IM Injections

  1. Situation: IM Phenergan injection in the deltoid of obese patient resulting in an immediate, small localized knot at injection site. I don't know the specifics of the needle size and method used.

    Question: What causes this? Is it just something that just happens sometimes or is it an operator error? I was thinking maybe it ended up being SQ because the pt was obese and the needle was too short. Or maybe it was pushed too quickly?

    Any input is greatly appreciated. I am a relatively new nurse. I had a patient ask me about this and besides not having an answer........ I of course became paranoid that I may do the same thing.
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    About lweatherby

    Joined: Jul '09; Posts: 150; Likes: 71
    Oncology RN; from US
    Specialty: 3 year(s) of experience in Oncology


  3. by   RNperdiem
    Phenergan is seriously corrosive. The pain of under-diluted IV phenergan is very painful.
    I had an IM shot of phenergan once, and the site hurt me for 3 weeks.
    It is a drug I tend to avoid giving and doctors here avoid prescribing for those reasons.
    Unfortunately, there is a shortage of anti-emetics so I have given more phenergan than I used to.
    So, to answer your question, you could have done everything right and still had that knot of irritation.
  4. by   roser13
    We have not given Phenergan IM for quite some time due to its corrosive nature. We only give it IV, greatly diluated and through the port farthest from the site.
  5. by   VivaLasViejas
    Even in the 'old' days when we gave Phenergan IM, it was NEVER given in the deltoid. YOWZA.
  6. by   GitanoRN
    phenergan injection should not be given by the subcutaneous route because evidence of chemical irritation has been noted, and necrotic lesions have resulted following subcutaneous injection. therefore, the preferred parenteral route of administration is by deep intramuscular injection. having said that, is because of the risks of intravenous injection, the preferred route of administration of phenergan injection is deep intramuscular injection subcutaneous injection is contraindicated. please read the directions on the vial!
  7. by   rgroyer1RNBSN
    And put injection deep im in a glute, not a deltoid site, have always given it in rear end.
  8. by   tcvnurse
    Our hospital doesnt even have phenergan as IV/IM anymore. Risk of complications way to high. I know a lady who got injections of phenergan and developed blood clots at the sites. Very bad news.