Injection Leaked! A lot!

[FolksBtrippin, BSN, RN]

Today I was giving a pt abilify maintena IM in the deltoid with the 1 inch needle in the package (don't remember gauge) I pulled the needle out and out came a small white bubble of medicine, no big deal. But then the patient coughs and a whole lot of medicine SQUIRTS OUT of the deltoid. I **** you not. I wiped it up and stuck a bandaid on it.

Now I am wondering why it happened and how can I prevent another event like this

FYI pt is 26 y old Male who works out.

Tya

[CalicoKitty, BSN, MSN, RN]

Did you do a good z-track? That should make the hole through the skin and muscle loose it's path.

[verene, MSN]

Did you give slowly and do a good Z-track out? I find that helps. It's such a thick med that it doesn't absorb well and can leak out easily if given too fast or with a straight in-out. You can also give in the gluteal and have the patient remain laying down for a bit after injection to help prevent leakage.

EDIT: Also if let the provider know about the leakage if you haven't already. If the absorbed dose is lower than usual the patient may start having symptoms a little earlier than normal, so it would be good to catch them on the earlier side of the next injection window rather than later.

[FolksBtrippin, BSN, RN]

Thanks for your responses. I have not been using the z track method but I will start.

I work in the community and had to give this injection in the car. It isn't the first time I've given one in the car. It was awkward and I think I probably rushed it. The patient was moderately anxious and mildly paranoid, and very stiff, which I think played a part in the whole thing.

Also, I did tell the provider.

[Chrispy11, ASN, RN]

Longer needle?

[verene, MSN]

Thanks for your responses. I have not been using the z track method but I will start.

I work in the community and had to give this injection in the car. It isn't the first time I've given one in the car. It was awkward and I think I probably rushed it. The patient was moderately anxious and mildly paranoid, and very stiff, which I think played a part in the whole thing.

Also, I did tell the provider.

That's a tough situation and I can understand why injection was rushed and not optimal.

I work in a locked setting so I have more control over the environment and can offer either chair or exam bed to patients during injections. I'm assuming your are ACT or other similar community based program? Would you be comfortable reaching out to your peers for advice on giving injection in these non-standard settings you encounter in this kind of work?

[FolksBtrippin, BSN, RN]

That's a tough situation and I can understand why injection was rushed and not optimal.

I work in a locked setting so I have more control over the environment and can offer either chair or exam bed to patients during injections. I'm assuming your are ACT or other similar community based program? Would you be comfortable reaching out to your peers for advice on giving injection in these non-standard settings you encounter in this kind of work?

Yes, I work for ACT. The advice I got from the RN I work with is to massage the muscle first. My NP says it has happened to her a few times after a muscle spasm. We think his muscle tightened up when he coughed. Injections in the car are just par for the course for us. Of course, we would always prefer to do an injection in a more comfortable environment.

[FolksBtrippin, BSN, RN]

Longer needle?

I might try that for this particular patient next time. He does have a big deltoid.