IM injection gone subcutaneous?

Kooky Korky, BSN, RN · Feb 18, 2017

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

She didn't use a 2 inch needle. She said her facility doesn't carry them.

Kooky Korky, BSN, RN · Feb 18, 2017

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.

Not saying she should split the LA med into 2 sites.

If there were going to be 2 shots for 1 patient, why not divide the medication into 2 syringes before injecting the first site? Then there's no issue at all re: infection.

Psychrn6685 · Feb 18, 2017

Hello :) thanks for the response.

not sure where the confusion started however I would never use a dirty needle for a second injection. What we do at our psych hospital which I've done at every psych hospital I've worked in is for example if I have to administer 300 of haldol dec we have three separate vials of the medication and I will draw up 150 in one needle and 150 in the other and the patient will receive 150 on each side... not with the same needle. Just like you're giving multiple vaccines. I have one guy who will not accept his meds unless I give 100mg in each deltoid -- he's terrified of butt injections . So yes... :) certainly not using the needle Twice

Elladora · Feb 18, 2017

Sometimes they just get wonky. I highly doubt it has anything to do with your technique.

anchorRN, BSN, MSN, RN, APRN · Feb 19, 2017

Hey - you should try and chill out. Even if it somehow did end up being given subq (with a 1.5" needle idk how that'd be possible), the medication will still get absorbed, albeit at a different rate. You have this doomsday scenario in your head that you caused this, but your patient obviously already has issues. I think you need some Haldol! LOL

oldpsychnurse · Feb 19, 2017

I've probably given a couple hundred Haldol dec injections during my career. We were left to our discretion what size needle to use, where to give it, etc. I pretty much always injected in the ventrogluteal and used my judgment as to the needle size by looking at the patient. I don't think you did anything wrong. Sometimes patients need a dose adjustment, or just become less responsive (or non-responsive) to meds that have worked well for them for years. They just adjusted his dose downward, so that probably explains why his level is low (even though I've only known Haldol levels to be drawn on maybe 20 patients in my 32 years of psych nursing). And on the bright side, the patient can always be supplemented with po Haldol if he's low, but there's not much antidote of a high level of Haldol dec. So you are fine with your practice. If you have a staff educator, you can always check with them and have your questions answered instead of scaring yourself half to death by going on line. Settle down, have a drink, and forget it.

Psychrn6685 · Feb 19, 2017

Can you guide me on something? In the VG site if the patient is less than 200lbs would you likely use a 1.5 still? I have some

guys that are oved 200 and I always worry what to use ... 1.5 or 2 in the VG and the DG. How about in the deltoid?

oldpsychnurse · Feb 19, 2017

Unless the patient is really skinny, I usually use a 1.5 or 2 inch in the bum. For the deltoid, I generally use a 1" unless the patient is way over or under weight. You'll be fine doing this with practice. Every nurse uses his or her own judgment and a lot of nurses think I use needles that are too big. I try to educate them about giving a 250 pounder an IM injection with a 5/8" needle but they think they're being kind. lol Anyway, there are a million reasons why your patient started hallucinating. Some patients are stable for decades and then go bad for no obvious reason. Guy will probably need a week or two in-patient while they sort out his meds and maybe start something new, but it didn't have anything to do with you or your practice.

Psychrn6685 · Feb 20, 2017

Thank you for this. It really helps. There's been a lot of anxiety in my heart and it's ruined my weekend. I used to be so confident in everything I did. A bad leader can really make you doubt yourself. Thanks for being supportive and offering guidance