New Nurse-IM injections question

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Hi All,

I am a new nurse that just started a new job. It's in a chiro office so it's a lot of administrative stuff but I will also be doing alot of b12 injections. They had me giving 3mls of B12 in the deltoid today. I came home to brush up on my injections skills and realized I should not be giving more than 1ml in the deltoid! I'm assuming their past nurses have been doing this also or I'm sure it would have been brought up...Anyways, my question is-Is is OK to give 3mls in the deltoid? No one complained of it hurting today. Also, isn't b12 supposed to be given in a z track method? How the heck do you do the z-track method on the deltoid easily? Thanks in advance for any help!

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You bring up good, valid points, but consult the P and P manual for the office.

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Specializes in LTC, medsurg.

I personally do not give any more than 1 mL in the deltoid. Anything larger than 1 mL should go into the gluteal. The B12 shots I give in the hospital are no more than 1 mL. Consult your text books.

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Specializes in geriatrics.

I rarely give IMs in the deltoid, and if I do, not more than 1 ml. It hurts more in the deltoid. I always use the Z track method so the medication is deposited and sealed within the tissues. Usually, I administer I'm in the thigh or the hip. Consult your manual and ask your supervisor what their policy is.

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Specializes in Psych ICU, addictions.

I personally am not comfortable with giving such a large amount in the deltoid. Perhaps if you split it up between the two deltoids so each gets 1.5 mL, maybe. 3 mL in one deltoid? No.

I prefer the vastus lateralis (thigh) for giving larger doses. I always Z-track no matter the muscle...yes, it's tougher to do with the deltoid but it can be done with some practice. You'd use your fingers instead of the side of your hand, as you might use when doing it in a larger muscle.

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Does it leak out when you withdraw the needle from the delt?

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Specializes in PICU, Sedation/Radiology, PACU.

I'm curious what you mean by "They had me giving 3mLs of B12 in the deltoid." Someone was making you give the medication in the deltoid?

You're correct that 3mLs is too much volume to give into the deltoid. Check your facility's policy regarding IM medication administration and plan on giving injections in the vastus lateralis or gluteal muscle.

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I'm curious what you mean by "They had me giving 3mLs of B12 in the deltoid." Someone was making you give the medication in the deltoid?

You're correct that 3mLs is too much volume to give into the deltoid. Check your facility's policy regarding IM medication administration and plan on giving injections in the vastus lateralis or gluteal muscle.

They didn't necessarily "make" me give it in the deltoid. I asked how B12 was given (prior to this the only injections I have done are a few pneumo vaccinations). The chiro I worked for said we give 3mls in the deltoid. That's why I administered it that way. Once I got home, I was looking online to make sure I was using the correct needle size for IM injections and that is when I realized that I maybe should not be giving 3mLs in the deltoid.

The office I work for does not have any kind of policies or procedures manual which is why I asked how they usually give the injections. It is a very small office that does mainly chiro stuff.

Am I putting myself at risk by giving 3mls in the deltoid? Can you all suggest any resources to show the chiro why I should not be giving 3mls in the deltoid when I bring it up? I just want to have something to back me up when I bring it up beacuse I don't want to "rock the boat" as it is a very low stress nursing job, with awesome hours and a decent salary.

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I'm wondering why you'd be giving B-12 injections at a chiropractor's office...do they do labs to check the levels first?

mc3

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They have an HCG weight loss program and thr shots are in conjunction with that. They also offer the b12 if people just want it for the boost. An MD is associated with the office as they also own/run a non narcotic pain management program though he is not physically at the location I work at. I know they are places in the area such as "Any Lab Test Now" facilities that you can go to in the area that offer b12 shots and you don't need a script for it so I don't think there is any legal issues with administering it.

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The hcg weight loss program participants have labs done at another facility before starting, but no labs are done on the people who just want the b12.

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Oh, OK. Thanks!

mc3

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