I was taught to put .10cc of air in the syringe for an IM injection. When did this stop being appropriate, or was it ever? I feel embarassed, the nurses I worked with had never heard of this practice. I checked my manual from my most recent schooling and it says not to add air to the syringe because it may cause an overdose of medication, which doesn't make sence either.  If you draw up the correct amount and then add the air there wouldn't wouldn't be any more medication in the syringe ( air or not). Help me out, I know I was taught this practice. I'll quit if it's negative, one nurse said "Oh my God you'll give the pt an air emboli"  OMG!

I laughed at the air emboli. I was taught this in LPN training in MT in 1980, so it has been a while. You know I wouldn't have just started doing this on my own, because I thought it would be a good idea. I think it's a bit like the concept of Lovenox and the nitrogen in the syringe that we aren't suppose to expel. I was told the .10cc of air blocks the medication in the tissue instead of letting it ooze out.  Thank shan, guess I'll give up this practice.

Well the instructors that taught me this was in 1980. I just asked my husband that just completed the first semester of the nursing program I just graduated from. He said they weren't taught to do this. I went into this program in third semester as an LPN, so we skipped the basics...medication admin. I just think it's interesting that the current that my medcation admin would mention putting air in the syringe. Maybe it is no longer proper, I wouldn't think it would have even been mentioned if it wasn't done in the past.

It said

Action: don't add any air to the syringe

Rationale:  The addition of air to the syringe is potentially dangerous and may result in an overdose of medication

?????????

Really? Nobody has been taught this? OMG!! I've been doing this for almost three decades. Anybody ever heard of this?? Anybody?? The research I've been doing shows they think it should be done because of the obesity problem. The article state the air will get the med to the muscle, the article said most of the injections aren't making it to the muscle because there is so much sub Q tissue. Come on help me out here, let me know which way I should go.

I graduated 3 years ago and have never heard of this. It is done with Lovenox, and this is to keep the medication from oozing back out, but it is also a SQ injection. As far as an air emboli, it would take alot more air than that, and this is an IM and hopefully if you are checking to make sure you aren't in a vein or artery by pulling back  you wouldn't be injectining into a vein or artery anyway.

Air embolus in a muscle?  I must be crazy too.  I learned to draw up the med and then a little bubble "LITTLE" for an IM  The bubble helps to expel all the med that is left in the needle, as long as you pull back to make sure your not in a vein, to me, this seems like the most effiecient way to make sure that the whole dose is delivered and a tiny bubble in a muscle?.    True though that some of the newer syringes have already taken this into account.  Your Facility Educator should be familiar witht the type of syringes used in your facility, and I wouldn't feel awkward saying that this is what you learned.  He/She gets these questions all the time.  When in doubt, or if you don't have an Educator, I'd go with the most recent Lippincott.  I was told once, by the CNO, that all of that facility's policies, were based on the Lippincott.

Just looked in my text from school 15 years ago and it talked about bubbles and Z-Tracking.  Now I wonder if this only has to be done with Z-tracking?  This will be my mission for the day.  I do always Z-track an IM.

smoxignal: No, at least from my training, you do not add in the "dose" in the needle and you should change the needle prior to administering the med because there are microscopic burrs made on the needle from withdrawing from the stopper. (WOW, I think that was a run on sentence. I was out of breath just writing it!). We have retractable syringe/needle combos and you cannot change the needle after drawing up the med, so basically they hurt like hell to have an IM injection!

As for the Z-track/air bubble thing, the only thing I was ever taught to do a Z-track with was Fe injections (I think). It's been awhile!!

You sharpen your own needles??? I don't sharpen mine, but I do lick them to keep them clean!! LOL

LOL!   Let me get my book!  Be careful when licking the needles.  Rationale:  One might injure their tongue!

Now see, we just save the rusted, square needles for the difficult patients!

We were taught we could use the Z track for pts with less muscle mass to prevent pain along with certain meds that are irritating to the muscle.  Never heard of the adding air to the syringe.

I just graduated 2 years ago--we were taught to use Z-track for IM injections which might stain the skin or might cause irritation if they leaked, but you don't normally have to do so.  I know that they mentioned something about an air bubble too, for the same reason (to keep medication from leaking out).. but don't remember the exact circumstances under which we were supposed to do it.  I know that for any injections I've done so far, you're *not* supposed to put air bubbles in those.  I think it may have only been to not get rid of the air bubble in prefilled Lovenox syringes.

trauma2009 says ...

I just had med admin. in the spring in the RN program and we were not taught to put any air in for any injections. We were taught of course that you need to inject air into the bottle you are drawing from but no air in the syringe. Also we were taught the Z track method for all IM injections.

About ten years ago, there was a going trend of not injecting air into vials.  Why you ask?  Because room air, unless you're in a vacuum is contaminated and you therefore contaminate your solutions.  Has anyone else heard of this?

LOL! Can we retitle this topic "if you are a student, DO NOT READ!"???

squirmals says ...

Wow, I haven't heard this one. I still inject the air into the bottle as taught many years ago, infact I think that was still in the procedure book.  I think it'll be hard to stop with the air bubble in the syringe, I'll try.

On a whole different subject, I was recently told that you don't insert the rectal suppositorys pointed side in, this student said the instructor states the pointed side aiming out to stimulate the rectal muscle. ?? They were told the flat end goes in first, never heard this before and it doesn't make any sense to me. The pointed end in first would be less trauma, and easy in.  Any thoughts?

I had an MD tell me this.....a GI doc.....One way to look at it is they cant see which direction its pointed unless your patient is a 2 headed contortionist.