lorelei13

I have two full-time jobs; one at a hospital, and one at a private clinic. As I'm struggling with IM injections, the head nurse said she'll have me give more of them until I get more comfortable. :) I typically give injections (IM, IV, SubQ) at the hospital, and only occasionally at the private clinic, where I almost always take blood samples only (still in the learning phase, so...). Recently I've started giving subcutaneous injections too, and those are the easiest. I wish all meds could be administered via that route. Thanks! I'll read the material right now. Hopefully my technique will improve over time.

Sadly, I occasionally hit a blood vessel... It happened to me a few weeks ago, and quite a lot of blood entered the syringe. The patient freaked out when I said I hit a vein... and so did I, to be honest. If I hadn't aspirated, I would have injected the med via the wrong route. The idea is making me very nervous, actually.

Well, I asked one of my "regular" patients whether she felt any pain during or after the injections, and she said her shoulder felt numb for a few hours afterwards. Also, she said the pain was radiating into her arm. She gets Risperidone shots every two weeks. Today I've injected her without aspirating, and she said she only felt a bit of stinging when I inserted the needle, but no numbness after withdrawing it. So I guess I was indeed inflicting unnecessary pain on my patients. Today I've also given a few subcutaneous shots, but those went very smoothly. Interestingly, I'm never afraid of hitting a vein or injecting into one when administering medication via this route. Bottom line? Unless the medication requires aspiration, I won't be doing it again. I've pointed out to my nurse that aspiration is no longer a good practice when giving IM injections anyway. As for hitting a blood vessel, well, as long as the injection site is carefully chosen and the needle and syringe are the right size, this shouldn't worry me. It will take some time to get used to it though.

Today I gave IM injections without aspirating. It's been quite stressful, but the patient said she hasn't felt anything at all, except for a sting when I inserted the needle. Also, she bled less than I expected. Most patients used to bleed quite a lot after withdrawing the needle. One nurse supervised me during the first 2 IMs, and she said I'm doing okay. I guess I'll ditch aspiration after all, though I'll probably check for blood return every once in a while. Thank you all for your support! It's much appreciated.

My nurse says it's okay to inject if those particles enter the syringe. Is it okay indeed or should I withdraw the needle and choose another spot?

Just as I thought. Plus, some patients will naturally be skinnier or more muscular than others, so the proximity of injection spots will be different as well. Thank you all for sharing your opinions! I'm still learning so it's helpful to get input from more experienced nurses.

I will spend some time doing research, but from now on I guess I'll probably aspirate for just 1-2 seconds or so, if at all. I guess that as long as blood doesn't enter the syringe from the very first moment, I shouldn't worry about having hit a blood vessel, so I can confidently inject medication. Btw, what's the recommended distance between two injection spots of the same muscle? I remember it's about 1 inch or so for the glute, but can't recall anything about the delts or vastus lateralis. The deltoids are small so you can't really have spots distanced at 1 inch from each other, unless we're talking about a muscular person, but what about the vastus lateralis?

I haven't dealt with any oily meds thus far, but I've heard they're quite hard to inject because they're denser. Anyway, my favorite site for IM injections is the deltoid muscle, but I usually select the ventrogluteal site if I need to inject more than 2ml of solution or if the solution needs to be absorbed over the course of several hours or even days (meds get absorbed faster in the deltoids). I find the delts easier to work with because the chances of hitting a blood vessel are smaller, and it's a lot more comfortable for me. I never inject in the same spot twice -- I rotate injection sites to avoid soreness and tissue damage. If I were to inject, say, 4 or 5ml of solution at a time, I'd split it into two injections and I'd probably choose either the delts or the glute (one injection/muscle). About the video -- I'd rather not. :)) That's pretty much what older nurses have told me, but I wasn't sure so I wanted to ask for someone else's opinion first. So those were capillary particles? This means I can't inject the med if those enter the syringe, is that right?

No particular medication; it was just a question. But as a side note, one of my patients was ordered daily Rocephin injections for 5 days. The injection sites were as follows: right delt, left delt, right glute (ventrogluteal), left glute (ventrogluteal), and left delt once again. The problem was with the last injection (second one in the left delt). When I aspirated, I noticed some sort of "particles" entering the syringe. My nurse said it was coagulated blood. It didn't look like blood at all (when I hit a vein, bright red blood enters the syringe). However, I've only noticed 1-2 particles and no actual blood. Is this normal? Does it mean I've hit a blood vessel? Or maybe there was still some med left from the previous injection. Can I inject medication anyway if anything like that happens in the future? FYI, I occasionally hit a small vessel so aspiration does help. I remember hitting one in a delt once. I freaked out because I knew the chances of hitting one in the delt are slim to none. I think I'm a bit too scared of hitting a blood vessel. One of my fellows unknowingly injected med into a vein and it resulted in a big, ugly bruise! Curiously, the first time I aspirate nothing enters the syringe except air, but the second or third time I see blood. Is this normal? If I hit a blood vessel and aspirate just once but nothing enters the syringe, I might accidentally inject in the wrong place!

Thanks everyone for sharing your opinions/experiences. In regards to the aspiration, well, my preceptor says I need to aspirate as a safety measure for every IM injection. Most of the older nurses don't; they just inject the medication. I know that injecting into a blood vessel can be harmful to the patient, depending on what's being injected, so I don't want to put their safety at a risk. I'm not confident enough to give an IM injection without aspirating. By the way, what are the risks of injecting in the same spot? For example, if a patient needs regular IM injections in the delts, and the medication is oily, it will dissipate very slowly. So the next time I inject him/her in the delt, the medication I've injected the previous day may still be there if the new spot is very close to the old one. Is this correct? So if I aspirate, the old med might enter the syringe if it hasn't completely absorbed. It's quite confusing for me. My nurse says I should always alternate the delts to avoid this, but I was just curious. Thank you!

Hello everybody, I'm a new nurse and I know I'm supposed to know how to do it already, but... I think I aspirate a bit too violently when checking for blood return (intramuscular injection). My preceptor says aspiration is a must for IM injections, and I'm quite scared at the thought of accidentally injecting medication into a blood vessel, so I always aspirate, even in delts. Whenever I give IM injections, I aspirate 2-3 times, just to make sure. We were taught to aspirate for about 5-10 seconds. Curiously, blood enters the syringe only the second or third time I draw up the plunger... If I was to hit a vein, I'd be in the danger of giving the injection on the wrong route if I aspirated only once. Is this normal? Isn't blood supposed to enter the syringe from the first aspiration? I aspirate quite violently, so can this be the issue? I mean, perhaps my violent aspiration is causing damage to the muscle tissue. Also, sometimes I've noticed some kind of "particles" entering the syringe. My preceptor says it's coagulated blood. Does it mean I've hit a blood vessel as well? Can I inject the medication anyway as long as it's not "regular" blood (bright red and liquid, so to speak)? Sorry for the many questions, but I'd like to hear multiple opinions.