Jump to content
What’s your favorite allnurses.com feature? Read more... ×

questionable IM injection

Nurses   (2,561 Views 20 Comments)
72 Likes; 4,395 Visitors; 112 Posts
If you find this topic helpful leave a comment.
advertisement

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?

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Edited by FolksBtrippin

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
advertisement
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.

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites

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..

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
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.

Share this post


Link to post
Share on other sites
×