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Discussion

IM Morphine possibly given SQ

Hi, I'm just a few days into my immersion experience and I could use some advice. I was told to give a Morphine injection (4mg /2mL) to a pt. The pt didn't have IV access (I'm pretty used to giving IV pushes) so my preceptor said to give it IM. She got called to a code as we were preparing to give the injection so she had me go in and give it by myself...well, I gave it in the upper arm, but I think I may have missed the deltoid and gave it a little farther back on the arm (not quite into the tricep though). I didn't really think too much about this until I got home and was going over the skills I performed for the day. It dawned on me that I didn't ensure the placement prior to injecting the medication. Is this person going to be ok??? It was only 2mL of meds so I'm hoping it'll be fine, but what complications could I have caused by not getting it in the right place???

Just out of curiosity, my professors in school have gone back and forth on whether we should aspirate before pushing the plunger...CDC says it's no longer required, but some of my professors (that have been nurses for quite a while) say it should always be done with IM injections. I've seen it both ways...just curious what everyone's thought is on that practice.

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    What was the length of the needle that you used, and the angle you gave it? The problem with giving an IM med subQ is that you can cause tissue necrosis, but if you used a 1 1/2 inch needle at a 90 degree angle, you more than likely hit muscle.

    I was taught to aspirate before I inject, both when I went through vet tech school, and when I went through nursing school five years later. I always aspirate before I inject.

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    We are taught to aspirate for IM in every spot except the deltoid.

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    Morphine is frequently given SQ so you should be ok there but you still need to let the nurse know that you might have not given the med IM......she really should not have left you alone. This med is OK SQ but there are many that are not. You need to be very careful about giving injections.

    I am old school and yes I aspirate slightly every time.

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    I am in nursing school currently and we have to taught to always aspirate on an IM, because if you don't it might be is the vasculature and hit the bloodstream, resulting in a much faster and potentially more serious reaction. So I would go on the side of caution and always aspirate to make sure you're not pulling back blood (plus it only takes a little bit so why not save the risk?).

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    I agree with the poster who said you need to let your preceptor know. However, morphine is fine given SC at the same dose as IM, so your patient will be fine. Take this as a good learning opportunity :)

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