PEDS NURSES: What am I doing wrong??

Specialties Pediatric

Published

I hope I'm not the only one who this has happened to, but I also want to know what I am doing wrong.

I work for a private practice. We had patients scheduled for the end of day and about 10 minutes before closing, the MD ordered some shots. I am new to the field and don't have that much experience with shots, so I take my time reconstituting each vaccine and making sure there are no air bubbles and ensuring I have the correct dose. Of course the MD is annoyed and rushes me because it's Friday and he wants to go home, which makes me nervous. I should also note we are a small practice and there is no one else with me other than MD. So I have no help.

What had happened was I injecting a vaccine subcutaneously into a Pediatric patient (the kid was crying and squirming, so I injected it kinda quickly as the MD has told me to do in the past with peds patients). I noticed a few drops leak out after withdrawing the needle. This happened on two different patients. This has never happened to me before until today. Does this happen? I wasn't thinking too much of it when it happened becsuse it was such a small amount. I figured it was excess medication seeping out because I saw the whole thing go in. But now I'm worried. Are the patients going to be okay? It was honestly a tiny bit, but the parent noticed. What do I need to do to prevent this from happening? I heard I'm supposed to wait a few seconds before withdrawing the needle, but that seems difficult with children.

I've been struggling so much in this field. I was the top of my class and picked up on everything within a week during my internship and had no problem with my skills. Does it get easier or is it just me? I've been working a little less than a year. I have a degree outside of the medical field in addition. Sometimes I feel like I should give up on medical all together and look for work with my other degree.

Please give me some insite on this and let me know if this has happened to you or someone you know and what happened?

Specializes in Oncology, Medicine.

I thought Z-tracks were only for IM injections? But even if you give those, the kiddos may make that technique difficult too if they aren't still. Do the parents help hold them? I don't work in peds but my kids' nurses, skilled as they were, sometimes had me help hold when the kids were young and squirmy. I think a little seepage is ok but if you do have an opportunity to shadow other techniques, can't hurt...

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Also, if I'm not mistaken (and y'all please correct me if I am!) the Z-track method is for IM injections. I've never heard of it being used subcutaneously.

My question is why were you giving the vaccines subcut? Vaccines should be IM (with the possible exception of the Hib, mentioned above, I guess).

Oh, and I give injections all day long - it's common to have a little bit leak out, and not a big deal.

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However, I also had a RN at my clinical site tell me that for IM, leaving a bubble in the syringe helps keep leaking from occurring, because you inject a tiny air pocket on top of the serum which helps hold it in. Anyone else heard of that?

Not quite the same, but I have found if I leave a bubble in my SQ hep injections, it keeps it from bleeding.

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Some vaccines are administered IM, some SC. Get yourself a chart (try immunize.org) so you have an immediate reference.

What your doing wrong is letting the physician rush you during the procedure. Were you taught the restraining techniques for a squirming child? If not You Tube is your friend.

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Specializes in Psych, Addictions, SOL (Student of Life).
Also, if I'm not mistaken (and y'all please correct me if I am!) the Z-track method is for IM injections. I've never heard of it being used subcutaneously.

nO YOUR RIGHT

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Specializes in LTC.

MMR, varicella and proquad (which is a combination of MMR and varicella, MMRV) are all given subcutaneously. I have never heard of Hib being administered SC. We always gave IM. I believe the former are all given SC because they are live.

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You might see if the Mods will let you change the title of the thread to something like:

"Peds nurses: what am I doing wrong?" or "Peds nurses: help me with injections." Then you might get more traction from pediatric nurses in this thread.

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I gave Varicella and MMR. We have a guide on our vaccine refrigerator/freezer that list the routes for our vaccines. Both MMR and Varicella are listed as SC.

It sounds like leakage is common. So the patients will be okay and most likely received enough to be protected?

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How do I contact the mods, horseshoe? I'm new to the boards.

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Specializes in Oncology; medical specialty website.
If this has only happened a couple of times I wouldn't worry - the child likely received enough vaccine to confer immunity ( Vaccines are only 90% effective anyway. I have been vaccinated for with MMR three times in adult hood and my tires continue to show I am susceptble to measals. You may want to try Z-tracking your injections. It prenets back flow of serum through the puncture.

Hppy

IIRC, Z-tracking is only for IM injections.

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K23RN: Sometimes the parents will help hold the kids down. One time (a different instance than the one we are talking about) I laid the patient on the exam table and had the parent stand next to them so they could distract them and block them from seeing me give the injection in their thigh. (This was a toddler).

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I agree with Emergent's post. This happens Try not to be hard on yourself.

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