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?

I agree with Emergent's post. This happens Try not to be hard on yourself.
Thank you JuliaRNMSN and everyone else for being so reassuring and helping me feel like I'm not as incompetent as I think I am. Maybe the MD I work for is bringing me down. Maybe it's time I look elsewhere.
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leaving a little air...it works.

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You are welcome. I don't appreciate being rushed during what I believe to be a procedure that requires my full attention. I want the best result too. I just ignore all the pushiness....unfortunately some folks perceive it as something negative and personalize it.

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Specializes in hospice.

I'm really confused by the whole vaccines given subcutaneously thing. I've watched my kids get vaccines all these years. I've gotten them myself. Taken the family for flu shots as recently as last fall. I've watched nurses give vaccines to patients....ALL IM. I guess I'm going to have to do some research because I literally have never seen vaccines given subcut and now it's BUGGING me!

Thanks for the summer research project. :p

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:D Exactly! I know all MDs surely want the procedure to be done correctly, which requires us to take our time and pay close attention to details. If we rush, careless mistakes are likely to happen. And in my case, I'm the only one there with the MD. It's not like someone else is there to help me prepare the vaccines.
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I'm really confused by the whole vaccines given subcutaneously thing. I've watched my kids get vaccines all these years. I've gotten them myself. Taken the family for flu shots as recently as last fall. I've watched nurses give vaccines to patients....ALL IM. I guess I'm going to have to do some research because I literally have never seen vaccines given subcut and now it's BUGGING me!

Thanks for the summer research project. :p

Go to immunize.org http://www.immunize.org/catg.d/p3085.pdf

If I posted the link correctly, it lists the routes of each vaccine. Some are given SC and some are given IM. And PPD is given ID. You should bring up your concerns to your child's pediatrician, too.

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Specializes in ER.

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

Think of it as similar to giving a liquid med to a baby or toddler. Does it all end up in their stomach? No.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Bambibelle, I believe your main issue right now is confidence, which is perfectly normal. I actually had one job that we called "the shot room", then I worked with an allergist and did allergy testing along with the allergy shots.

You may want to do some review of your proper procedures during down time, but with practice things will go more smoothly.

There are some threads here with lots of ideas for properly restraining a child for the few seconds it takes to give the injection. Enlist the help of all adults in the vicinity if need be.

I agree I would not ask the doctor to teach you a z-track injection. There are lots of tutorials out there for that. Some injections don't go as well as others, but despite fears I have had, nothing catastrophic has ever happened with a little medication or blood leaking from the injection site.

No, I don't think you should quit your job over this if you otherwise like your job. I'll look for some older threads for you that have lots of tips and tricks.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Here are a couple of links. I find it necessary to keep up with CDC recommendations for all of this. Doctors do not necessarily know the most current information.

Vaccines: HOME page for Vaccines and Immunizations site

Here's an allnurses thread on the topic.

Physical restraint on uncooperative children

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Specializes in Pediatrics, Emergency, Trauma.
I'm really confused by the whole vaccines given subcutaneously thing. I've watched my kids get vaccines all these years. I've gotten them myself. Taken the family for flu shots as recently as last fall. I've watched nurses give vaccines to patients....ALL IM. I guess I'm going to have to do some research because I literally have never seen vaccines given subcut and now it's BUGGING me!

Thanks for the summer research project. :p

As far as SC injections, remember it depends on the length of the needle and the bunching technique, meaning, it may have looked like an IM injection, but because of the needle length, it was SC.

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I look forward to your projects information!

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