IM injections in a site with edema?

[mmcewan]

I am a hospice nurse. My patient needed a shot of lasix. Her arms are skin and bones and her lower body is extremely edematous. I gave the shot in her vastus lateralus. Since that time the site has been leaking fluid which we are actually collecting in a colostomy bag. It is not hurting her and actually losing that extra fluid is not so bad but a colleague told me I should have still given the injection in her deltoid. I would like to hear people's opinion on this.

[Remy Ox]

If it was more than 2mL you should not give in deltoid with edema. It probably leaking because the puncture made a path for fluid to go from surrounding tissue. Maybe could have happened in the arm too. I think you did nothing wrong

[AspiringNurseMW]

If it was more than 2mL you should not give in deltoid with edema. It probably leaking because the puncture made a path for fluid to go from surrounding tissue. Maybe could have happened in the arm too. I think you did nothing wrong

The deltoid did not have edema. Only the lower body did.

[mmcewan]

Yes, thanks for clarifying. The patient has pancreatic ca and her lower body is extremely edematous but her upper body is not. She is so cachectic that I didn't feel like like I could give the shot in the deltoid. Did I have any other choice but to give it in the thigh? Thanks to everyone for responding. I really value your input.

[Coffee Nurse, BSN, RN]

If you need to give the medication intramuscularly, and you instead inject it into a pool of fluid, the med isn't going to have the desired effect.

[mmcewan]

She did actually urinate more than usual within the next couple of hours so it did have some effect. Plus I used a 1.5" needle. What else could I have done? Maybe oral; the patient was able to swallow, but then we would have had to get the order from the doc and wait for it to come from the pharmacy the next day. I wanted the immediate effect.

[Remy Ox]

In that case I would see no problem with deltoid but if she is bony it might hit bone. Maybe consult with MD?

[Remy Ox]

Maybe also ask for IV or PO

[NotAllWhoWandeRN, ASN, RN]

Depending on your goals for treatment, allowing the injection site to continuously drain may not be the best idea. A site that drains continuously (I've had post-paracentesis patients that would drain for the rest of their lives if you just left an ostomy bag over the site) because of an underlying problem won't heal.

The fluid loss from the site is probably not enough to increase comfort, so if the patient will need frequent IM injections leaving many leaking sites, or if the patient will be alive long enough that the injection site could heal, it would be better to apply a pressure dressing. Trauma from adhesive could create a problem, but that could happen from ostomy appliance adhesive as well.

As far as which site is better, I think as long as you ensure you got to muscle, you did the right thing.