IM inj hitting humerus

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hybr1d

49 Posts

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

2,774 Posts

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

1 Article; 20,908 Posts

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.

hybr1d

49 Posts

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.

RNsRWe, ASN, RN

3 Articles; 10,428 Posts

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

1,334 Posts

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

1 Article; 722 Posts

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.

nurseprnRN, BSN, RN

1 Article; 5,115 Posts

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.

allnurses Guide

BostonFNP, APRN

2 Articles; 5,581 Posts

Specializes in Adult Internal Medicine.

There is no pain reception IN the bone, but there are lots of receptors in the periosteum where that IM injection hit.

hybr1d

49 Posts

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 :)

I'm glad you think it's refreshing and not just shrug me off like dumb or something. I really really want to learn everything but I guess that's not really possible.. can only do so much theory. :-) Yes I'm sure it differs quite alot. My university is very research oriented so I did too much theory in my opinion.

hybr1d

49 Posts

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

Heebie jeebies :D good description. That's what I got, for sure. Doing it on such a small one, I can imagine the horror!

hybr1d

49 Posts

I ment bone itself, I know the periosteum holds a lot though. I've read a lot of posts of pt not reacting at all with needle hitting the bone (hehe found the search function!) I'm not sure if the different bones periosteum vary with the amount of nocirepectors they hold?

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