Bad day giving vaccines

Nurses Medications

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I had a to give two vaccines to a patient today. I work in peds, so I have done this loads of time before. The office procedure (if they are younger) is to lay the patient on the table. I along with the dad were the only two in the room. I use one arm to hold the legs down, and one hand to give the injections into the thighs. The dad was holding the upper body. However, he failed to secure the kids hand on the side I was giving the first injection. I got the needle in, injected the medicine, and then the kids hand grabs part of the needle, and the needle bends as I was withdrawing it from his leg. That had to be a painful experience, but all was okay. There was no obvious tissue damage, and the patient didn't seem to be in anymore pain than the typical 2 year old receiving shots, and he wasn't bleeding either. Therefore, I moved on to the next vaccine, which I gave in the other thigh.

I held a lot tighter this time, and made sure the dad had the child's hands really well too. I insert the needle, inject the medicine, withdraw the needle, only to be met by a stream of blood. I was taught not to pull the syringe back for vaccines because the syringe was 0.5 ml, and was prefilled. I knew that I had hit an artery or a vein, probably an artery because it squirted up in the air a little, and it was pulsing. I grabbed the gauze and pressed and held it on the wound. I held it there until the bleeding stopped which surprisingly was not long at all, probably less than 30 seconds. I put the band-aid on, and all the while I'm trying to maintain my composure because I knew that no lasting damage had been done.

I explained to the dad what had just happened, and told him that there may be a bruise to form at the injection site from the bleeding. I told the doctor about what happened with the artery, and he said not to worry about it, that I most likely missed the femoral artery. However, I think I did 'nick' a small area of a branch of the femoral artery. I was in the mid-outer portion of the mid 2/3 of the thigh muscle; however, I probably could have gone over more, and in the future, I will! I still feel really terrible about what happened, and surprisingly the dad didn't seem to care too much, and even more luckily, I don't think I did any lasting damage. I checked in on the patient about 5 to 10 minutes later, and he was doing fine, and was actually walking down the hallway on his way out.

It was difficult to maintain my composure because I was nearly freaking out in my head because this had not happened to me before, and I thought I had inflicted more harm than I intended.

Have you guys ever experienced such a bad experience when giving injections?

Try not to stress too much, this stuff happens. I've had a bent needle, a kid that pulled out a needle before i could injunction, and have had tons of bleeders. He will be okay. Great for you to see it as a learning opportunity!

Specializes in Nursing Faculty, ER Nurse.

I give injections in the ER all the time and like Hockeynursing stated, this stuff happens. Kids pull at needles. Sites bleed. The kid is fine! Don't beat yourself up about it. Totally normal for these things to happen sometimes.

Specializes in Community and Public Health, Addictions Nursing.

This has happened to me too- both the child getting free from a hold (can happen a lot) and the bleeding you described (which only ever happened to me once, and I bet this won't happen to you again either for a very long time!). When I did health center work, I tried to be super careful about making sure the parent was safe to hold their child, and if I needed backup, I'd make sure I had it. I'd also try to keep an eye on the child's hold while giving the vaccines, and if the hold wasn't safe anymore, I'd stop and ask the parent to hold their child better until it was ok to proceed. Some parents have very strong children who are hard to hold, and I completely understand that, but other parents just didn't have a clue and seemed to think it wasn't a big deal that both of their three year old's hands were free and ready to grab anything in sight!

As for the bleeding, you're right with your vaccine administration- we don't pull back on the plunger of the syringe. Especially when dealing with kids, you have to work quickly and avoid any practices that could slow the process down. Getting the injection site correct is the best way to prevent bleeding, excess pain, etc., but sometimes bleeding happens, and when it would happen for me, I always had a wad of gauze ready, made sure my patient was ok and the skin was cleaned well, and just let the parent know there could be a bruise. I think people do better when they know what to expect.

Specializes in HH, Peds, Rehab, Clinical.

For my own morbid curiosity, when is your licensure level?

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Have you guys ever experienced such a bad experience when giving injections?
No. Since my conscience is not extremely active, I tend to not worry or freak out over any harm I might have caused. I know that may have sounded really bad, but I remain detached to a certain degree.

Hang in there and good luck to you.

Specializes in ER.
No. Since my conscience is not extremely active, I tend to not worry or freak out over any harm I might have caused. I know that may have sounded really bad, but I remain detached to a certain degree.

Hang in there and good luck to you.

Crusty old bat!

When I worked in the ED and in Peds whenever we had to give two injections to a child I always had another nurse come with me and we double-teamed the patient giving both shots at the same time (in different legs of course). Parents controlled the upper body and we each walked in and simultaneously secured the leg we were going to use, swabbed, 1-2-3, injected and out. The entire procedure lasted about 5 seconds so no time for grabby little hands and only one traumatic event rather than two. It sounds terrible but it really worked well.

like posted said, we used 2 nurses to give 2 shots at 1.

but don't sweat it, this stuff unfortunately happens. learn from it. I've seen an NP give a vaccine with a safety cap....so she injected the needle and couldn't push med cause a safety cap was in place. I've also seen someone give a flu shot and the kid grabbed the needle out scrapped up his thigh! Ouch.

If available, i would suggest a second nurse next time.

Specializes in Ambulatory Care-Family Medicine.

I've had bleeders, I've had kids grab for the needle, even had a teenager jump during her depo shot (which she has been getting from me for over 2 years and is normally fine with them) and left a nice scratch. It happens to all of us. Try not to beat yourself up about it. It was a learning opportunity for everyone. Maybe dad knows he needs to hold on tighter next time and you've learned a bit more about injection practices.

By the way, yes you are correct not to aspirate for prefilled vaccines.

Specializes in Renal, Diabetic.

I hate giving shots to children. They are strong, despite their size, and it happens to everyone at some point or another when the needle comes out. I will normally have another co-worker come in with me to assist because I've learned that I'm unsure if I can trust the parent to be as strong as I need them to be. I do give them a heads up why there are two people helping and I tell them why (if they kick, and it comes out, I have to poke again, and I can't guarantee that the child will let me.)

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