IM injection question

Pneumothorax, BSN, RN · Sep 25, 2011

i have another injection question - i really wish my book had more details about this!
A 23 yr old female arrives on the floor recovering from surgery for appendicitis. She complains of severe pain and asks for a shot. The physicians order is:
meperidine (demerol) 50 mg IM
promethazine (phenergan) 25 mg IM } q4h prn
How would you give it for the best effect?
I checked my drug guide and these meds can be mixed into one syringe. The dose ordered/dose on hand calculates to 0.5 ml of each, so 1 ml total. Would I be wrong to mix these meds and give them as one injection into the deltoid site? My text says "medications that are known to be irritating, viscous or oil solutions" go into the ventrogluteal site. But the drug guide says that repeated injections into the same site could cause irritation.
The amount (1 ml) total is appropriate for the deltoid site. I am inclined to give it there instead of the ventrogluteal because I would not have to reposition the patient. She's already in pain and has had abdominal surgery so I would imagine that turning her to her side for access to the ventrogluteal would be painful and possibly injurious.
Am I correct in my thinking here or is giving these meds into the deltoid a mistake?

would i mix the two? im not sure, i havent learned how to do that with a pain med & an antiemetic..they are usually given seperately in our hospital.

i would give one in each deltoid. VG is probably my least favorite IM site VL or Deltoid.. nice & meaty :)

Clovery · Sep 25, 2011

hmm okay thanks! my main concern was about the deltoid site. My text makes it sound like only biologic injections (vaccines) are given there, but I know that must not be true in practice. It also says that the vastus lateralis is not used for adults?

the } symbol in the physician's order was confusing me a bit. I know it means that the schedule applies to both meds, but I thought maybe that meant he wanted them mixed together?

My text says it's okay to do that if they're compatible and at least one of them is in a single dose vial. But the only thing we practiced mixing in one syringe in lab was insulins. This is just a worksheet I have to do - I will probably just write that they can be mixed, so I would do that if possible, but if not, one in each deltoid.

Thanks for your reply :)

Double-Helix, BSN, RN · Sep 25, 2011

I'd ask the doctor to switch the order from IM to IV. If she is a fresh post op, she is going to have IV access and she is going to need frequent pain medication. There is no need to be giving IM injections every few hours when you can be giving IV medications painlessly.

If you have to give them IM, I would mix them together in one syringe and give them in the vastus lateralis. In the vastus, you can use the z-track method to keep the injection from being so painful or irritating. Giving them seperately subjects the patient to two sticks, rather than one. Can you imagine two IM injections every four hours?

Clovery · Sep 25, 2011

thanks for the reply :)

you're right about the IV... I'm sure that's what would happen in actual practice. But this is just a worksheet for my lab for injections - we haven't learned IVs yet, so as far as what my instructor wants as an answer, this patient definitely has to suffer through getting an IM injection.

So despite what my book says, the vastus lateralis is commonly used for adults?

Double-Helix, BSN, RN · Sep 26, 2011

thanks for the reply :)
you're right about the IV... I'm sure that's what would happen in actual practice. But this is just a worksheet for my lab for injections - we haven't learned IVs yet, so as far as what my instructor wants as an answer, this patient definitely has to suffer through getting an IM injection.
So despite what my book says, the vastus lateralis is commonly used for adults?

Yes, especially for large volume injections and irritating medications. IM iron is always given via z-track. And you can only do z-track in the vastus.

Meriwhen, ASN, BSN, MSN, RN · Sep 26, 2011

Phenergan burns like hell so unless they have gigantic deltoids, you'd be better off with the larger muscles.

Personally I'd put them both in the same syringe (if they're both compatible) and give one shot in the vastus lateralis--large muscle, can hold a lot, pain isn't too bad, no chance of hitting the sciatic--but the ventrogluteus could also work.

Clovery · Sep 26, 2011

Yes, especially for large volume injections and irritating medications. IM iron is always given via z-track. And you can only do z-track in the vastus.

We're learning that you also do z-track in the ventrogluteal. I think they said that was new? Also a new thing for this year is that you NEVER aspirate.

Clovery · Sep 26, 2011

Okay I'm going to take everyone's advice and change my answer to give the shot in the vastus lateralis. I wouldn't have to reposition and it's a bigger, safer site that I can z-track to avoid causing irritation. Thank you all for your help :)