Vaccination administration question - Help

[Irishlass79]

Hello, I am a new graduate nurse and I wanted information about the method of administration of the Tetorifice booster to an adult patient. I witnessed a patient get a booster and am confused because the staff RN gave the booster in the deltoid with a subcutaneous needle and pinched the skin when giving it. I thought the Tetorifice booster is an IM injection (not pinched but in the muscle) with a 22-25 gauge needle that is 1-1.5 in needle length? Will someone inform me as to the reason the nurse did this? Does the needle length not matter with the booster? Does the patient get protection from this administration? What are the benefits to this choice of needle length.

All you experienced nurses thank you very much!

[lrobinson5]

That sounds incredibly painful. Tetorifice is a really irritating injection to get. I've never heard of this being done, it has always been IM

[tachybradyRN]

was the patient cacechtic? i personally have never done this, but i have heard of nurses using SQ needles to give vaccines to very very thin patients with extremely low muscle mass. i do not know if this is considered best practice, but it's the only motivation i could think of.

[lckrn2pa]

Patients don't always read the books so you have to modify your treatment accordingly. As you progress in your career you will be able to judge what needle to use in whatever situation. Did the RN give it at an angle consistent with IM or SubQ? You can use smaller needles to give IM injections in the delt on thin patients though, nothing wrong with it. Eventually you will develop your own way just like we all have and it never hurts to ask the person after the fact. Something to the effect of "hey, how do you judge which needle to use when giving IM meds like the TD we just gave?" Forming it into a question looking for advice will put the nurse in the mode to give as opposed to a question like "hey, TD is always given with a 22-25g, 1-1 1/2in needle and given IM, why did you do it your way?" This will put them on the defensive and likely not get anywhere.

[tewdles, RN]

Your co-worker would benefit from an in-service on vaccine administration.

[CrunchRN, ADN, RN]

Your co-worker would benefit from an in-service on vaccine administration.

That is what I was thinking. IM is IM. Just use a short needle but pull the skin taut. And if the arm is to scrawny think about using the thigh.

Another thought - read the drug sheet that comes with the vaccine - maybe it is one that can be given SQ or IM. That would be soemthing to check. If it is only to be given IM then that technique was not good.

[CodyRN]

I thought SQ needles were 24g so that falls in between your 22-25g range. You can choose whatever length of needle you think is appropriate for a person's muscle mass, some people have smaller muscle and a longer needle will hit the bone. Also, for some people with small amounts of muscle, I am aware that some nurses will try to bunch up the muscle to give the needle somewhere to go, it may appear similar to pinching but it is quite a different "pinch" than you would expect with SQ where you are really trying to keep it in the fatty tissue away from the muscle. For IM, the idea is to get the vaccine in the muscle and sometimes you have to modify your technique based on patient's needs.

[caryrey02]

I thought SQ needles were 24g so that falls in between your 22-25g range. You can choose whatever length of needle you think is appropriate for a person's muscle mass, some people have smaller muscle and a longer needle will hit the bone. Also, for some people with small amounts of muscle, I am aware that some nurses will try to bunch up the muscle to give the needle somewhere to go, it may appear similar to pinching but it is quite a different "pinch" than you would expect with SQ where you are really trying to keep it in the fatty tissue away from the muscle. For IM, the idea is to get the vaccine in the muscle and sometimes you have to modify your technique based on patient's needs.

I agree with this poster...not everything is black and white. Sometimes, given the special situation you have to adjust the way things are done to make sure you inject the medication into the muscle.