IM questions

hi everyone,

i am an rn and i am just starting a new job in community mental health, where we give many im injections. in my previous job, i did not give im's, and i only gave a couple back in school.

can someone answer a couple questions?

1) do you have to z-track in the deltoid - why or why not? i do not even know how you could because of the little area you are working with. most shots that get this are done in the buttocks/vg site.

2) air bubbles - do you need to do this? yes you have to get the air bubbles out of the im shots.

3) upper quadrant versus vg site - i was taught in school to use vg to avoid the sciatic nerve, but everyone at work uses upper, outer quadrant, and that is what the patients expect and want. is this safe? we use it where i work but have been told from more recent grads that the site is no longer taught in the school i attended for the same reason that you mentioned above. i have heard that they are really trying to discourage you from useing this site.

thank you for your help!!

hope this helps some!!

leslie

Hi everyone,

I am an RN and I am just starting a new job in community mental health, where we give many IM injections. In my previous job, I did not give IM's, and I only gave a couple back in school.

Can someone answer a couple questions?

1) Do you have to Z-track in the deltoid - why or why not?

2) Air bubbles - do you need to do this?

3) Upper quadrant versus VG site - I was taught in school to use VG to avoid the sciatic nerve, but everyone at work uses upper, outer quadrant, and that is what the patients expect and want. Is this safe?

Thank you for your help!!

You always have to leave the air bubble in the lovanox for the full dose to be dispensed

Hi everyone,

I am an RN and I am just starting a new job in community mental health, where we give many IM injections. In my previous job, I did not give IM's, and I only gave a couple back in school.

Can someone answer a couple questions?

1) Do you have to Z-track in the deltoid - why or why not?

2) Air bubbles - do you need to do this?

3) Upper quadrant versus VG site - I was taught in school to use VG to avoid the sciatic nerve, but everyone at work uses upper, outer quadrant, and that is what the patients expect and want. Is this safe?

Thank you for your help!!

Thanks for your replies so far. The bubble question isn't whether to get the air bubbles out, I know you do that. What I'm wondering is if you are supposed to add a bit of air after you draw up the dose to seal the med into the muscle. I wasn't taught to do this, but it's in some of the literature. Thanks again!

if for no other reason, air bubbles take up space in the syringe. That means you have air mixed with medicine and probably do not have the correct dose of medicine. Especially troublesome to diabetics getting insulin. The correct dose is essential. Of course insulin is SubQ, but the rationale is the same.

You always have to leave the air bubble in the lovanox for the full dose to be dispensed

Lovenox is not given IM but SQ. Which brings another question, does anyone know why the instructions for Lovenox state to have the patient lying down? I even contacted the manufacturer, but all they did was send me a package insert.

I believe the OP is talking about drawing up a small bit of air that you would make sure enters the body LAST, therefore leaving a small air "plug" that would seal in the medication. Some of my NS instructors advised it, and of course, some didn't. (Do they *ever* reach a general consensus?!?) Anyway, with a particularly irritating medication that air "plug" makes leakage less of a problem. And of course you draw up the small bit of air AFTER you've drawn up the appropriate amount of medication.

Lovenox is not given IM but SQ. Which brings another question, does anyone know why the instructions for Lovenox state to have the patient lying down? I even contacted the manufacturer, but all they did was send me a package insert.

If I remember right, the manufacturer's instructions also state it should be given abdominally, so I think having the patient lie down would ensure the syringe is in a more vertical position to ensure that air bubble remains near the plunger and can follow the medication in upon injection

If the patient was sitting up or standing, the syringe would be in a more horizontal orientation and that air bubble could shift away from the plunger. If memory serves, the goal of the air bubble is to prevent any amount of the medication to remain in the syringe, although I've heard the air plug explanation also...either way, the goal is to have the air bubble go in after the medication.

As far as IM injections go though...I'm in school now and I've never been taught to include air to follow the IM medications. However, I must admit that IM injections are few and far between. I've only ever done some immunizations IM. Time to go look for some articles about this! :)