Penicillin G IM injection?

Published

Has anyone ever given this IM? I had a patient come in with Group A strep and they were admitted to my unit. The order was to give Penicillin G IM injection. The patient had a PIV so the first thing I asked was if it could be given IV instead of IM. I am a peds nurse and the last thing I want to do is stick a child when I don't have to. I asked the resident about this and was told that the IM was specifically for strep A and due to the concentration and delivery this was more appropriate than IV.

So then it comes up from pharmacy and the med is white and very thick. There was a small air bubble in it and it was so thick the air did not move. It looked a lot like the zinc oxide cream we put on diaper rashes, it was that thick! I showed it to my charge nurse, who had never given it either, and she said it didn't look right and I need to double check it with pharmacy. At that point it was shift change. I hated to pass it on but I did not yet feel comfortable giving that med when it was looking like that. The oncoming nurse agreed it was very thick and she was planning to send it back to pharmacy to verify that it was properly constituted. Not sure what happened with it, if it was always that thick in the vial or what.

Has anyone given this med IM before? Just looking for feedback.

Up Vote Up Vote ×
Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Yes, I have given many of those. It is thick and hard to give. And it is painful for the patient as well.......especially peds patients.

Up Vote Up Vote ×
Specializes in Hem/Onc/BMT.

I never gave it but have received it. Yes it is thick and it was the second-most painful IM injection after BCG.

Like the resident said, penicillin is given IM because it will slowly absorb and maintain therapeutic level in blood for days, which may be better than multiple IV injections, especially in an outpatient setting. Sorry a kid had to go through that...

Up Vote Up Vote ×

Yikes! Poor kid! This patient had been admitted and would probably stay at least a day or two for other issues besides the strep A. I feel sorry for the kid and for the RN who probably gave the dose today. It's policy to put lidocaine cream on the site first so hopefully they were able to do that and it helped some.

Up Vote Up Vote ×

I had to give Penicillin G IM 600,000 units to a 7 year old in the ED for suspected Group A strep and scarlet fever. I had never given it before and was also surprised at how thick it was! I used a 23 gauge 1 inch needle and gave in the gluteus, but it felt very difficult to inject, and seemed to take forever as the kid was screaming. Should I have used a bigger gauge needle? Any recommendations for how to give this medication more easily and efficiently?

Up Vote Up Vote ×

Part of the reason that it's so thick is because it is stored in the freezer in the pharmacy. I don't know how volatile it is in terms of waiting for it to come closer to room temp which might make it less viscous. In any event, while the treatment is undoubtedly painful, it's better than developing complications from untreated GAS.

Up Vote Up Vote ×

Just gave this today for strep! Very painful for the poor patient.

to answer your question about giving it iv - no, it can't be given IV because it can cause severe neurovascular damage

Up Vote Up Vote ×
Specializes in Hospice.

Back in the day, it was procaine pen g. Did they take out the procaine? If they did, no wonder it hurts!

Up Vote Up Vote ×

I give it to adults now and again when we diagnose syphilis in my clinic. It is indeed a very thick liquid.

Up Vote Up Vote ×
Specializes in Acute Care Pediatrics.

It is like MAPLE SYRUP! Horrible. yes I have also given it to a pet's patient. Ugh. Horrible. :(

Up Vote Up Vote ×
Specializes in Nursing Professional Development.

I was on the receiving end a couple of times as a kid. Ouch! It made me terrified of injections -- and I didn't outgrow that fear until I was well into adulthood.

Up Vote Up Vote ×
Specializes in Psych, Addictions, SOL (Student of Life).

I have given this IM once or twice to adult patients and yes it is thick almost a honey consistency. Our pharmacy used to send up the vial with a ampule of Lidocaine which we used to dilute it into two equal syringes. The divided doses were then given into each buttock or ventral-gluteal space. Still these were adults who understood why they were getting this shot (both for gonorrhea) and it was still quite thick and painful. The Lido just dulled the pain after the fact.

Hppy

Up Vote Up Vote ×
+ Join the Discussion