Aaron86

If anyone is interested, I've been doing some digging into this topic for the last few days and finally found a good article on the topic: http://www.nursingtimes.net/nursing-practice-clinical-research/are-techniques-used-for-intramuscular-injection-based-on-research-evidence/1952004.article They do a wonderful job of breaking down the whole article to the main points of interest too. Page 1- -The technique for IMI needs to be reviewed in the light of existing evidence. -Evidence supports the use of Z track technique and stretching the skin of the injection site. -Evidence supports the use of the ventrogluteal site for all ages. -The dorsogluteal site should not be used for injection as it poses unnecessary and unacceptable risk for patients. -Needle length and tissue depth are linked to adverse events as obesity has increased. Patients should be weighed and assessed for the required needle length with needles inserted up to the hub to ensure the full length is used. (someone touched on this one too, about IM shots ebing given SC because of improper needle length) Aspiration should be undertaken with dorsogluteal procedures as needle insertion is close to the gluteal artery but is not necessary with other sites. From the A&P I've been going over, you arn't really at risk for cannulating a vein and depositing an IM drug as IVP. The whole aspiration practice arose from penicillian and other large molecule drugs being pushed into arteries (scary!) and causing embolism. The sites we use for IM injections today are chosen specificly because they lack those major arteries and nerves we want to avoid (with the exception of dorsogluteal) Using sites other than dorsogluteal, at 90 degrees if you encounter a small vein its almost always going to be punching through and not going into it. Yes you could get a blood return, but thats essentially blood that has seeped into the same potential intermuscular space that you are utilizing for drug placement. Just something to think about. That said, I'm still going to look deeper before I make a descision on how I will practice.

This sort of treatment of new nurses was a major factor that pushed me into the military after graduation. And you *really* got to want it to get into the military as a nurse these days. They are flooded with applications. Sorry to hear your hospital is being so irresponsible about training and orienting you! Speak with your unit manager and tell them you need more time for orientation or let them know you might not be able to take a full patient load just yet and be safe about it.

sorry to resurrect a dead thread here, but this seems to be the most current one on the subject. i'm just wondering if anyone has come across any research on the topic that doesn't relate to pediatrics and vaccine administration. i know the british journals of medecine, who, cdc, and us dept of health all say aspiration is not required of im and sc but these are specificly spelled out as vaccination guidelines. what concerns me is all the confusion between giving a flu shot im and say... dilaudid im. get the flu vaccine into a vessel and its not going to harm to the patient, however they may get a less effective immune response. in this case, i see how the extra manipulation of the needle could potentially cause way more harm to the patient vs. a reduced benefit of the vaccination. a dilaudid im dose going iv though... i see that as being an issue. so, any research nuts out there able to point out to me a non-vaccine study saying aspiration is necessary? i've got experienced nursed saying "yes! definitely aspirate on every im even that flu shot on a 2 year old" while at the same time having another nurse say "no, you don't have to aspirate on any ims anymore" i suspect the true evidence based best practice lies somewhere there in the middle, but its really hard to support or disprove it looking for research on the subject

First of all THANK YOU Carolinapooh! Love the advice and its got me pumped and looking forward to COT on Aug 23. Got my orders in the mail yesterday and this finally became real to me after more than a year waiting. Didn't sleep much last night from anticipation. I've done some quick searching around but didn't find anything specificly answering this, but are the glossy low quarters OK for COT? My Dad is retired enlisted and he told me it is definately something to find out. When he was in basic they were not allowed, but once he got out of basic he never wore the polish ones again in 20 years. I wasn't sure if it would be the same for officers as well. By the sounds of it, we won't have any free time to be polishing shoes every night, so I'd like to do without (if it is allowed).

I was just talking about the running times. I know many women that can outrun me - any time, any place. Just wished the time to shoot for was the same since the running portion is what is killing my score at the moment. I'd be passing by a good margin according to the female's running times vs. failing on the men's.

Thanks for the info, I just thought we might have to qualify with pistols since the nurse I interviewed with specificly asked if I had any moral objections to using a firearm since I would be required to do so if I was sent to the middle east. Guess that is something that will only happen if you are in a situation where you need to carry one. I also have the current standards for the physical fitness test from the COT website already, there wasn't any specifics about the 5K run except that there would *be* one. I mean I could do 5k easily at my own pace. Just wondering if I should step things up to try beat a certain time. On a side note: I wish I could go by the women's standards! Would be so easy

Hello everyone, I'm set for COT on August 23. Good to see there is a facebook group for us, I will make sure to join it. Just a question for anyone here who has done this already or knows someone who has, Is the 5k run timed? If so what is the time limit? I've never been a runner, but I feel like I can work on getting the 1.5 mile in a reasonable time in the next couple months. The 5k is a whole other story... =( Also, does anyone know at what sort of score at what ranges we will need to qualify for the pistols? Shot a pistol at the shooting range for the first time today, scared me a bit at first but I wanted to be familiar with it before the pressure was on.

i too will be going to arizona for ntp right after cot at maxwell. i get the joy of doing it during the heat of summer however. just a pointer for anyone looking to join or considering starting the paperwork - start the year before you graduate! i started the whole process in february... of 2009. i finally got my cots date today. yes, it took well over a year to get this far and guess when my cots date is? august 23! over a full year after i got my rn license. my recruiter seems pretty apologetic about the whole thing since it was originially going to be january, then february, then march.... and he has mentioned over and over that i would normally be headed for cots 2 weeks ago, its just they got so many nurses applying and they don't have enough seats per cot date to train them all. i'm excited to be going to arizona for the ntp and then on to travis in san francisco bbut it is small comfort considering i've been basically unemployed for a year already and will need to scrounge up $2000 to cover cot expenses! but enough negativity there, looks like a few of you are in the same boat and we can't do anything about it now but enjoy our extended spring break!

As i was signing papers with my recruiter he told me that I would need a minimum 6 months of continuous full time work experience as an RN to even get an increase in base pay and be able to skip some of the more intensive training and go stright to the first duty station. I'm not sure how many years experience someone would need to go in at a higher rank.

Well I got my Live Attenuated virus a week ago and no ill effects so far. Not even so much as a runny nose. Personally, I liked it better. When I got my seasonal flu shot my arm hurt as if someone had been punching me for nearly a week. I'm also more than happy to have saved a dose of the injectible for someone who really needed (and wanted) it. Someone like the nurse who posted earlier saying they had asthma. Our hospital system implimeted a new policy this week saying that, untill all forms of the vaccine become widely available, anyone wanting a vaccine will go through the full screening and only be given the shot if they have some condition that rules out the mist. We also just opened up the flumist to families and children of employees. In 3 hours on a Sunday we got nearly 800 family members along with a few of "lower risk group" workers (environmental services, maintenance, etc.). To put that number in perspective. I spent nearly 12 hours over the course of the last few weeks offering the vaccine to the various units on the hospitals. I only administered about 25 intranasal doses in all that time. I recognised one nurse who didn't want to take the flumist bring in 3 of her children for the mist. So I don't think the major concern is the safety and more the stigma of wearing a mask.

http://www.cdc.gov/vaccines/vac-gen/6mishome.htm#risk http://www.who.int/features/factfiles/immunization/facts/en/index.html i think those are two reputable sources on the subject of vaccination in general. and that is all the more i will say on that. it is not my intention to argue that everyone needs to be vaccinated. if someone objects to receiving the vaccine, it is their decision about their body and i have to respect that - any thing related to that deserves its own thread. ----- my issue was with healthcare workers eligible for a more the widely available vaccine (which is not licensed for use on those who have the highest risk for death and hospitalization) insisting on waiting for the trivalent inactivated version. these are healthy people at low risk for h1n1 complications taking the inactivated instead while the people that really need the inactivated can't get it. meanwhile the laiv allocated to those healthy healthcare workers under the age of 50 is hoarded in a hospital doing no good at all. if the trivalent inactivated h1n1 vaccine was as widely available as everyone was lead to believe this wouldn't be an issue. but it is an issue. the ethics in question here isn't the decision to vaccinate or not to vaccinate. it is unnecessary consuming limited resources that are badly needed by those people most likely to *die* if they get the flu.

Thanks! This makes a lot more sense to me than the kink/flush/push/flush/unkink way. I really wish I had a set of IV tubing around that I could push colored dye into. I wonder how much diffusion actually moves the meds up or down the line once a little bit has been pushed.

Well I finally got my H1N1 LAIV today. So I will let you all know if any ill comes of it. Originially it was only for the tier 1 employees but so few got it they finally told us we could get it ourselves last week. I'd been pretty much on my own so I had no chance to get it myself. I finally just had a nurse check off my form and got it.

i know that we deal with people and not just facts and figures. this is mainly why i was driven to even post (which won't be happening again soon) any seasonal flu clinic i go to i get hundreds of questions from anxious parents asking when we will give out the h1n1 vaccine. what do i tell them? we do, in fact, have over 6,000 doses of h1n1 sitting in a fridge reserved for healthcare providers who are holding out. i'm sorry mam, your kid might end up in a picu because resources are being tied up like this rather than getting to the people most at risk. i put myself in her shoes and see how rediculous it is that i am twiddling my thumbs trying to get healthcare workers vaccinated with the alloted vaccine. meanwhile the public is driving from doctor's office to doctor's office trying to find it. let me put it this way: someone is at a pizza party. there are 10 pizzas with meat, and 1 that is cheese only. of course, this is a stupid way to hold a pizza party because there are a lot of vegetarians there. this person knows damn well there are vegetarians at the party but they insist on holding off on the meat and eating the whole cheese pizza themselves. because, you know, that meat has more cholesterol in it.

Haha, you'd think that would make it better for those healthcare workers who are afraid of needles! If I could pick between the two, all things being equal, I would probably choose the h1n1 shot too. It so much manlier to bear the arm and take it. But if my getting the shot means a pregnant woman and her child go unprotected? I'll take the runny nose for a few days. Also, kind of off topic here but going back on your previous post: those diseases are rare *because* of the vaccine. Untill it becomes erradicated in the wild (small pox) the risks of the vaccine still must be compared to the risks of the disease. DTaP or MMR and polio may seem like rare and exotic diseases in the U.S. but they are endemic in many countries that tourists visit and people immigrate from. It may be hard to think of it like this, but less than a death in a million due to a vaccine reaction is immensely preferable to thousands of deaths per million from the disease. I make sure to go through any contraindications and ask for questions before administering vaccine even to someone who absolutely wants it. Because you know what? that 1 death in a million might be better than thousands but you still try to rule it out at every possible chance.