long-acting IM going SQ?

[Umberlee]

Ugh, I feel like such an idiot...I have a client who is getting stable on haldol decanoate, but he is gaining weight due to taking PO lithium as well. I gave his decanoate in his deltoid, per his usual preference, but I was on the fence as to whether I needed to go with a longer needle due to his weight gain. In hindsight, a one inch was definitely too short and I don't know what I was thinking. I'm beating myself up over it. In the meantime, today (three days after his shot) he's reporting that it's been hurting ever since his injection, his "whole" arm is swollen (no fever), and he's been feeling sick to his stomach and having trouble sleeping as well. The only thing I can think of that I possibly did wrong is not going up in size on the needle, so I'm guessing that the pain and swelling is because of a pocket of medication knotting up in the space prior to the muscle?? And maybe the nausea/sleeplessness is due to pain and agitation? No reports of any oversedation or change in mood etc. I can't assess the client because none of our team is on staff and everyone is busy this weekend with Memorial Day weekend plans (just received a call from his mother about it) and we are prohibited from seeing clients alone. I just advised her to have him ice and elevate it and if he has a temp or any systemic symptoms, OR if she is really concerned about the swelling and it seems beyond just sore/irritated to take him to the after-hours clinic. What I'm most worried about, though, is whether it not being IM affects the bioavailability and distribution of the haldol. I haven't been able to find anything about whether it will be or not.

Has anyone ever accidentally given an IM wrong? I feel like such an idiot and I feel horrible for my client. He has been doing so well but he's very suspicious about his meds and I'm afraid this will make him reluctant to continue with being med compliant.

[RNcashy89]

I am aware of rare cases of adverse interaction between Haldol and Lithium which can lead to an encephalopathic syndrome which could be categorized by weakness, lethargy, tremulousness, EPSE, confused state, you need to monitor patients who are receiving Haldol and Lithium closely for any indication of neurological toxicity. Regarding the injection, what gauge needle did you use and how obese is the patient?

There is a risk of of abscess, fat necrosis, ulceration, pain and swelling if a lot of the solution was administered into the subcutaneous tissue.

[mikenmim]

I always use a 1 1/2" needle for IM's.