Im injection screw-up

DSkelton711 · Jul 31, 2012

Always take your time and find your landmarks. Never force something. If you have to, pull out, put on a fresh needle and go again, possibly in different site. Better safe than sorry. Seems I make mistakes when I am rushed or don't follow step-by-step protocols. Now I make sure to take my time and things are less stressful.

bertha1 · Jul 31, 2012

I feel like I did all that. The only thing I can think of is that I wasn't in the most comfortable position for myself, I was sitting a little awkward. I think that's what it was. It threw me off a bit and I just couldn't tell until mid injection. I am really concerned about the person. I hope she won't have any complication. I have't heard back about anything bad yet, I'll see tomorrow as it's a coworker. When stuff like this happens I really doubt I want to be a nurse b/c it's a huge responsibility and others are trusting you. I mean even if your technique is good, things could go wrong and then it's on your hands. I can really do without that kind of stress.

unicoRNurse · Jul 31, 2012

Hi. I don't start school for a month yet, so I am obviously no help to you in that regard, but I do have a question for you. What, if anything, did you say to your patient when this happened?

I ask because of an incident that happened to me when I was getting my vaccines for school last month. I got a flu vaccine, and it really (REALLY) hurt, took an unusually long time to be administered, and when the girl (an MA, I think) removed the needle from my arm, it made a loud slurping/suctioning sound. The girl ignored the noise, slapped on a BandAid, and rushed out of the room.

I could have forgiven her mistake a lot more easily had she 1) been honest with me and acknowledged what she did, and 2) given me a heads up about the effects I could expect as a result of her mistake. Instead, I was caught off guard by the pain and significant swelling of my arm, from elbow to shoulder, and under my armpit, that lasted more than two weeks. I am still considering writing a letter to my doctor's office about the incident, not because the mistake was made (people are human), but because of how it was handled.

So, how did you handle the situation with your patient?

Thanks.

bertha1 · Jul 31, 2012

Well I wasn't exactly certain that I didn't get it all IM at the time, I was thinking at the time maybe I wasn't in the muscle all the way. It was later on as I was thinking about it that I was more concerned so I gave my medical director a call to ask his opinion. He was concerned it wouldn't take or be effective. When I brought up my concerns about abscess he said that wouldn't happen and was surprised I would even think of such a thing. Well after googling online I know it could be a problem, even though he wasn't the least bit concerned about that aspect. The person I injected was at work all day and she didn't complain of any after effects to me or anyone else.

I'm sorry about your experience. Maybe the MA was caught off guard if it never happened to her before so she didn't know what to expect. How soon after did you feel the adverse reactions you described?

Are you doing ok now?

Anna Flaxis, BSN, RN · Jul 31, 2012

Today I screwed up on a Hep B injection. I thought I had it in the muscle but felt resistance as I got about less than 1/4 of the vaccine in. I pushed the needle in further and felt a breakthrough, like now I'm finally in muscle. I was able to finish, and when I pulled the needle out along with a drop of blood I saw a drop of what I think is the vaccine on the injection hole. I'm concerned b/c I know this vac is for IM not SubQ or dermal. I'm worried this'll give the person an abscess or something b/c it wasn't done properly. Any advice or similar experiences?

I think the medical director is correct that if some of the vaccine went into subcutaneous tissue rather than muscle, then the vaccine could be less effective. As far as seeing some of the vaccine seep out of the tract made by the needle, using the Z-Track method will prevent this.

bertha1 · Jul 31, 2012

well regarding that i found this online which makes me feel a bit better if some of the vac got in the subq.

subcutaneous administration of inactivated hepatitis b vaccine by automatic jet injection

to assess the feasibility of jet injection for mass immunization against hepatitis b virus, inactivated, alum-adsorbed hepatitis b vaccine (merck, sharp, and dohme research laboratories, west point, pa) was administered subcutaneously by automatic jet injection to 19 volunteers lacking antibody to hepatitis b surface antigen (anti-hbs). three 20-μg doses were given at 0, 1, and 6 months. of 19 volunteers, 5 (26%) developed anti-hbs by 1 month after the first injection, and 15 of 19 (79%) were anti-hbs-positive 6 to 8 weeks after the first booster administration. following the second booster, 16 of 19 (84%) recipients had detectable anti-hbs. possible systemic reactions were limited to low-grade fever (37.8°c) in one volunteer following one injection, and mild lethargy in a second recipient. local reactions to jet injection of vaccine occurred more frequently, with indurated, nodular lesions 3–10 mm in diameter developing at the site of 19 of 57 (33%) vaccine injections, compared with 2 of 57 (3%) saline placebo injections. such nodules were generally painless. sore arms were noted in 11 of 57 (19%) vaccine injections.

with the exception of frequent but minor local reactions, subcutaneous administration of inactivated hepatitis b vaccine by automatic jet injection is safe, and results in vaccine immunogenicity approximating that associated with intramuscular needle injection.

veggie530 · Jul 31, 2012

I'm sorry for not contributing much to this topic, but I literally LOL'd @

it made a loud slurping/suctioning sound. The girl ignored the noise, slapped on a BandAid, and rushed out of the room.

I just imagined the situation of a wide eyed MA running out of the room as if a bomb was about to go off.

OnlybyHisgraceRN, ASN, RN · Jul 31, 2012

I'm sure the patient is fine. I work as a flu shot nurse during flu season and even though I've given a thousand shots sometimes I have my "Screw ups".

Find your landmarks, use a dart like motion at 90 degree, inject slowly, pull out quickly. :hug:

bertha1 · Jul 31, 2012

Thanks OnlybyHisgraceRN!

KaeliF · Jul 31, 2012

I'm glad it ended up only being a minor error, but next time you give an IM try aspirating first. We were taught this in school but I'm surprised to see that a lot of nurses don't do it, but that will let you know for sure if you're in the muscle BEFORE you give the injection. If you get blood back, go deeper.

DSkelton711 · Jul 31, 2012

aha. A co-worker. Seems like anytime it is someone I know or work with I goof up! I'm sure she'll be fine. And I see you already read about subq. Hope you feel better about it.