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Discussion

IM injection (current research?)

I have gone from the ICU where we gave no IM (everything central line, art, IV, SQ). So I have no real experience giving IM injections since nursing school.

The job I am in now (psych) I need to prepare to be able to give IM's for our emergency situations (we give zyprexa zydis IM for example) and I was wanting to the most current info on site selection, etc. Seems everyone does it a tad different, but I'd like to do it according to most current research/EBP because I don't want to risk my patients getting nerve damage, etc.....I was just reading an article about nurses and IM injections and most give them wrong and lots of patients getting nerve damage, and other tissue and muscle problems.

I work with adolescent males 13-18 years old.

Thanks!

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The scary thing with IM injections, IMO, is even if you give the injection in the perfect place anatomically as described by academia, how do you know THIS particular individual doesn't have a strangely-placed huge nerve network? I mean, people have abdominal organs in the "wrong" place sometimes, surely anything else can be in the wrong place....

I received IM something (maybe Stadol?) during labor in my leg, and I had some numbness and tingling for about two years afterward. I didn't have an epidural either. The nurse's technique wasn't wrong I don't think...it's just that, essentially, you are stabbed. Who knows exactly what you are putting that med into? It's a muscle, for sure, but what else is there?

I have occasionally had to give "emergent" psych meds on a medical floor, (in one case with two doctors, two security guards, three nurses and a tech trying to wrestle down a 300 pound combative man)...it was IM Geodon, and there was NO WAY I could get to his backside. The doctor said "just give it in the arm!" And I did, very poorly probably...very difficult to hit a moving target...but I didn't feel I had a lot of choice, either.

I am in nursing school, and my textbooks (which are all published in the last two years) say that the worst place to give an IM injection is the posterior aspect of the glute because of the possibility of hitting the sciatic nerve. The best place with the least nerve involvement, they say, is the ventrogluteal site. They say the problem with the deltoid is that it's so underdeveloped in most people that it won't hold much medication.

  • Expert

For 17yrs I gave IM injections and as far as I know never gave it in the wrong place. There is a technique in doing it correctly and it is far less scarey than IV in my opinion. If you give pain medications IM they tend to last longer than IV but they also take longer to have an effect. It is like everything we do in nursing there is are pro's and con's.

we were taught several ways to give IM injections one way was quater the buttock and use the lower outside quater. or the one I use is find the hip bone with your thumb then do a sweep with your middle finger (almost like you are drawing a semi circle) any part of the exposed flesh between the finger and the thumb is relatively safe, of course you must draw back to check that you have not hit anything and are not drawing blood. I have never ever drawn blood when I have used this technique nor as far as I know caused any problems.

When confronted with an angry, delusional, combative, wild-eyed psychiatric patient; I believe the current literature states to stick the needle any where you can. Preferably in the patient and not yourself or a coworker.

  • Expert
When confronted with an angry, delusional, combative, wild-eyed psychiatric patient; I believe the current literature states to stick the needle any where you can. Preferably in the patient and not yourself or a coworker.

This the exact same technique I use! :D

OP, you won't be giving Zydis IM but I have heard that with Zyprexa its good to Z-track...when you can.

Amen to the ventrogluteal site, every time I have used it the response I get is "okay I'm ready", as I'm tossing the needle into the sharps box. The problem with this site is that I'm sure that you would run a pretty fair chance of castrating the poor chap in an emergent situation.

That's what she said :)

Is it just me or does the Tensor Fasciae Latae mucle seem to be a little to close to comfort to the Ventrogluteal site? all the diagrams you see dont even show it however mine seems to wrap dang near half way around my side??

I give injections weekly at our clinic, as we have about 30 or so patients who receive long-acting injections, and both they and I prefer the dorsogluteal injection to ventrogluteal. I asked most of them why and they said they didn't like having to expose that much of themselves for a shot, and were uncomfortable. They're more comfortable having the shot in the dorsogluteal, and really, as long as they're willing to have their shots, I'm willing to put it JUST about anywhere they want! (just about:D)

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