IM injections

nurseygrrl, LPN · Oct 30, 2003

I never learned to draw up meds that way, but when we get pre-filled syringes, there is always about 0.1mL of air in there. My supervisor caught me one day pushing the plunger to get the air out, and she told me that the air was supposed to be there for the same reason you specified. I have seen this in Rebif and Copaxone (MS drugs) and also Heparin...although these injections are SC.

fab4fan · Oct 30, 2003

Actually, I read in a pain mgmt. manual to use this technique when giving IM pain meds because: 1) the air bubble helps to push the med deeper into the muscle, and 2) the air bubble will clear all the medication from the dead space in the needle.

So it doesn't sound like this technique is just limited to those of us who were taught it back when dinosaurs freely roamed the earth. :chuckle

proud2basn · Oct 30, 2003

I am in my first semester of nursing school and the instructors told us that that is one method of giving IM injections. It is even shown in the fundamentals book. So, you can't be that old!

panda_181 · Oct 30, 2003

The only part that won't get to the patient is the tiny bit that's in the needle itself...and that's not even really 0.1mLs. To prevent anything leaking back out after you remove the needle we were taught to hold the needle in place for 3 seconds after finishing injection. It absorbs enough that it won't come back out. If we had air bubbles in our syringes, we had to take them out!

Amanda :)

meownsmile, BSN, RN · Oct 30, 2003

I use bubbles. Only rational i can muster not to is because of medication not being cleared through the needle. In actuality, the needle holds so little medication that it is really irrelevant unless it is a big bore needle. Then we should pull back and get air into the barrel and remeasure the medication anyway before pulling the air bubble.

I'd say check with the instructor, see which way she wants it done, do it that way during your clinicals, then after you are out of school go with what you are comfortable with.

ragingmomster, BSN, MSN, RN · Oct 30, 2003

Thanks for such quick responses. Fortunately I have the kind of instructor who is willing to listen and learn. When I gave her my rationale for the use of the bubble, she thought it sounded reasonable but wanted some printed info to back it up. Unfortunately, I don't have a Fundamentals book to draw upon tonight, I tossed my old one from the first time around and was able to skip that level of classes when I returned to school. Panda, I can't imagine holding a needle in for 3 seconds, doesn't that irritate or hurt more?

ceecel.dee, MSN, RN · Oct 30, 2003

We get rid of all bubbles prior to injection.

Hooligan · Oct 30, 2003

We were taught that the only time you draw up an air bubble is when administering a Z-track injection. The rational behind this is to prevent any irritation from medication that could possibly leak out of the needle upon removal. We were actually taught to draw up 0.2mls of air for these...

~Bean

twarlik · Oct 30, 2003

I'm a first term nursing student and this technique is talked about in our fundamentals text. They recommend adding a 0.2mL bubble. Our instructor told us that it isn't used very often any more and that policies regarding its use differ among institutions.

LydiaGreen · Oct 30, 2003

I'm in my final semester of nursing school and, correct me if I'm wrong, but you draw back to get an air bubble in the needle to insure that you are correctly placed in muscle tissue and not in a vein or artery. Therefore, you will have an air bubble in the syringe whether you put in 0.1 ml when drawing the med up, or not.

PlanetCaroline · Oct 30, 2003

This is really interesting how education varies. Potter & Perry 5th edition (2003) says there should be no air bubble in IM, use the Z-track method, an aspirate the needle to make sure that we didn't hit a vessel.

It is hard to trust the textbook though b/c Potter & Perry (2203 ed.) said we should leave the needle in 10 seconds after injecting to make sure the medication gets in the muscle. The instructors told us that was completely wrong & I tend to agree. Who would tolerate having the needle in their arm extra time? :confused:

I hope variations in nursing technique are okay b/c I sometimes don't know what to believe. I tend to go with what the book says for tests & what the instructors say for life.

:)