Pediatric vaccine gone wrong

[Kazed]

So I work in a family practice, being trained on vaccines. Have done 100 so far, minimal issues. 18 month is in for his 12 month shots (delayed), first injection went bad... child flung free from fathers grip with needle still in arm, lost some vaccine, some mild bleeding. Wait and then go in for last 2 injections. Did subcutaneous first. Kid again jerked his arm, lost some vaccine and again bleeding. Nurse supervising told father he needs to get a better grip and advised me to just do last one. I tried but the kid kept squirming. Needle went in then slipped back out. Had to quickly do it again.

Child's arm was red, Puffy, Slightly swollen at injection site. Advised parent to wait 20 minutes to check for reaction they declined. Explained the doctor should assess the injection site as it was a rough injection and it looked puffy. They declined. I told the doctor and noted in the chart. I feel like I never want to do pediatric injections again. The nurse said it happens sometimes but unless we get someone else to restrain the child I feel I cannot trust the parents to secure them.

[Kazed]

I really wish she would have taken over. I did not have control. The dad did not have control. The poor kids arms are definitely going to be sore for awhile. I felt like a failure. Thank you for the advice

[Wuzzie]

38 minutes ago, Kazed said:

I felt like a failure.

You did the best you could in a new, stressful situation with what sounds like very little guidance. You did not fail then and you are not a failure now.

I cannot say the same for your "preceptors".

[HiddencatBSN, BSN]

34 minutes ago, Kazed said:

I really wish she would have taken over. I did not have control. The dad did not have control. The poor kids arms are definitely going to be sore for awhile. I felt like a failure. Thank you for the advice

I think your supervisor is the one who dropped the ball here. This was a situation where they needed to either guide you and the dad into a better position or help with positioning. Some kids have a ton of fight and things are still challenging but it sounds like your supervisor could have helped things and that the issue is perhaps your supervisor not having the tools herself to manage this type of common pediatric situation. This is why I always get peds specific care for my kids though- peds specific practices tend to be better at the holding/distracting/expecting kids to fight certain things skills.

[Sweetheart2005, ASN]

I’ve been out of family practice for five years now, but almost always went with the thigh up through age two as my injection site of choice. Seems easier to hold the younger ones effectively.  
I agree with the others. Some of these kiddos are strong! The other nurse should have stepped in to assist in restraining and provide specific  instructions to dad on how she wanted him to hold. 

This was a difficult situation, and sounds like you did nothing wrong. 

[2BS Nurse, BSN]

On 8/25/2020 at 7:31 AM, JKL33 said:

Also wouldn't consider papoose board. That is not good optics for routine, non-emergent peds/family wellness care. Particularly when very brief assistance from another set of hands can make it completely unnecessary the grand majority of the time.

Yes, papoose only for suturing if absolutely necessary.

Don't get too discouraged. We learn from these types of scenarios. The photo example above is a good one. It sounds like this patient is an exception for you. You should have another nurse or MA help in the future if necessary. 

[Wuzzie]

1 minute ago, 2BS Nurse said:

Yes, papoose only for suturing if absolutely necessary.

 They can also be used for blood draws and IV starts. The bad optics can be ameliorated with good teaching/preparation and using kid friendly words. I have never had a parent get upset or a kid fight me using one. In fact, most parents seem relieved to not have to hold their child down themselves.  I also always let the parent "rescue" the child by being the one to get them off the board. Papoose boards get a bad rap that they really don't deserve.

[HiddencatBSN, BSN]

22 minutes ago, Wuzzie said:

 They can also be used for blood draws and IV starts. The bad optics can be ameliorated with good teaching/preparation and using kid friendly words. I have never had a parent get upset or a kid fight me using one. In fact, most parents seem relieved to not have to hold their child down themselves.  I also always let the parent "rescue" the child by being the one to get them off the board. Papoose boards get a bad rap that they really don't deserve.

They can definitely increase the anxiety and trauma of a painful procedure. 

[Wuzzie]

28 minutes ago, HiddencatBSN said:

They can definitely increase the anxiety and trauma of a painful procedure. 

Sure, so can having a parent hold unsuccessfully, or having 4 staff people the kid doesn't know grabbing their flailing extremities, not to mention the noise that causes which just increases the chaos. Restraining a kid under any circumstance is traumatic and painful. It's up to the provider to do everything they can to lesson the drama. I have had very positive outcomes correctly and compassionately using a papoose board and the hold I posted earlier. 

[HiddencatBSN, BSN]

We don’t have them at my current hospital and I find I don’t miss them at all. In the absence of papoose boards, we use comfort holds more frequently, use much more distraction, use things like buzzy, etc. 

[Wuzzie]

31 minutes ago, HiddencatBSN said:

We don’t have them at my current hospital and I find I don’t miss them at all.

Super! Glad you have a system that works for you. 

[HiddencatBSN, BSN]

31 minutes ago, Wuzzie said:

Super! Glad you have a system that works for you. 

It’s not about what works for me but about what reduces trauma for the patient best. I’ve used them in the past. If one doesn’t have the resources I currently have at my facility they are useful but it’s not an intervention that comes without risk. When that risk balances the alternative it’s certainly appropriate to use them, but I’ve definitely worked at places where they are routinely used before less traumatic alternatives. 

[Wuzzie]

7 minutes ago, HiddencatBSN said:

It’s not about what works for me but about what reduces trauma for the patient best.

Okay, I've done my best to not take the bait but honestly I resent your implication that I inflicted trauma on the patients I used the papoose board on. Apparently you missed the part about proper preparation and kid friendly terms. It does not have to be traumatic if it is introduced and used correctly, however it is clear that you have a different viewpoint and are unwilling to accept that perhaps other people could be successful with a different approach.  Just to be clear I never used a papoose board in such a manner that it inflicted any additional trauma on any patient I have ever taken care of. I do not in any way condone it's misuse and feel terrible for the children who suffered at the hands of misinformed, under-educated, unskilled and uncaring health care providers. I do not happen to be one of them.