresh clean needle will burn less upon injection.

2. Student re-caps needle when finished injecting

That's not illegal. It's neither the best nor safest practice though. If one really has to recap a needle, it should be the one-handed scoop method.

3. Student places needle in trash can

Here's your problem. Sharps need to be disposed only in a sharps bin/container.

4. (Don't remember full answer) Student was or was not using some sort of machine or technique that started with a C or Ch

In light of #3, whatever this is, is probably correct.

[BuckyBadgerRN, ASN, RN]

Recapping needles in dentistry is allowed. It's very possible that you will reuse the needle on the patient if you need to add anesthetic to the operative site

[northmississippi]

its its not a sata, i'd say when the student put the needle in the trash,, some syringes have caps that your supposed to push up and cover the needle when done, then put it in the sharps container.

[Conqueror+, BSN, RN]

2 and 3. 2 puts the student/nurse at risk and 3 puts everyone else at risk

[KelRN215, BSN, RN]

I'm not sure why withdrawing medication from a carpuject compatible vial would be considered a "no-no." This has been daily practice in every ED I have ever worked, as pharmacy only stocks that type of Morphine and Dilaudid and we don't actually stock the carpuject devices. I mean, essentially, it's just like any other vial, with a port to withdraw medication from with a blunt tipped (or any othe type of) needle. The only caveat being that you don't inject air into these types of vials.

Same. I have never seen a carpuject device in person but that's how our IV valium and 2 mg/mL morphine came when I worked in the hospital. I withdrew meds from these vials every single shift I ever worked in the hospital, as did all of my colleagues. There's no problem there.

The answer to the OP's question is 3. Recapping a needle is sometimes necessary. Most hospitals carry safety needles but the insulin needles I see in daily use don't have safety devices nor do the vast majority of the IM or subq needles I use in home health. The fact alone that the student recapped a needle isn't wrong. Placing sharps in the trash can is always wrong and the only thing on this list that is universally unacceptable. (Well, at least in the developed world. I have seen nurses in Africa simply dispose of sharps in the regular trash.)