IM injection gone subcutaneous?

Nurses Medications

Published

You are reading page 2 of IM injection gone subcutaneous?

Psychrn6685

22 Posts

Thank you so much for your kind words

Specializes in critical care, ER,ICU, CVSURG, CCU.

If you used a 2 inch needle, as I do on larger patients, you probably gave a therapeutic I'm injection.... The illness you are dealing with fascinates..... You probably gave therapeutic injection but the pathophysiology of your patient, may have altered response....

i don't know I only have 4.5 decades of experience and critical thinking skills...

my advise give yourself some credit..

And again,

best wishes

oceanblue52

462 Posts

Is there packaging that comes with the Haldol recommending the type of needle to use? Invega comes with both a 1.5 inch 23 gauge) and a 2 inch (21g) in the package and if I recall, insert recommends using 2 inch on all gluteal injections, unless the person is under a certain weight (I think 80 kg or so). Take a look at the insert next time.

That being said there are all sorts of factors for why person is experiencing hallucinations...perhaps it is not an appropriate LAI and the provider could switch them? Or maybe their metabolism is a bit off. Don't beat yourself up too much about it, and take extra time next appointment to see what manufacturer recommends for your own peace of mind.

Specializes in critical care, ER,ICU, CVSURG, CCU.

You did alright.... I use 2 inch needles a lot, on appropriate patient population, trust my in excess of four decades experience..... With a two inch needle, you did not give a sub que, injection..

It will get better

Psychrn6685

22 Posts

Hello there...

so my invega box comes with only a one inch and 1.5 inch for dorsogluteal injections! So it basically says use 1 inch for the deltoid or 1.5 in the deltoid if they're over 200 and then it says 1.5 for dorsogluteal no matter what. Which is what I always do. I always use 1.5. I'm honesty shocked that it doesn't have a 2 inch in there for the more obese patients. Should I use a 2 inch anyway?

Specializes in critical care, ER,ICU, CVSURG, CCU.

Don't suck me to your clients delusional reasoning...

remember you are the more sane person

i personally see no error on your part... Ofcourse I only have 44.5 years experience as RN,

calm down own you did not error,,,

best wishes

Psychrn6685

22 Posts

But... :( I used a 1.5 not a 2. I didn't have 2 available and I even checked on our psych unit and they only had 1.5 too. Ugh. The anxiety is overwhelming

Psychrn6685

22 Posts

Thank you :( I hope I make it that long !

TriciaJ, RN

4,328 Posts

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I think you are unnecessarily second-guessing yourself. I've never used a 2 inch needle in my life because I've never worked in a place that had 2 inch needles. The reason your patient is still psychotic is because he is psychotic. Maybe the Haldol just isn't working so well anymore. Maybe he needs a dose increase or to be switched to a different med. I'm pretty sure you didn't do anything wrong.

Psychrn6685

22 Posts

Thank you. This helps me a lot. He used to be on 150mg then they lowered him to 125 because of EPS. I just really hope they bump that up. I'm going to split that dose in half and give it in each arm. No more in the butt! He's too fat and I just don't feel he gets the full effect! Thank you so much

oceanblue52

462 Posts

Honestly, if you are not supplied with any 2 inch needles, I wouldn't worry about it, you do the best you can with what you have. If he is having EPS and hallucinations it sounds like he needs a different medication, or at least a tweaking of his other meds to better control the EPS. Have you relayed your concerns with the provider? Providers often only assess every few months and might warrant an earlier appointment.

More seasoned nurses can probably offer you better feedback, but my understanding is that you never split a dose into 2 separate muscles on a LAI, because it messes up the absorption rate. Not to mention that you would have to place a second clean needle on a dirty syringe...which strikes me as a major infectious disease prevention no-no.

quitor1moretry

22 Posts

He probably needs his meds adjusted. what ever dose he was an needs to be increased I have only given z trac for iron, but sometimes a small amt of the drug does leak out if the needle is pulled out immediately after the medication is administered. but usually it wouldn't be enough to cause a patient to revert into a full psychotic state. Tell our doctor about your fears. He will probably feel sorry that you had a conniption over this, and give you a little mini in service, and a perspective we don't get in nursing school. Never fear admitting to an employer if you feel this way. Even if something was not done correctly this is how hospitals are learning why mistakes happen, and we can prevent them from happening again.

+ Add a Comment