How can I make Rocephin I'm hurt less???

Specialties Geriatric

Updated:   Published

I gave Rocephin I'm for the first time today and I went home feeling like the world's worst nurse. I read up on the med before giving it, so I expected it would hurt, but my little old lady hollared very loud. I just feel like I could of done things better. I hugged my resident for a good five minutes after it was over, I felt so bad. Any suggestions on how I can do things better would be greatly appreciated. I work in an LTC, so my resident is thin with very little body fat. I used a filter needle to ensure the needle I was injecting with would be sharp. I reconstituted the Rocephin with 2.1mls of 1% lidocaine. And I gave it in the middle third of the lateral thigh. What's the smallest gauge and length needle you all would recommended for someone with little to no body fat? Should I have used the gluteal muscle instead? Is it better to go fast or slow? Please help, feeling so guilty!!:bluecry1:

You didn't do a thing wrong. Screw it.

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Don't feel bad. You administered an ordered ABX for a resident who really needed it. There's nothing you could have done differently. An IM injection for a LOL is going to hurt, unfortunetly.

And I'll echo the sentiment that many LTC facilities (mine included) simply do not "do" IVs. So it's either give the shot, or ship them to the ER.

I wish we did start IVs, though. Likely this resident would benefit from some IV fluids as well. If we could treat our UTIs with IV abx and fluids to rehydrate I bet we'd be able to treat a lot more residents in house. It's within the LPN SOP in almost every sate to hang a bag of IV medication. Even a low acuity facility like mine could handle a few IVs here and there.

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Specializes in LTC, OR.

I found that if I inject Rocephin really slow (good 90 seconds), it helps to avoid excessive pain at the injection site.

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CapeCodMermaid said:
I'm anything in an elder hurts. Get the doc to change to IV.

IV? Would that not be painful as well? Our docs have been prescribing I'm rocephin lately and I always ask them to reconsider and give an oral antibiotic to our elderly unless they refuse to take the medication. I hate to stick them, they are so fragile and have very little body or muscle mass.

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Specializes in Reproductive & Public Health.

I give rocephin a LOT (for gonorrhea though, which I assume is not a huge problem in LTC, but what do I know). It hurts, and I feel bad too. I do mix with lidocaine but am not convinced it helps. Maybe try some of the techniques used for pedi IMs? Distraction, cold pack, rubbing (if the skin can handle it)? Maybe even a sweet to help the medicine go down, if appropriate for the patient.

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I mostly use the vastus lateralis for Rocephin, it does hurt. Technique helps, but no one thinks it great to get the shot.

Our facility frowns upon the dorsogluteal site. And I agree that the ventrogluteal is a good site, but I am not as good with finding the landmarks.

I have used cold packs, cold spray before cleaning the site for the injection.

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Specializes in ER, ICU, MS, SNF, OTC, Perianesthesia, LTC.

1% Lido needs to be mixed with your rocephin. That's what we do in ER and outpatient therapy.

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Specializes in corrections and LTC.

Rocephin I'm just flat out hurts, it hurts the patient and it hurts the heart of the nurse giving the injection.

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On 2/10/2012 at 6:38 PM, JessaL said:

Is it correct to dilute a 1g vial of Rocephin with 2.1mL of Lidocaine? The reconstitution instructions on the insert says that 2.1mL will yield 350mg/mL of Rocephin. This math does not seem to add up. I need to give the whole 1gm so I realize that no matter how much liquid is used, as long as I use all of it it will equal 1g dose. But is 2.1mL going to be too concentrated & irritate the tissue??

The math does add up.  You would need 2.85ml of the reconstituted Rocephin to make 1gm.  The dissolving powder increases the total amount of the volume in the vial that you would draw from.  As long as you get around that 2.85ml when you withdraw the med from the vial you're fine.  I put 2.1ml in and withdraw the entire amount from the vial and that gives me around 3ml in my syringe.  No matter what volume of Rocephin is in the injection, it will irritate the tissue and hurt.  I would seem to think that a smaller volume would be less painful.  Just my thoughts.

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