questionable IM injection

[guest974915]

I recently switched specialties from surgery to corrections and recently observed a fellow nurse administer a viscous depot injection (4ml) into the deltoid muscle of a adult, small-built male. This seemed wrong to me but since I graduated from my primary nursing school almost 26 years ago and hadn't given many IMs in the past while working in surgery, I attempted to review current guidelines. However, I became more confused by the conflicting information on the internet (some sources suggest 5mls to be the maximum, some sources 4mls, some 2mls)? At any rate, I don't think the deltoid would have been the preferred site for this particular drug and I personally would have split the volume into two injections or opted for Ventrogluteal, Dorsogluteal, or Vastus Lateralis. What are your thoughts please?

[klone, MSN, RN]

Best practice is not to give more than 1 ml in the deltoid. VG is a much better site for viscous medications, and I would also divide that amount into two injections.

You should avoid dorsogluteal due to the high risk of hitting a nerve or blood vessel.

[guest974915]

Thank you! That confirms by initial inclinations.

[FolksBtrippin, BSN, RN]

What med is it? I administer a lot of IM depot meds in community psych.

I agree with Klone never to use the dorsogluteal, you can easily injure the sciatic nerve. Go for the ventrogluteal instead. In NS I was taught to use the vastus lateralis, but in practice I find there is just too much pain afterward for that. So I don't do it at all anymore for IM depot. It is still my first choice for IM emergency meds as there is a larger area to hit and it is more easily accessible, less traumatic for the patient.

According to manufacturer guidelines you can administer Invega Sustenna which comes in a 1.5mL syringe into the deltoid. So I do. Same for abilify maintena. These are not that viscous though. Haldol dec is very viscous, so I try to give ventrogluteal if I'm giving more than 1 mL. But if my patient insists on the deltoid and has a large deltoid I accommodate rather than have this extremely important med refused by a patient who may tend toward suspicion or just really not want to take their pants down.

I am also often administering meds in uncomfortable and difficult locations, where the deltoid is much more doable than the gluteal, and this is an important consideration.

So I can't say for sure that what happened was wrong. You need to know the med that was administered and the reason why the deltoid was chosen.

[guest974915]

Thank you so much for your excellent points! Haldol Decanoate was the med. My thinking was that 4ccs of decanotate into the deltoid of a cooperative psychiatric patient (when there was not a a lot of muscle mass and other alternative sites were available) seemed like a poor choice at the time.

[FolksBtrippin, BSN, RN]

Thank you so much for your excellent points! Haldol Decanoate was the med. My thinking was that 4ccs of decanotate into the deltoid of a cooperative psychiatric patient (when there was not a a lot of muscle mass and other alternative sites were available) seemed like a poor choice at the time.

I'm surprised that 4 mL was administered. Is this 100mg/mL? Because my understanding is that we max out at 300 mg.

[guest974915]

50Mg/1cc X 4=200Mg total (4ccs). 4ccs of this just seemed like a lot for a deltoid!

[TriciaJ, RN]

50Mg/1cc X 4=200Mg total (4ccs). 4ccs of this just seemed like a lot for a deltoid!

I've never given more than 2 mls into the deltoid, viscous depot or not. If the patient was unwilling to bare his bum I would have divided the shot and used both deltoids.

[FolksBtrippin, BSN, RN]

50Mg/1cc X 4=200Mg total (4ccs). 4ccs of this just seemed like a lot for a deltoid!

I wonder why the 50mg/mL was used. I would ask for 100mg/mL for the future. That's part of the problem right there.

[Rainbow_RN, BSN, RN]

definitely questionable, I would not give more than 2mL of anything into the deltoid. anything viscous I would go with the VL or ventrogluteal for sure. basing this on personal experience as well as work.. I take hormone shots (depo-testosterone) every 2 weeks. it's only 1 mL but the solution is so thick i always use vastus lateralis anyway! couldn't imagine putting viscous anything into my delts so that's just my two cents..

[djh123]

I recently switched specialties from surgery to corrections and recently observed a fellow nurse administer a viscous depot injection (4ml) into the deltoid muscle of a adult, small-built male. This seemed wrong to me but since I graduated from my primary nursing school almost 26 years ago and hadn't given many IMs in the past while working in surgery, I attempted to review current guidelines. However, I became more confused by the conflicting information on the internet (some sources suggest 5mls to be the maximum, some sources 4mls, some 2mls)? At any rate, I don't think the deltoid would have been the preferred site for this particular drug and I personally would have split the volume into two injections or opted for Ventrogluteal, Dorsogluteal, or Vastus Lateralis. What are your thoughts please?

I have no idea what a viscous depot is (unless of course, it's Viscous Depot! - For All Your Viscous Shopping Needs! :^) ... but I did quickly find a website that said all viscous or oily (?) injections should be in the gluteous muscle. 4 mL does sound like a lot into the deltoid to me too.

[FolksBtrippin, BSN, RN]

I have no idea what a viscous depot is (unless of course, it's Viscous Depot! - For All Your Viscous Shopping Needs! :^) ... but I did quickly find a website that said all viscous or oily (?) injections should be in the gluteous muscle. 4 mL does sound like a lot into the deltoid to me too.

Viscous = dense and thick liquid.