Need answer quick! IM inj.

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Specializes in peds, allergy-asthma, ob/gyn office.

Soon to give 112 mg of methotrexate to a morbidly obese patient. The strength is 25 mg/ml. So I know I need to give 4.48 mls.... the problem is the largest needle we have is 1.5 inches! I know this is not long enough for anywhere but maybe possibly deltoid? Can I give 2 doses of 2.24 in each deltoid? How I wish we could have gotten 50 mg/ml of methotrexate. I tried calling around to borrow a longer needle but nobody has them. I tried to get our supply person to order longer ones awhile back, but she was told they are not made longer than 1.5 inch.

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Specializes in Clinical Research, Outpt Women's Health.

I did a quick search and basically if it has to be IM they say you may have to use a 2-3 inch needle in the very obese or the medication will be SQ. Even for deltoid........

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Specializes in critical care, ER,ICU, CVSURG, CCU.

we use 2-4inch needles for extream obese patient injections every day in my practice, physician office

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Specializes in peds, allergy-asthma, ob/gyn office.

We can't seem to stock a longer than 1.5 inch. I called pharmacies, other physician offices, floor at hospital. Where do you get them? We order from PSS.

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

Also can't give more than 1 mL in the deltoid. I see that Methotrexate comes orally, is that an option?

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Specializes in Nurse Leader specializing in Labor & Delivery.
Also can't give more than 1 mL in the deltoid. I see that Methotrexate comes orally is that an option?[/quote']

You can give up to 2 ml in the deltoid in an adult (I don't, but you can). No, oral methotrexate is not an option for the OP's purposes (I'm guessing it's treatment for ectopic pregnancy?).

OP, what did you end up doing?

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Specializes in peds, allergy-asthma, ob/gyn office.

Discussed with senior doc. He agreed longer needed. Checked around and couldn't get it. Failing that he agreed deltoid ok. Rationale being this was a larger person. Gave 2.24 ml each deltoid slowly. Pt said it wasnt painful. Worked well as shown by her dropping Bhcg level.

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Specializes in Nurse Leader specializing in Labor & Delivery.

So do you not see many obese patients in that practice? I'm curious that this is the first time you've encountered this. I give VG injections all the time (Rhogam, depo provera, ceftriaxone, etc), and it does necessitate using a longer needle.

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Specializes in peds, allergy-asthma, ob/gyn office.

Yes we have other obese pts. Drives me nuts because our rhogam comes in pre filled with needle that can't be changed. Luckily I don' have any obese pts on depo. Have only had to give one rocephin so far. I really want access to some longer needles. Our supply salesman from PSS says anything longer than 1.5 inch is a spinal...

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Specializes in critical care, ER,ICU, CVSURG, CCU.

my pss/ now mckesson, provides us with 3.5-4.5 inch needles

which we routinly use for obese patients

and yes it looks like a spinal needle

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Specializes in peds, allergy-asthma, ob/gyn office.

I am going to have to approach this again with our supply person!!

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