IM antibiotic

[RoyalNurse]

We haven't had any official "IM" needles for a week now, people have been using the 23 gauge, 5/8 inch SQ needles. I tried it on a patient, it only goes to the subcutaneous tissue. SO, for this antibiotic, I got an 18 gauge, 1.5 inch needle, and inserted it about 1 inch. Another nurse watched me do this, and told me we should only use the official IM needles, and if they're not available, to use the 5/8. I really don't see how this could be considered correct, it's even a med error, because there's no way you could say on this patient that 5/8 inch would reach her muscle. 18 gauge is too big, but it was an antibiotic that I had to mix, and I wanted to make sure she got it all. Any one else run into this problem, and any suggestions?

[PAERRN20]

Ouch an 18g needle for IM? I would imagine everything would leak out of the tissue with that size. Do you have a 21 or 22g? I would be inclined to use those. If you don't have anything other than the 18g and 23g, I'd use the 23g. You really should be taking this up with your nurse manager or DON.

[Larry77, RN]

You come at me with an 18g for my IM...I'm going to swing! lol

Depending on the size of the pt, 5/8 might be fine, otherwise I've been in similar situations and could usually find a muscle by pushing through the adipose tissue.

[mwboswell]

with an 18ga you could lacerate a vessel.

An 18 ga is unsafe and unprofessional practice, and liability.

Check your hospital nursing policy; there should be something on needle sizes. And if they don't have what's in the policy tell them.

If you go against policy you're opening yourself for personal liability and getting fired.

[canoehead, BSN, RN]

A 25G 5/8" vrs an 18G 1.5" I'd use the 18G and Z track the injection, but I'd also write a note to my manager.

[Virgo_RN, BSN, RN]

Yowch!

[tewdles, RN]

Sounds like you have no good choice. You cannot use the 5/8 inch as it is not long enough. The 18g is, well...it is barbaric! Please notify your department manager that you need 23g 1 and 1.5 in needles for proper intramuscular injection technique. If you need to get them fast, tell the next MD who orders an IM that you cannot give the med because the hospital has not provided adequate or appropriate supplies...I bet you will have some lickety split.

[Lunah, MSN, RN]

If you need to get them fast, tell the next MD who orders an IM that you cannot give the med because the hospital has not provided adequate or appropriate supplies...I bet you will have some lickety split.

That was my first thought!

[MauraRN]

Do you have any friends on other units that could slip you a few? If not, I like the idea of giving an MD the heads up on this one.