I Hit A Bone!!

augigi, CNS · Nov 23, 2006

Most textbooks are out of date as soon as they are printed, if not before.

A look at the current literature recommends:

"A 1- to 1.5-inch needle should be used to give influenza vaccine to adults." (CDC guidelines)

"Insert needle at an 80-90° angle into densest portion of deltoid muscle--

above the level of armpit and below the acromion." (CDC website, attached)

Thus I'd say you should choose a site with adequate muscle in which to inject it. I've also attached an interesting article about deltoid thickness in the elderly.

CDC_Injections.pdf

IM injection in elderly.pdf

breakin_moon · Nov 23, 2006

Straying a bit... but, why don't they teach us how it's done in the "real world," instead of by the book? I prefer the book myself, but someone will always say "that's not how it's done in the real world;" or "for test purposes..." :confused:

jill48, ASN, RN · Nov 23, 2006

Straying a bit… but, why don't they teach us how it's done in the "real world," instead of by the book? I prefer the book myself, but someone will always say "that's not how it's done in the real world;" or "for test purposes…"

Alot of things ARE done differently in the real world, and you will only be able to find those out by experience, as we all do. But some things really are textbook:studyowl: for a reason, some of the things they teach us really do have to be done that way because it's the safest way or least:cry: painful. You will find out in your experiences what has to be done by the book and what you will be able to shortcut. Just have faith in your common sense:yelclap: and your education and you will do just fine. By the way, maybe this thread should have been called "I hit a nerve" rather than "I hit a bone" because it really has some riled up:argue: . Good luck to you Breakin Moon, and never stop asking questions; everyday is a school day, no matter how long you have been a nurse.

Hellllllo Nurse, BSN, RN · Nov 23, 2006

How could anyone experienced or not only dart "half way"? That's nuts!

I've had to dart half-way when I worked at a facility which did not provide the correct needles for IM injections. I could not use a tuberculin, because the injection was 2cc. I had to do that a lot, actually. It works.

Hellllllo Nurse, BSN, RN · Nov 23, 2006

Alot of things ARE done differently in the real world, and you will only be able to find those out by experience, as we all do. But some things really are textbook:studyowl: for a reason, some of the things they teach us really do have to be done that way because it's the safest way or least:cry: painful. You will find out in your experiences what has to be done by the book and what you will be able to shortcut. Just have faith in your common sense:yelclap: and your education and you will do just fine. By the way, maybe this thread should have been called "I hit a nerve" rather than "I hit a bone" because it really has some riled up:argue: . Good luck to you Breakin Moon, and never stop asking questions; everyday is a school day, now matter how long you have been a nurse.

:yeah: :yelclap:

jill48, ASN, RN · Nov 23, 2006

:yelclap:

:kiss

Hellllllo Nurse, BSN, RN · Nov 23, 2006

:kiss

:caduceus: :studyowl: :nurse:

You're welcome!

zenman · Nov 23, 2006

Actually, comparing a spinal tap too an intramuscular injection is like comparing apples and oranges (or duh's and trouts in your case); just because there is a needle involved doesn't make it even close to the same procedure - that is like comparing your IM to starting an IV. And darting an injection does not mean you are using your whole arm to force it in the patients body, you make it sound violent. Darting is a wrist motion only. I have complete control over my wrist motion and therefore my dart. Your way sounds painful. Now, here is your Duh, and here is your trout.:trout:

My analogy is very appropriate when one thinks that it's a "sin" to not sink a needle all the way in. That should now be clear to everyone. "My way" is based on lot's of experience (33 yrs) as well as teaching in both ADN and BSN programs. "My way" is very smooth and therefore causes little or no pain and many do not even realize they have been stuck. Books are references and please keep in mind many instructors are lacking in real world experience. I think I personally will stay with the proven. You feel free to do as you wish. It's not a point worth arguing over. The students posting here have asked for help...consider it given.:nuke:

zenman · Nov 23, 2006

Straying a bit... but, why don't they teach us how it's done in the "real world," instead of by the book? I prefer the book myself, but someone will always say "that's not how it's done in the real world;" or "for test purposes..."

Frustrating isn't it! I can give you my viewpoint. In the classroom, you have to present a lot of info to a lot of people. Some of my classes had over 110 people. That info has to be geared to getting all those people up to speed as quickly as possible. Doing it the textbook way is one way to do that. Then, hopefully in clinical, I would teach the person with short stubby fingers one way and the person with long fingers another and the person with no arms another. Then you'll run into other nurses who might have a different technique that you like or you might just accidently have an "ah" moment.

When you know the principles behind what you are doing, there are lot's of "correct" ways to do it. (You may even have a reason to do it incorrectly.) I did the same thing with my Hapkido and Zen Shiatsu students, both activities that require a lot of muscle control and finese. Doing a technique by the book might have resulted in one of my Hapkido students being killed in the street.

I know students want to know "the way" or it causes a lot of anxiety. I've had a few say, "but that's not the way so and so told me to do it." My response, "consider yourself lucky. Now you know two ways to do it."

goats'r'us, ASN, RN · Nov 23, 2006

in weeny people like you describe, i've been known to use a s/c needle.

TazziRN, RN · Nov 23, 2006

but if you find a textbook it will tell you that you insert the needle all the way and in one smooth motion, not half way, and not fast through the epidermis and dermis then slowwwwly into the subq.

When did I say slowly??? I said "gently"

THAT is "who I am" to say the other method is not proper. It may work for you, but that is not textbook.

I am not trying to offend with this question, I'm really not, but since Brian started tweaking things the "years experience" is missing. Have you been nursing long enough to know that many things we do are not textbook? It doesn't make it wrong, not at all. There are many things that, in the real world, are not done the way the textbooks taught in school. I remember my instructors telling us "When you graduate you'll learn the real world way of doing things but this is how you need to do it to graduate and pass your boards." And it's not just my school that said that, there are two schools of nursing in this county plus two in the next county and I've dealt with students from all three during their clinicals. They are told the same thing by their instructors.

Starting IV's......I remember my text showing one way and one way only to dress a fresh IV site. Do I it that way? No. Do other nurses do it that way? Some do, most don't. Does that mean the ones of us who don't are wrong? Of course not!!!!

You are entitled to your opinion, not faulting you for that at all, but for you to say that the textbook way is the only way, and in the manner that you have ---- I picture you glaring at me with your hands on your hips ---- is the fastest way to offend.

smk1, LPN · Nov 23, 2006

As a student. It seems to me that the "correct" way to give an injection, is to use aseptic technique, locate one of the proper sites, use one of the proper needle gauges and lengths for the individual patient, and to end with the injection going into the layer that it is supposed to. Z-tracking, air locking, darting or semi-darting or going in at a 90 or 87.5 degree angle etc.... all of that is up to the nurse as long as the aforementioned requirements for the injection have been completed by one of the MANY correct ways.