IM injection help: maximum amount given in ventrogluteal site

[christine2005]

Help!!! I drew up 1gm of Rocephin per Dr's order. Mixed it correctly with 3.6 ml's of sterile saline. Told the Dr. I thought it should be given in split doses. Dr. said he didn't want it split. Wanted it given in one dose. Went into the room (I work in a Dr's office), had the pt. stand (no tables just exam chairs in rooms), administered in Rt. hip. Pt. had tensed leg muscle bracing for injection and immediately got a cramp in the hip. He hobbled around the room, was in a lot of pain. I got him an ice pack and stayed with him. Within 5 mins he was somewhat better but I could tell it still bothered him. I told him 1 gm of rocephin is a hefty dose because of the abscess he had. He said that was okay, whatever the Dr. wanted him to have. I have worried myself sick since yesterday about this. I told the Dr. and he said it was fine. Has anyone else had this type of reaction? Was 3+ ml's too much to inject into the ventrogluteal area? In pediatrics we always did 1ml in each vastus lateralis muscle - 2 injections. Help!!

[LPN1974, LPN]

Mariah3 said:

I am new to the site and couldn't resist this thread, even though it is a bit old. I am an RN student but I was in the hospital recently myself. After surgery, the RN came into my room with a syringe to give me my requested pain meds. She did not tell me she had prepared the demeral and phenergen for IV administration already and had diluted it in 10 mil of fluid. I did not notice the size of the syringe and she asked me if I wanted it in my hip or in the IV. Knowing that it would last longer in the muscle, I selected that. She gave the injection but I began to think something was amisss when she was taking a very long time after inserting the needle to inject the meds. When she finished, I asked her how much fluid she put in my hip and she replied 10 (TEN) ml, explaining that she intended to give it via IV. Now do you want to talk about a sore rear end or what?? All she had to do was tell me it was diluted for IV and I'd have said fine and taken it that way. She did not seem to realize she had done anythng wrong in putting that much fluid in my hip. I was amazed that a RN could not know that. I was also amazed I could walk at all the next day! Also the medicine did not absorb properly with that volume and I was in pain for the next 4 hours till I could get another shot. (Shaking head in amazement!)

Wow! Hope I never have to be that nurse's patient.

If she mixed it up for IV admin she should have given it IV. The choice was already made according to how she mixed it, wasn't it?

10 ml in the hip is unbelievable.

I always mix Rocephin with Lidocaine and split the dose. That's the way I was taught.

[MMARN, BSN, RN]

Mariah3 said:

I am new to the site and couldn't resist this thread, even though it is a bit old. I am an RN student but I was in the hospital recently myself. After surgery, the RN came into my room with a syringe to give me my requested pain meds. She did not tell me she had prepared the demeral and phenergen for IV administration already and had diluted it in 10 mil of fluid. I did not notice the size of the syringe and she asked me if I wanted it in my hip or in the IV. Knowing that it would last longer in the muscle, I selected that. She gave the injection but I began to think something was amisss when she was taking a very long time after inserting the needle to inject the meds. When she finished, I asked her how much fluid she put in my hip and she replied 10 (TEN) ml, explaining that she intended to give it via IV. Now do you want to talk about a sore rear end or what?? All she had to do was tell me it was diluted for IV and I'd have said fine and taken it that way. She did not seem to realize she had done anythng wrong in putting that much fluid in my hip. I was amazed that a RN could not know that. I was also amazed I could walk at all the next day! Also the medicine did not absorb properly with that volume and I was in pain for the next 4 hours till I could get another shot. (Shaking head in amazement!)

1st for the OP (even though he/she might not see this), I'm being taught in nursing school (1st semester student here) that no more than 3mls should be given per site. I would have split it without the MD's opinion. When it comes to your patients, you have to have autonomy (sp?). You decide what and how to do your job.

Now, as for Mariah3:

OMG!!! If that nurse had already made the decision WHY ask you for yours??!!! That was ridiculous and a bit dangerous in my opinion. Sorry you had to go through that.

[Mariah3]

zacarias said:

Mariah, did you have IV access already? Why on earth would that nurse give it to you in the hip??

Yes, I had IV access. She gave it to me in the hip because she asked me which I would prefer. I know that the pain relief lasts longer in the muscle than in the IV so I told her IM in response to her question. She gave me the choice. What she did NOT tell me was that she had mixed the drugs in 10 ml because she assumed I would choose the IV route. Most people don't want a stick when they don't have to have one. But knowing it was already mixed for IV, she had already made the choice and should not have asked me my preference. I only found out it was 10 mil after the fact. She took so long injecting it that I flat out asked her "Hey how much fluid did you just inject in me?" I did refuse her care after that and the supervisor wrote her up and moved me. I still can not believe any nurse would put 10 ml in my bottom, but she did!

[galenight, BSN, RN]

Mariah,

That nurse was wrong on a number of facts. When giving an IV injection, you never mix two drugs. Give one... flush, give another. The demerol and phenergan shouldn't have been mixed unless she intended to give it IM. And of course, if it was to be IM then no additional dilution would be required. Depending on the dosages of each med, the total volume IM would be about 2ml. Good for you for refusing care from this uninformed nurse.

[jimthorp]

shadowflightnurse said:

I have always used 2.1cc of 1% Lido to dilute 1GM vials of Rocephin.

That's what I do as well. I also avoid the ventrogluteal site if at all possible. I prefer the dorsogluteal as it is further from the ciatic nerve and the major blood vessels of the leg

[spidermonkey]

$

[zacarias, ASN, RN]

I always thought ventrogluteal is further away from most people's sciatic nerve. Will have to look that up...

[steelcityrn, RN]

No one is coming near me with a 10 ml im injection, thats for sure! Whats with the im in the hip?? God, please go for the padding!

[leslie :-D]

zacarias said:

I always thought ventrogluteal is further away from most people's sciatic nerve. Will have to look that up...

hmmmmm......i too thought the ventrogluteal site was farther away than the dorsogluteal site (from the sciatic nerve). that's why i always doublecheck and triplecheck my landmarks before any im injection.

leslie

[biker momma]

We use alot of Rocephin in our practice. The standard here is that for 1gm you mix it with 2.1cc of 1% lidocaine; this is on the bottle and on the package insert. This allows for a less painful injection (still hurts but not as bad).

[shannonFNP, BSN, MSN, RN]

The ventrogluteal is now the preferred site for IM injections. It's given in the hip. The dorsogluteal has been used for years, but many schools (including my own) aren't even teaching it anymore because of the increased risk for hitting the sciatic nerve. The ventrogluteal site is the lest vascular and very small chance of hitting the sciatic nerve.

Ummm... and someone else said that we can't give mixed meds IV? We're taught that we can. Demerol and phenergan are given together in one syringe IVP on a mini-infuser just to name the one that's off the top of my head. I think Reglan and Pepcid too are giving pre op but don't quote me on that. I'm about 80% sure that they were standing orders for the pre-op unit. They were mixed together.

And WOW, 10 ml's to the booty?! OUCH! I was taught no more than 3 mls at any site and no more than 1 to the deltoid.

I know this is an old thread, but I was just doing a search for the ventrogluteal site and found this... shocking =)

[GrumpyRN63, ADN, RN]

I would have definitely mixed w/lido, no more than 3 ml's , but I would have gone postgluteal as I hate the ventral site and have never used it --just my personal preference, I would have split the dose, I wouldn't have asked the MD, its not like the pt wouldnt have received it all at the same time anyway, he orders it, he (many times) doesn't know how to administer it