Trouble giving IM injections :(

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I never got a chance to give IM's during school, just watch and do them on a dummy in class. I have tried a couple times now that I just started nursing, but every time I draw up blood. I'm very careful to pinpoint the ventrogluteal site, since I was told it's preferred instead of the dorsal gluteal, to prevent hitting the sciatic nerve or blood vessels. But the few times I've tried, some blood came out and I had to draw up a whole new syringe of med. The nurse watching me didn't let me do it again. I just don't know why I keep hitting a vessel.

Is it always necessary to draw up a whole new syringe when a bit of blood is drawn and exactly where should I be trying to prick to avoid getting blood?

Also, if someone is very overweight where it's hard to make out the hip bones or waist, how do we know where the Ventrogluteal area starts? I feel so hopeless.

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I know they tell you not to use the dorsal gluteal muscle however I favor the right dorsal gluteal muscle??? If it is a small dose less than or equal to 1 ml i will give it in the deltoid??? Ask the nurse you are training with for some suggestions. If she doesn't help go to a nurse you trust and explain to her your problem. If none of these people help you go to the charge nurse, your educational person and so forth. I don't know why you are drawing back blood except that your aim is off. Good luck.

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I know they tell you not to use the dorsal gluteal muscle however I favor the right dorsal gluteal muscle??? If it is a small dose less than or equal to 1 ml i will give it in the deltoid??? Ask the nurse you are training with for some suggestions. If she doesn't help go to a nurse you trust and explain to her your problem. If none of these people help you go to the charge nurse, your educational person and so forth. I don't know why you are drawing back blood except that your aim is off. Good luck.

Thanks for your advice. But what exactly happens if the med happens to be injected with blood? I was under the impression there are no major arteries in the ventrogluteal area, and I thought the blood was probably just small veins. If there is any blood in the syringe does it always mean a major vessel is punctured, and would the med be absorbed too quickly?

The dose is more than 1ml so I was told not to inject in the deltoid.

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Specializes in High Risk In Patient OB/GYN.
Thanks for your advice. But what exactly happens if the med happens to be injected with blood? I was under the impression there are no major arteries in the ventrogluteal area, and I thought the blood was probably just small veins. If there is any blood in the syringe does it always mean a major vessel is punctured, and would the med be absorbed too quickly?

To answer your questions as best I can-even if it is a small vein and you inject the med into it, it's the same thing as giving the med IV Push, so yes, it would be absorbed quicker and differently than if truly given IM. So if there's blood, you have to redo.

As for aiming? I've honestly only hit a vein once, and I don't aim anywhere specific. Most people I know have only hit the veins a few times...I've never heard of someone doing it frequently. I always thought it was just luck, and not really related to aim, depth, angle, etc....

Maybe someone else can help you with that?

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

Also if you re-inject blood into a muscle that can be very irritating and increase chance of introducing infection since you would be enterying the skin twice with the same needle/syringe.

Swtooth

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you could also be hitting capilliaries.

but either way, the med has to be redrawn (w/new needle) in the event it is a vein you hit.

im is not same rte as iv.

you're sure of your landmarks?

leslie

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you could also be hitting capilliaries.

but either way, the med has to be redrawn (w/new needle) in the event it is a vein you hit.

im is not same rte as iv.

you're sure of your landmarks?

leslie

Yes, I'm being very careful landmarking, taking my time, but isn't there capillaries in most areas? I wish I had practiced this in clinicals, but we never had the chance to do so. I just don't see how I'm supposed to look for a specific spot where there won't be any chance of capillaries, esp. if the body surface area is large, as in many overweight people that I've been assigned. But even in thinner pts, I landmark carefully and even try to 'look' and see if there are any visible veins, but of course capillaries close to muscle may not be visible. I'm just wondering if it's just a bit of blood from capillaries and not actually a vein.

I'm just so frustrated, and never think I will get it right.

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Is it fear related? Are you hesitating or just darting it in? Had one student that I took over/redrew/gave then took her in the med room & did a little teaching. She was hesitant, which hurts & is more likely to cause pain/bleeding than just darting it in there & getting it done. After talking to her & calming her nerves she did just fine the next time.

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Specializes in DOU.

Since the topic is IM injections, can someone tell me if it is usually more difficult to aspirate with a pre-filled syringe? I've only given one IM injection, and I was really surprised to see how hard it was to pull back compared to what we have done in class...

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Specializes in Community Health, Med-Surg, Home Health.

I say to pay strong attention to your landmarks. What I do is use the alcohol pad to place my landmarks (sort of helps with visualization for me), and then, go upper and outer. Works everytime for me. I paid special attention when I had to inject Bicillin. It is an exceptionally large bore needle that can really hurt someone. One of the RNs showed me that little trick, and since then, I didn't have a problem. Good luck.

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Specializes in PICU.
I say to pay strong attention to your landmarks. What I do is use the alcohol pad to place my landmarks (sort of helps with visualization for me), and then, go upper and outer. Works everytime for me. I paid special attention when I had to inject Bicillin. It is an exceptionally large bore needle that can really hurt someone. One of the RNs showed me that little trick, and since then, I didn't have a problem. Good luck.

Could you explain the little trick?

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First of all, whoever told you that you could possibly hit the sciatic nerve is full of it. The only way you could hit the sciatic nerve is with a 7in needle and a ton of force. Whoever told you that needs to take an anatomy class, or even better, go to a cadavier lab and perform a few autopsies. Site depends on medication. Dont assume anything, if you are unsure look it up. You can always find drug information on the manufacturers site. Use your phone if you dont want people to know your looking stuff up, we all do it, nobody knows everything! Some meds must go in specific sites, for example: Testosterone. People give it in a bunch of sites. But it is only supposed to go in 1, the dorsal gluteal! The reason is, the med has to last for upwards of 1 month, if you put it in a active muscle it will be push into the blood and metabolized too fast. Sometimes the blood is gonna happen, depending on a ton of variables, injections take practice. Just remember to go fast! The main sensory nerves are all surface, so get through the skin quick, just dart in and your PTs will appreciate it. Have the PT unload the muscle by standing on the opposite leg only, that should help with the blood. If they are standing on the leg, its engorged with blood, and some is bound to push out.

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