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Interesting discussion with a couple nurses

J_Diggs

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I recently had a great conversation with a couple nurses in regards to injection techniques. I think there are some popular myths and misconceptions that are floating around to a great degree and I'll honestly admit to have been a believer of them.

First off, without getting into too much detail, I have a family member with a disease that requires me to administer a weekly intramuscular injection. Before getting started with the protocol, a couple nurses came to our house to talk to us about how to administer, etc. The injections would take place on their thighs only (this is by choice, but could also do shoulder). The needles used can range from 23G-25G and 1"-1.5". We're currently using the 25G, 1" for this protocol.

Here are my observations and I would greatly appreciate if someone IN THE MEDICAL FIELD can reply with how they perceive this to be. Of course I encourage everyone to reply but I'm obviously very interested in what other practices are being educated on these days.

#1) You do not need to aspirate the needle before pushing in the solution. I specifically questioned this and they said the previous school of thought was to do so, but now it is only performed when an IV injection is given.

#2) Having a few bubbles in the solution is no big deal. The preloaded syringes that we use actually come with a rather large air bubble which is supposed to help push the solution through.

#3) The more quickly you insert the needle, the less pain will generally accompany the administration. The slower you go, the worse it is for muscle tissues with an increased probability of irritation.

#4) Administering an IM injection directly on top of the quad is perfectly fine and actually one of their preferred sites. Same rules apply where you take your hand extended from hip and one from knee to find the 'sweet spot'.

#5) Ensure alcohol from swab in completely dry before administering to avoid irritation. I admit that I'm sometimes a bit impatient and either inject without it drying or waive my hand to dry (which the nurses said should also be avoided since you're potentially spreading aerial germs to the site).

Hopefully I remembered everything; if not I'll edit and add. Please let me know your thoughts since I can't tell you the number of times I've read on bodybuilding forums that would state to do otherwise (per the aforementioned). Taking #4 into consideration would be a big win for me since I prefer injections into the quads myself, and adding two more easy to get to sites would just help to reduce overall potential of scar tissue. I've seen diagrams that mention it, but I never hear anyone talking about actually putting it to practice.
 

BigEnough

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My girl is an RN.. She has always told me to aspirate oil based IM injections. The rest sounds right though.
 

Tom

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i have worked with RN's for 22 years. i am amazed that a large percentage of them even made it through nursing school. i would continue to aspirate. some compounds are not designed to be put into a vein.
 

Michael2

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Aspirate and clear out the air in the syringe

BIG D
Registered ICU Nurse
 

mexbeast

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if you don't believe in aspirating, just ask milos saceve [spell] he could tell you what a bad idea it is not to aspirate!!! put some oil into your bloodstream and it could be the last thing you do!. i agree with the rest of your list.
 

iprimate

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#1) You do not need to aspirate the needle before pushing in the solution. I specifically questioned this and they said the previous school of thought was to do so, but now it is only performed when an IV injection is given.
I'm not in the medical field but #1 is illogical. The problem with saying

it is only performed when an IV injection is given
is that you may be giving an IV inadvertantly when you are trying to do an IM. The point of aspirating is to confirm that you are actually doing an IM and not an (inadvertant) IV. You don't want to IV an oil.

#2) Having a few bubbles in the solution is no big deal. The preloaded syringes that we use actually come with a rather large air bubble which is supposed to help push the solution through.
Whether air bubbles are a problem depends on whether you are injecting IM or IV and on the volume of the air. Air bubbles in veins is generally not a good idea.

#3) The more quickly you insert the needle, the less pain will generally accompany the administration. The slower you go, the worse it is for muscle tissues with an increased probability of irritation.
The degree of pain is determined largely by (a) the sharpness of the needle; (b) the gauge of the needle; (c) whether you strike a nerve; and (d) whether the substance you are injecting is itself irritating. Speed doesn't matter.

If you do stab the needle in quickly you have no chance of withdrawing if you hit a nerve. If you go slow you can withdraw the needle when you start feeling the dull toothache-pain that comes when you touch a nerve.

Nursing textbooks (but nurses and doctors never do this in practice) recommend that you draw out of an ampoule with a (purpose designed) blunt needle, then throw it away and insert an injecting needle. In their haste, doctors and nurses use the same needle to draw from an ampoule and inject and almost always hit the bottom of the ampoule with the point of the needle and so blunten it.

Irritation can only be an issue if the substance you are injecting is irritating. Remember, when you inject IM you are creating a depot inside the muscle. The amount of oil on the surface of a needle is negligible compared to the surface area of the depot which will be in contact with the muscle tissue for many days. There will be no irritation from the needle itself since it is sterile stainless steel.

#4) Administering an IM injection directly on top of the quad is perfectly fine and actually one of their preferred sites. Same rules apply where you take your hand extended from hip and one from knee to find the 'sweet spot'.
There are more nerves and veins on the top of the thigh than along the vastus lateralis.

#5) Ensure alcohol from swab in completely dry before administering to avoid irritation. I admit that I'm sometimes a bit impatient and either inject without it drying or waive my hand to dry (which the nurses said should also be avoided since you're potentially spreading aerial germs to the site).
True.

(1), (2) and (3) sound like self-serving rationalisations for just injecting patients as quickly and carelessly as possible and getting the job over with. Doctors are also guilty of this.
 

Michaelthomasj

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My girl is an RN.. She has always told me to aspirate oil based IM injections. The rest sounds right though.
X2 Thats the only problem i see in the list. The air bubble myth is just that. You need a lot of air to cause a problem im or iv. So much that no one should worry about this. A few bubbles will do nothing, and thats the most you could inject...unless your a retard; in that case you should not be fucking with any injectables. My pathology teacher said you would need about 50 cc to cause death. He was the pathologist for, if i remember correcty, Columbia presbyterian hospital. A very well respected pathologist.
 
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npcout

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Aspirate and clear out the air in the syringe

BIG D
Registered ICU Nurse
Agreed 100%.

BSN, RN. Cardiac Procedural Critical Care
 

Anafit

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Not what I thought I was going to see when I clicked on that title. But great information, thanks for posting it.
 

taba

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i have worked with RN's for 22 years. i am amazed that a large percentage of them even made it through nursing school. i would continue to aspirate. some compounds are not designed to be put into a vein.
How true. I talked to an older nurse and she confessed that she wasn't all that smart with just a "C" average as a student. She claimed it was very easy to become an RN back then. Now her niece is having a hard time getting accepted into the nuring program.

Nowadays in order to get in the nursing program you need to have a high GPA. Straight "A's" to be accepted. My oldest son made the program out of the 45 positions offered for the semester at his college. His best friend and roomate didn't make it in because he has a B+ average. Lots of competition these days because it is a practical and stable position to hold.
 

Michaelthomasj

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How true. I talked to an older nurse and she confessed that she wasn't all that smart with just a "C" average as a student. She claimed it was very easy to become an RN back then. Now her niece is having a hard time getting accepted into the nuring program.

Nowadays in order to get in the nursing program you need to have a high GPA. Straight "A's" to be accepted. My oldest son made the program out of the 45 positions offered for the semester at his college. His best friend and roomate didn't make it in because he has a B+ average. Lots of competition these days because it is a practical and stable position to hold.
Absolutely...Its a very tough program, and nurses hold everything together at many facilities.
 

N623

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i have worked with RN's for 22 years. i am amazed that a large percentage of them even made it through nursing school. i would continue to aspirate. some compounds are not designed to be put into a vein.
Bump that up!

ALWAYS ASPIRATE
ALWAYS ASPIRATE
ALWAYS ASPIRATE

:banghead: DON'T EVEN GET ME STARTED WITH NURSES :banghead:

But thanks for posting and looking out for us
 

Skip

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I am sooo glad to see a lot of you pointing out CLEARLY to aspirate. You put some shit in your vein once and you will NEVER not aspirate again, ever. It feels like battery acid and is one the most painful things I have felt in my 40 years. Absolutely not fun.

Skip
 

tenny

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I am sooo glad to see a lot of you pointing out CLEARLY to aspirate. You put some shit in your vein once and you will NEVER not aspirate again, ever. It feels like battery acid and is one the most painful things I have felt in my 40 years. Absolutely not fun.

Skip
the closest ive EVER felt to dying

:(
 

eroc613

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How true. I talked to an older nurse and she confessed that she wasn't all that smart with just a "C" average as a student. She claimed it was very easy to become an RN back then. Now her niece is having a hard time getting accepted into the nuring program.

Nowadays in order to get in the nursing program you need to have a high GPA. Straight "A's" to be accepted. My oldest son made the program out of the 45 positions offered for the semester at his college. His best friend and roomate didn't make it in because he has a B+ average. Lots of competition these days because it is a practical and stable position to hold.
Where I live there a ton of nursing programs, (4 or 5) and it is not as difficult as it is, where ever your located. A "B" average will get you in most schools. There is one Unversity where everyone "thinks" they only take the straight "A" student, and only take about 45 students each term. But really it's based on the interveiw process, in reality they actually take more "C" students than any other school.

My wife is an RN and I'm applying next term, not scared at all about not getting accepted. Would be, if I listened to people that were not as informed.
 

Steve123

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It takes a whole, whopping 1-2 seconds to Aspirate. I just can't see why not to do it.
 

J_Diggs

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Thanks for all the input. Just to clarify, I've never not aspirated, nor was I planning on not aspirating in the future. I questioned them because I didn't think they were right and I didn't want to get in a lengthly discussion/argument with them at the time with my family around.

This just goes to show you that it really doesn't matter who tells you what, you still need to ask questions and research on your own.
 

The Dude

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the closest ive EVER felt to dying

:(
I always aspirate, but there have been a couple times that when I would withdraw a large amount of blood would come out, my heart would race, I'd immediately start to sweat, get dizzy, and start coughing / vomitting.... I really thought I was going to die. Now I do the same spot on each bodypart and use ultrasound to prevent scar tissue.
 

Thunderascherub

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I am a Paramedic, i can tell you that Nurse has helped cause a lot of issues with patients. Always Aspirate!!!!
 

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