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IM inj hitting humerus

Hi. I'm a new nurse on my first nursing job. I was giving vaccinations today on 2 teens. One of them was really really skinny and I managed to hit bone. I've been feeling horrible all day, naive me never even thought of that happening, no one ever mentioned it during my education, not the books either. I wanted to take a smaller needle but it came prefilled with needle that wasn't removeable She was a bit nervous and flinched when I pierced the skin but didn't say anything, I know bone doesn't have pain receptors but could I have hurt her beyond pain? I pulled the needle back a tiny bit before injecting, there was basically almost no room to use. I got so horrified I forgot to aspirate too. I might just be the worst nurse ever :( Just looking for some support!

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

BREATHE! You are not the worst nurse ever. In very thin patients you grab and pinch the skin to avoid hitting the bone. As long as you didn't break the needle tip you're fine. I am more concerned about a teen girl being that thin and an eating disorder..

Thank you thank you Esme12. *breathes a bit* Yes, I should have pinched, I thought I'd manage without doing it and simply being a bit more careful with how far in I put the needle. Needle was maybe 1½ inch and I hit bone not even having half in. PT was 13 years old. Yes when you mention it, I mean some are just skinny but she was really skinny. Though she got tbe-vacc due to competing in orienteering, maybe skinny due to that, I don't know. I barely got any contact with her, very flat responses. Maybe she was just shy though.

Northern European university. I mean logically of course I realize that it's possible just surprised that I've never heard anyone mention it. Maybe it's something you don't tell other nurses though? I ask a lot of questions and asked a whole lot about injections, like tell me everything type of questions but nope, no one mentioned it during my internships or anything.

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

The only place you need to aspirate is dorsal gluteal. Anywhere else, not necessary to aspirate. I have to ask, though, where were you giving it if you think you hit the humerus.

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

Fwiw, I was giving an injection in the deltoid to a very thin woman and I hit the bone too.

As a nurse who's been hit in the humerus while receiving an injection from an inexperienced medic, trust me--your patient will be fine. S/he probably won't forget it, but s/he'll be fine.

Northern European university. I mean logically of course I realize that it's possible just surprised that I've never heard anyone mention it. Maybe it's something you don't tell other nurses though? I ask a lot of questions and asked a whole lot about injections, like tell me everything type of questions but nope, no one mentioned it during my internships or anything.

It's something you should have learned in school, right on the same page as 'this is how you do it correctly'. The same instruction should have included 'and this is what happens when you do it incorrectly'. That's why you were asked where you got your education.....it was supposed to be part of it.

No, it's not something "you don't tell other nurses". We learned it in school, before being let near a patient....that's why you were met with surprise that you didn't know this. And it hasn't been best practice to aspirate since.....when?

BREATHE! You are not the worst nurse ever. In very thin patients you grab and pinch the skin to avoid hitting the bone. As long as you didn't break the needle tip you're fine. I am more concerned about a teen girl being that thin and an eating disorder..

I once was that skinny but I didn't have an eating disorder. It's possible that she just can't put on weight like me. That changed later in life.

Junebug903, LPN

Specializes in LTC, SNF, Rehab, Hospice.

Yes, it happens. Some elderly, etc. are so thin. No worries. Somethings you may only learn by experiencing it.

I totally agree, this is something I should have learned. I was quite displeased with my education overall and did voice it too, this didn't better my impression. Though my best friend who's at a imo better university hasn't been taught it either, yet. klone, I injected in the deltoideus muscle. Regarding aspiration: Sweden still has guidelines for aspirating when IM. For a country with really good health care I'm not sure why if there is no reason behind it. But I've been annoyed before with guidelines that waste material like putting heparin locks in ports, no actual scientific reason behind it yet one of the best university hospitals here still have guidelines for it along with most other hospitals - "better safe than sorry" or something.

I did learn something for sure, completely horrifying feeling though pt seemed to only react to the skin being pierced, I looked up and asked if it was going ok and she said yes. She's coming back for second vaccination in a month, if I'm on duty I'll do my best to pinch whatever little muscle there is.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion.

You can also estimate the needle depth you actually need and control the depth. It does take a little practice but I did this all the time the thin elderly. It also keeps my other hand out of the way with less chance of hitting myself with the needle. I have seen a lot of nurses poke themselves this way even going through theri skin..then the patients. :no:

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I once was that skinny but I didn't have an eating disorder. It's possible that she just can't put on weight like me. That changed later in life.

I get it but it would prompt questioning to be sure there isn't an underlying cause.

Edited by Esme12

A question - have any of you injected encepur (or FSME-immune) vs TBE in the gluteal muscle instead? I mean she is really tiny I'm scared I'll like fail again :o Instructions for it says deltoid but yeah. Scared I'll manage to put it sc too, not that there's much sc fat on that pt.

I totally agree, this is something I should have learned. I was quite displeased with my education overall and did voice it too, this didn't better my impression. Though my best friend who's at a imo better university hasn't been taught it either, yet. klone, I injected in the deltoideus muscle. Regarding aspiration: Sweden still has guidelines for aspirating when IM. For a country with really good health care I'm not sure why if there is no reason behind it. But I've been annoyed before with guidelines that waste material like putting heparin locks in ports, no actual scientific reason behind it yet one of the best university hospitals here still have guidelines for it along with most other hospitals - "better safe than sorry" or something.

I did learn something for sure, completely horrifying feeling though pt seemed to only react to the skin being pierced, I looked up and asked if it was going ok and she said yes. She's coming back for second vaccination in a month, if I'm on duty I'll do my best to pinch whatever little muscle there is.

Since you aren't practicing (nor licensed) in the US, it's more easily understood why you learned things differently (or didn't even get it!); since this forum is primarily US members we can forget sometimes that not everything is as it is here. Apologies for that. Best I can say, when it comes to 'best practice' is to just keep up continuing education whenever possible, so you are most likely to be up to date when it comes to nursing techniques.

Kudos to you for asking the questions; it's refreshing :)

KRVRN, BSN, RN

Specializes in NICU.

I once hit the femur giving the vitamin K injection to a 24 weeker. Eek, ick, ugh, gave me the heebie jeebies.

BloomNurseRN, ASN, BSN, RN

Specializes in CMSRN.

I hit the bone on my very first IM injection when in nursing school but had been warned it can happen with super thin (especially older) people. My patient didn't flinch and didn't notice at all.

I don't know why you say there's no pain sensation in bone. If you have ever bumped your shin on a low table or broke a bone, you know that's not true.

As a matter of fact, here's a great way to test for pain in someone with altered level of consciousness. Hold the person's pointer and middle fingers together loosely, and place your (closed) scissors flat between them close to the palm. Holding the two fingers together, turn the scissors on their long axis (like turning a key in a lock) so the rounded metal edges bump hard against the insides of the fingers, impacting the phalanges. What you're doing is bruising the periosteum without breaking the skin.

Try it on yourself. It's incredibly painful even if you don't do it hard, but to the family at the bedside it looks completely innocuous, unlike the other classic maneuvers like sternal or supraorbital pressure with a knuckle. And nobody who is faking unconsciousness will fail to react. You can do toes, too, to check pain sensation in them.

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