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.

Again, I was probably too hasty in how I presented the topic and that leaves it open to misinterpretation. My issue here is not with people who refuse vaccinations. My issue is with nurses and others who want to get vaccinated for h1n1 insisting on consuming only the most limited of resources. And they appear to be doing so for no reason other than, what I consider to be, conveniance.

first of all, thank you for advancing discussion rather than latching on to a few poorly chosen words on my part. from my understanding: 1: the intranasal vaccine is essentially geared to and marketed toward pediatrics. children make up the majority of the market share for the manufacturers so it is just not economically feasible to extend clinical trials on proving the safety or efficacy on those people over the age of 49. (the clinical trials only included significant numbers of people up to age 49) 2. theoretically its possible to pass on the laiv to a patient. this is especially true during the first 48 hours. vaccine virus shedding peaks at 48 hours and then drops off significantly, but can shed up to 2 weeks. this is however, much less likely to pass on to someone else let alone make them sick then say.. you got the actual wild type h1n1. in which case you are putting patients at risk for 48 hours+ while you are infectious but not symptomatic. since there is a chance a nurse will be working with a patient who has a weakened immune system and neither know about it, our hospital system has instituted a policy of wearing a mask if you will be in patient contact areas in the next 48 hours. this is a major sticking point with nurses who otherwise were ready to take it. their concern is not with the laiv or anything like that... they just don't want to wear a surgical mask for 48 hours while at work. 3. if you had a 39 wk old premie i would turn you away. a premie falls under the category of the immune compromised. however low the risk of transmission of vaccine virus is, it hasn't been adequately studied in those with severely weakened or under developed immune systems. 4. see above. you would also be a rule out. if you went ahead with it i would recommend masking while around this person and limiting contact. think: protective isolation. 5. the answer here is "enough". honestly, there is never enough data to be absolutely sure and there are many other medications out there on the market approved for use with higher risks and dubious benefits. yet receive far less scrutiny. there are hundreds of studies cited in the cdc's guidelines and i am slowly working my way through them. (its not exactly exciting reading and this is during my free time!) 6. i'm really trying not to hedge here, but this one is an ethical dilemma and you have to decide for yourself. personally i see it as somewhat of a catch-22. you are putting your family at risk by simply working in the hospital. no matter the precautions you take, you might still carry something home. at the same time, if you are working in the hospital, it is ethical, moral, and professional to minimize the danger to those entrusted to your care. personally, if i had any of the rule-out conditions ( a premature infant, a parent on chemo, etc.) my responsibility is to my family.

I don't intend to be overly insulting. Perhaps "ignorant" is too loaded a word to use -- how about "uninformed"? I just find something wrong with a secretary perfectly eligible for the nasal vaccine telling me that she is going to wait for the shot when it is available. I told her that we don't know when or how much of the injection vaccine we would receive and that when we did, it would go to those with conditions that make them ineligible for the intranasal form. Her response? "Oh we always manage to get it here anyway." Meanwhile im thinking of a nurse who I had to turn away last week. She works in a PICU overflowing with critical H1N1 cases. She has asthma. And she takes care of her mother who just underwent chemo. She can't find a shot anywhere. Personally, I think all those who can take the flumist but don't want to should sign a waiver and then the hospital should release their 6,000 doses of flumist to the public. Better that it does some good somewhere rather than sit in the fridge.

hey everyone, i'm a recent graduate and got my first job as a prn flu shot nurse. anyone involved with flu shots this year is probably aware of the high public turnout and the issues with low supplies, but has anyone been involved with healthcare worker vaccination? i have and, quite frankly, i'm disgusted! nurses and other educated medical professionals are declining to be vaccinated and most of them really have no good excuse for putting their patients at risk. at a time when people are standing outside clinics before sunrise for the chance to get an h1n1 vaccination, i find myself sitting in a hospital (and more recently taking the vaccine to the actual units) with a large amount of h1n1 flumist and no one will take it! in case you haven’t had a chance to look into it, the flumist is a live attenuated influenza virus (laiv). it is only approved for use in healthy people ages 2 - 49 years. no pregnant women, no asthmatics, no diabetics, and no one who is taking anything that suppresses their immune system. in short: none of the people at highest risk for influenza complications. so why then does a healthy 30 year old mother in a critical care unit or emergency dept. decline? why does the 22 year old perfectly healthy phlebotomist that visits hundreds of patients each day decline? the most common thing i hear from people when i roll my cart onto the unit? "i'll wait for the injectible" that is, except for the > 50 crowd who almost all seem to want the vaccine but can't get the nasal. from them i usually hear "oh i see how it is, over 50 and left to die!" =) i get the fears about it being a live attenuated virus, but i would expect these fears from the general public and not other nurses or healthcare professionals! i have the information from the cdc, i've educated myself on the various clinical studies and results and i share this with the employees and they still insist on waiting for the injectible. what do you all think? should these people even be allowed to have the injectible when they are otherwise good candidates for the much more widely available, but also more restrictive, nasal vaccine? i say, save the injections for those that *really* need it and can't have anything else. not the paranoid and uninformed.

All good questions that I too would like to know the answers to. It is incredibly frustrating trying to learn things when you see 50 different nurses doing it 50 different ways. I've had preceptors tell me I need to stop the saline when doing IV psuh because I don't want it going in too fast, but this makes no sense to me. Wouldn't that just mean your injection would fill the line and just sit there till you restart the saline? Wouldn't that just give them a concentrated amount as soon as you unclamp the line?

That does sound like a huge waste of time, money, and materials! No wonder healthcare costs continue to skyrocket. I don't see why the pharmacy doesn't just mix them up, lebel them, and then stock them. If it is decided it is out of the nurse's scope of practice, thats fine. But it sounds like they either need to re-evaluate their procedure or order some smaller dose vials!

Wow good lord 90 miles? Thats crazy that they would have to spread out so far in Maryland. Northern Virginia schools seems to have sites mainly in fairfax, arlington, and alexadria. Notable exceptions would be the few in Loudin and Prince William counties as well as mary washington hospital in Fredericksburg, but not many. and here I thought having to go 30 miles for my psych clinical was outrageous.

New-grad nurse here with just about no experience and hoping to get by with a paycheck or two administering flu shots this season. I'm was just wondering if anyone has seen an allergic reaction to a flu shot or vaccination after they administered it? If so, how soon after injection did it manifest? What actions had to be taken? I know that, as a child, I was often told to go to the waiting room for 15 minutes or so after I recieved an immunization but in recent years it seems people are just sent hope with a piece of paper. Are life threatening reactions really that rare? or are nurses and clinics just becoming lax about safety. Also, is there any word on weither or not the new H1N1 flu vaccination be any different from flu shots in the past?

While Government service is indeed a very cushy job with plenty of benefits, they too have a minimum 1 yr clinical experience requirement on all of the GS nurse jobs that I have found. Though, you can substitute a Master's degree for experience in most cases strangely enough. "Open nursing positions" and "willing to hire and train new graduates" seem to be two mutually exclusive categories these days

While I went to JMU as a nursing major my freshman year, I can't really help you out since I transfered out as soon as I could. Where do you go currently? I assume there isn't a nursing program there? Or is this a change in Major? The reasons I transfered out were numerous but top on the list was the general "party and drink! who gives a darn about education" atmosphere and the fact that there are no hospitals in the area. I believe JMU nursing students have to drive to UVA's hospital on weekends to get their clinical experience. Personally, unless you live in or near Harrisonburg it might be more cost effective to try for the community college nursing program or another university. The tuition at JMU is not cheap, especially if you live on campus.