Second week leaning injections and I am a little worried/confused/nervous!

[TessaMae]

First let me say that I realize I wrote "leaning" not "learning" in my title but it wont let me fix it!

Ok well my title probably made it seem worse than it is but I do have a dilema. (I put my actual questions in bold and the rest is an explaination) One of my lab instructors is a lovely woman who is doing her teaching internship at our school this year. As I said she is so nice but not the best teacher yet. She speaks very monotone and soft and isn't really good at explaining techniques. I ask a ton of questions to try to understand things better and unlike some of the others in my lab I feel for her and do not make fun of her behind her back or whatever-that could be me one day! Anyway, the past two weeks we have been going over injections, we are going to start giving insulin in two weeks at our clinical site and also do a flu clinic at the end of the month. I understand all of the injection sites but it is the techniques I am having a problem with. We have these little square things that are supposed to resemble a muscle (I assume most schools have something like this) When she demonstrates for example the Z track method, the skin obviously doesn't really pull over on this demo so as she aspirates with the same hand she is holding the syringe the needle is wiggling all over the place. When we practice on our demo the same thing happens. First off, when I aspirate there is alot of resistance on the plunger so aspirating is kind of difficult with one finger while holding the syringe - is this just the demo we are using or will there be the resistance in a real patient? So then I ask how to minimize pain, when I have gotten injections throughout my life some nurses are really good at their technique and it can be a pleasant experience and how when I and the others are aspirating the needle is wiggling all over the place which would cause discomfort in a "real" muscle. Well she say to me, "you need to tell them it is going to hurt, of course it will hurt" and went on about techniques to distract people that are nervous. She never really answered my question, I know it is going to hurt, but the way she is showing us seems like it would cause extreme pain. So my next question is, When aspirating on real people is their resistance when pulling on the syringe? Can enyone offer suggestion on how to minimize movement of the syringe especially when doing the Z track method? Is there any websites that have good video demontrations? I know that practice makes perfect and I do plan on going to open lab next week to get more practice with the head lab instructor. I feel stuck because in our lab there are 20 people each week we split into three groups one group is run by the head lab instructor, one group is head by one of the clinical instructors and one group gets the student teacher. I have had lab with the other two women and learned so much, when the other students that got put with the student teacher those weeks were gossiping about how awful it was I kind of thought they were just being mean but now I agree unfortunately. The level of learning is just not the same and she is just not good at teaching yet. She is an older woman, nice and needs to learn, I just hate being the guinea pig. So any advice on what to do? I don't think complaining to one of the other professors is the right thing to do in my second month of nursing school, plus if she found out I certainly wouldn't want to have an even harder time in lab because I do want to learn of course! Ah what to do I guess this e-mail is part questions and part rant, sorry about that but I appreciate any feedback/help you can give. :wink2:

[AOx1]

It is much easier on a real patient. It is easier to aspirate also. You will want to move the pt's skin to the side an inch to an inch and a half, inject quickly, aspirate, wait, then remove needle and release skin. You are trying to "seal" the meds in the muscle.

As far as reducing pain, I have found it helps to be very quick. For an IM, use your wrist to quickly inject, almost like you would throw a dart. As far as reducing pain, I apply firm pressure right over the area I will inject into using my gloved hand pressing onto an alcohol pad. The pacinian corpuscles are deep in the sub-q tissue, and applying really firm pressure immediately prior to an injection can "confuse" them- making it hard to differentiate pain from pressure. I then z-track, quickly inject, aspirate, and let go of skin while withdrawing the needle. There is also some evidence that chilling a needle prior to injections reduces pain, but I have only seen this done in practice once.

See if there is any way you can practice with your peers. This should help your confidence a lot.

This is a youtube link, although she does not mention that the dorsogluteal is no longer a recommended site, and does not use Z-track, you can at least see the injection technique she uses.

This clip shows Z-track on an injection pad, but again, she doesn't mention that dorsogluteal site is no longer preferred.

[TessaMae]

It is much easier on a real patient. It is easier to aspirate also. You will want to move the pt's skin to the side an inch to an inch and a half, inject quickly, aspirate, wait, then remove needle and release skin. You are trying to "seal" the meds in the muscle.

As far as reducing pain, I have found it helps to be very quick. For an IM, use your wrist to quickly inject, almost like you would throw a dart. As far as reducing pain, I apply firm pressure right over the area I will inject into using my gloved hand pressing onto an alcohol pad. The pacinian corpuscles are deep in the sub-q tissue, and applying really firm pressure immediately prior to an injection can "confuse" them- making it hard to differentiate pain from pressure. I then z-track, quickly inject, aspirate, and let go of skin while withdrawing the needle. There is also some evidence that chilling a needle prior to injections reduces pain, but I have only seen this done in practice once.

See if there is any way you can practice with your peers. This should help your confidence a lot.

This is a youtube link, although she does not mention that the dorsogluteal is no longer a recommended site, and does not use Z-track, you can at least see the injection technique she uses.

This clip shows Z-track on an injection pad, but again, she doesn't mention that dorsogluteal site is no longer preferred.

Thanks for the video clips. How aspiration was demonstrated made alot more sense than how our instructor was showing us. She was putting the palmar side of her hand flat onto the skin and pulling it over which did not allow you to use the fingers of that hand to stabalize the syringe. She had us use the same hand that we made the injection and try to pull up with our thumb while stabalizing the needle. The position was awkward and the resistance also made it hard to aspirate with that one finger and stabalize the syringe. As far as practicing with our peers, our school does not allow us to do that.

[Daytonite, BSN, RN]

first off, when i aspirate there is a lot of resistance on the plunger so aspirating is kind of difficult with one finger while holding the syringe - is this just the demo we are using or will there be the resistance in a real patient? when aspirating on real people is their resistance when pulling on the syringe?

i have been giving shots for years. once the needle has penetrated the skin and has gone as deeply as you want it to go, rest the palm of one hand on the patient and hold the base of the syringe between your thumb and/or another finger (the index and/or third finger will do) to stabilize it. now, with the fingers of your other hand you can pull up on the plunger while the other hand is holding the syringe stable. yes, there will be resistance in a real patient because you are pulling against a vacuum. you only need to pull back a few millimeters, maybe 5 ml. if blood is going to enter (it has happened to me 3 times over the years), it will happen very quickly.

always throw the syringe a bit like a dart so the needle goes into the skin rapidly. rapid needle introduction through the skin results in less pain to the patient.

can anyone offer suggestion on how to minimize movement of the syringe especially when doing the z track method?

when doing z-track technique, you will need a way to pull the skin and maintain that pull. that's where resting the palm of one hand on the patient is going to work very well for you and maintain some downward pressure to keep the tissues pulled. you will inject the needle with the other hand, stabilize the syringe with the fingers of the palm that is holding the tissues back for the z-track, and aspirating the plunger with the hand that did the injecting.

is there any websites that have good video demonstrations?

not a video, but:

https://allnurses.com/forums/1547609-post10.html

videos

(i did not view them):

http://www.brooksidepress.org/products/administer_im_sq_and_id_injections/videos.htm

[truern]

When learning to give injections I practiced on myself. Believe you me, you'll learn the not so painful technique pretty fast!

Also, because I'm diabetic and give myself insulin several times daily, I don't use a fast darting motion because the needle is so fine and short that it's less painful to just "press" it in (for want of a better word). Remember, though, that's just insulin injections.

[TessaMae]

When learning to give injections I practiced on myself. Believe you me, you'll learn the not so painful technique pretty fast!

Also, because I'm diabetic and give myself insulin several times daily, I don't use a fast darting motion because the needle is so fine and short that it's less painful to just "press" it in (for want of a better word). Remember, though, that's just insulin injections.

I am not so sure how I feel about injecting myself...hmmm What do you practice with saline? Plus they only give us a handful of sterile needles, do you sterilize your own or something?

[Daytonite, BSN, RN]

I just got my flu shot the other day in the doctor's office and his MA injected that sucker in so fast I didn't even feel it! I give my cat insulin twice a day and I inject it fast also or I notice her flinching with discomfort.

[truern]

I am not so sure how I feel about injecting myself...hmmm What do you practice with saline? Plus they only give us a handful of sterile needles, do you sterilize your own or something?

We had vials of sterile saline and packaged sterile syringes w/needles. I asked for some extras and my lab instructor gave them to me.

I've only been insulin dependent since my breast ca diagnosis in March of this year. Now I "practice" on myself all the time....not nearly as much fun as it once was. LOL

Daytonite, maybe the difference is I have more adipose tissue than your cat. (I refuse to call myself "fat"...):wink2:

[Daytonite, BSN, RN]

i find that some of those insulin needles get dull. i think that pushing them through the rubber stopper of the insulin vial may dull them. then again, after many, many injections of insulin and being poked, the skin does toughen up. we had a lady in one nursing home where i worked years ago who was addicted to demerol. she got demerol q3h round the clock for years and no one knew how long that had been going on. shots always went in the gluts. giving her a shot was like stabbing a compacted bale of straw. you could feel the needle just tearing through the hardened tissue every time you gave her a shot. you literally had to push the needles in. you had to hold the plunger down for a few minutes before withdrawing it also or demerol would ooze out of the injection site when you withdrew the syringe. the last thing you needed was lost demerol because this patient would be at the nurse's station begging for her next shot after 2-2 1/2 hours.