IM question.

[linzz]

I am taking an IV course and the instructor was telling us that IM injections are not ever needed and that most hospitals are getting away from them. Does anyone have any comment on this?

[EricJRN, MSN, RN]

If a patient has IV access and a med can be given either IM or IV, then IV makes good sense. However, there are plenty of things that shouldn't be given IV (vaccines come to mind), so IM injections won't be phased out any time soon.

[blkloc11]

hello - working on med/surg floor i frequently see demerol given im post op (often with vistaril) - although not really sure why when you think about the fact that 50mg of deerol is equal to a couple es tylenol:coollook:

[NRSKarenRN, BSN, RN]

there is a difference between practice in a hospital setting where most patients have an iv site compared to the rest of the world!

im meds that come to mind beyond immunizations include haldol deconate im, bicillin im and epinepherine....

intramuscular injection (self-injection) - im injection; injection ...

these medications may be given using an im injection:

• certain antibiotics
  
• certain contraceptive hormones
  
• most vaccines
  
• epinephrine injections for severe allergic reactions

:)

[Babs0512]

For all the reasons everyone else stated, I agree IM injections won't be phased out.

There are many reasons IM injections or sub Q injections might be preferable to IV. With Demerol, IM may take longer to start working, but it will last longer than if it was given IV. On the other hand, Hum R insulin works faster if given IV, but if you want to cover someone before a meal, it's better to give it sub Q where it will take a bit longer to work, therefore giving the patient time to eat before the insulin fully kicks in.

These are just two examples, but they can be substituted for many other medications.

IV is a great route for many medications, just maybe not always the right route for every situation.

[P_RN, ADN, RN]

BUT, with Demerol, (meperidine, pethidine) you have that risk of the build up of the metabolite norperidine. I'd be most happy if this med fell off the edge of the earth. Seizures are not fun for anyone.

And yes in the last 40 years I have noticed a huge drop in IMs. 40 years ago nurses hardly ever started IVs. Doctors took that as their task. The super might take you behind a screen and show you how but it was not the norm.

[Fiona59]

I'll give you the western Canadian answer. No we're not moving away from them out here, in the hospital setting. Our CNEs are just asking us to use different sites than previous years. Mostly vastus lateralis and less use of the deltoid.

[blondy2061h, MSN, RN]

We never give IM, but we're special. Our patient's platlets are usually far too low for IM injections. I gave tons of them in my primary care rotation, and never gave them anywhere else.

[EarthChild1130]

I would think having worked inpatient psych you would still give a fair bit there...we always gave a LOT of IM Haldol, Ativan, Benadryl, Zyprexa...now I give Haldol Dec, Risperdal Consta, and Prolixin Dec.

[SixFive]

They won't ever be phased out.

I have worked with a few surgeons who refuse to even prescribe IV pain medication; they always go with an IM injection.

[annreese]

IM injections being phased out? eek thats scary. It reminds me of an incident a few months ago when my mother was in the hospital (not mine), the nurse came in to give promethazine. I expected her to do it IM, but she diluted it and did it IV, I nearly had a heart attack as my experience and policy tells me never to do it IV. I guess some hospitals do. When I asked her she said that they too were moving away from IM injections to prevent needlesticks. So I guess that its dependent on the policy. But this particular hospital, I question there policies a little bit, this is the same one that started an insulin drip at 1u/hr on the med/surg floor (first eek) for my mother whos bg was 110 (second eek). hmmmmm

[MN BigJ]

There are a lot of reasons to give meds IM, Not a lot of common meds have to be IM though there are some. Depends on what meds are frequently used at the hospital.