IM/IV med administration

IVRUS, BSN, RN · Sep 23, 2016

FISHING for a vein is never appropriate. A nurse should ALWAYS be holding traction on the skin distal to the VP insertion site to keep that vessel from moving. Accessing metacarpal veins in the back of the hand do hurt, but even moreso if one is fishing.

wordrm · Sep 23, 2016

Honestly I didn't even watch him, it just felt like he inserted it 3 separate times, which I know he didn't but I guess that was him moving it around. You could see the vein because I'm pale but I don't think it was as easy as he was expecting.

HouTx, BSN, MSN, EdD · Sep 23, 2016

In A & P, nurses learn about the nervous system - including the distribution of 'sensory' pathways throughout the body. Some parts of the body have a LOT of sensory nerves.... fingers, hands, mouth, eyes, naughty bits, etc. This means that those are the areas most likely to cause a lot of pain when they're poked with needles. Makes sense, right?

When it comes to IVs, the choice of insertion site is normally based upon a couple of factors. First of all, we try to do distal first...so if there are subsequent issues, we haven't messed up the entire downstream access for that vein. Secondly, we consider position and ease of access... we try not to put a cannula into a 'bendy' place like an elbow or wrist if possible - because that causes greater inconvenience and won't last as long even if we strap it to a board (to keep from bending). Ease of access is a huge consideration... in an emergency, it will take precedence over everything else. Unfortunately, the degree of pain sensation in a particular site is not usually a deciding factor because (hopefully) the insertion will be very quick. Under NO circumstances should you ever "fish" for a vein. Most organizations have a policy that requires a nurse to seek a more qualified/expert person to do the IV if s/he has done 2 or 3 unsuccessful sticks.

With IM injections, the major consideration is to avoid damage to underlying anatomical structures. Hitting a nerve is not only extremely painful, it can sometimes result in permanent disability of a limb. Hitting a major vessel will turn it into an IV injection.. with negative consequences. Hitting an artery can be disastrous. So - whatever wrist technique you need to get the job done is appropriate... most people describe it as "throwing a dart".

IVRUS, BSN, RN · Sep 23, 2016

Good Post, but remember INS states that one nurse should make NO MORE than 2 VP and there should be no more than 4 sticks total before that expert is called in

CrunchRN, ADN, RN · Sep 23, 2016

The hand vein is much more painful and for IM's the dart motion is best.

J Friday · Sep 24, 2016

Hands hurt more, bottom line...

And... Just try for a smooth entry into the muscle, if the needle is new it shouldn't be a problem. Do not use the same needle you used to draw the medication.... and use the "dart" like motion as described above.

SIDE NOTE: I hope he used a new needle with every attempt.... :bag:

I hate watching people risk other's infections like that... or worse, rub with alcohol, and and then proceed to rub their ungloved (or gloved) finger tip over the vein to find it again.... :no:

applesxoranges, BSN, RN · Sep 25, 2016

People feel different levels of pain.

1. IVs hurt. It's a needle. I tell people that.

2. Anywhere with less fat tends to hurt more. Hands don't have that much fat. The wrist is painful. Fingers are painful. Forearms are fairly painful. Tops of arms I don't think hurt as bad.

3. Bigger needles hurt. There's a reason why patients try to con people into using "baby needles."

4. In general you should work your way up the body. If you can get a decent size in the hand in the squad, go for the hand. I have seen once a situation where the squad tried the AC and then went down to the forearm and the site where they tried the first time started swelling when I had to dump a lot of fluid to hypotension so I had to restart the IV further up.

In the ER, I rarely go for the hands because if they need a CT or MRI with contrast then they will need to have the IV restarted higher up. Our company policy that is loosely followed is mid forearm or higher for IVs. One of the hospitals that has another policy of no AC starts for IVs but we generally say "screw you guys, we have sick patients" to that policy.

Sub-q/IM - You eased the needle in? Ew. I do it pretty quickly. I would imagine if you do it slower it'll hurt more. Pushing the pace varies depending on the medication. Some are thick that you can't help put push it slower.

Some vary in whether to aspirate before hand. It depends on the med and location. In the butt you should always aspirate. Vaccines it isn't really recommended anymore because it increases the pain and most are in the deltoid. I honestly will say most shots that are aspirated hurt more.

Also, some protocols for patients that require immediate resuscitation and are unstable allow EMS paramedics to go for an IO after 3 attempts.

wordrm · Sep 25, 2016

No I inserted the needle fast, my classmates were laughing and thought I was being funny and trying to hurt the people I administered on but I thought that was least painful to have it inserted quickly.

bgxyrnf, MSN, RN · Sep 26, 2016

The guy who tried to start a line on me used my hand which was against my better judgement but he thought it was easiest access. It hurt! Like I'm saying Ouch 3 times and like making painful faces. I guess the vein rolled and he was fishing for it but OMG. Does any one else see the hand being more sensitive?

Heck yeah! Hands hurt like h-e-double-dog-legs. I let students and newbies practice lines on me without reservation but with one condition... no hands.

I rarely start lines in the hand unless I just can't find anything else simply because hands are so much more sensitive than the arms.

2. When we were doing Sub-Q and IM administration, I "popped" the syringe in. They all eased in the needle, I was gentle but I was under the impression that shots were somewhat a fluid motion with the wrist. We all laughed about it but I honestly now I'm not sure if I'm inserting the needle with the correct pace?

I jab the needle in in one quick, smooth motion... no point in prolonging it. However, the pain really derives from the medication far more than from the needle.