NursingLink

This information should be in your basic nursing text.  Kozier and Erb, Potter and Perry, pretty much every text should have it.

For the deltoid I would use a 1" needle, 21-23g, and inject no more than 0.5 ml.  I prefer a 22g for all IM injections when available.  I only use the deltoid for vaccinations

For ventro-gluteal, I would use a 1 1/2" needle, 21-23g (22g preferred), and inject no more than 3ml.

I do not care for the vastus lateralus site in adults unless absolutely necessary--too easy to hit nerves and arteries.  But if I were to use the VL site, I would use a 1"- 1 1/2" depending on how big the patient is.  I would not inject more than 1.5 ml.  The VL is preferred over ventro gluteal in children not yet of walking age.  For neonates I use a 27g 1/4" needle or a 25g 5/8ths.

I also do not care for the dorso-gluteal site.  It is far too easy to miss the mark and hit the sciatic nerve; you can do permanent nerve damage if you do hit it.  I've read some sources that say you can inject as much as 5 ml, but I think that is too dangerous.  3ml should be the max.

You do not want to use a gauge size that is too large:  makes the stick too painful.  You do not want to use a gauge size that is too small:  the small pipe requires more force to do the injection, causing more pain, and also increases the risk of the needle breaking in the muscle.  So I would not use anything larger than 21g or smaller than 23g for any IM site.  If the needle is too long, you risk it breaking off.  If the needle is too short, you won't get into the deepest part of the muscle for best absorption; worse you might put the medication into subq tissues.  Some medications like Demerol are very irritating to sub q tissues.  Others, like Vitamin B shots can leave a permanent stain.

Of course, if drawing up from an ampule you should use a filter needle.  If drawing up from a vial, I always use a large gauge needle (18 g when available) because it makes it easier.  Then I change to the size I'm actually going to use for the injection.  Every time you poke a needle through the self sealing stopper you dull the needle.  Since sharp needles hurt less than dull needles, I always change needles before administering the injection.

You also want to make sure you are using the right size syringe for what you are doing.  Most injections will require a 3 ml syringe.  If you use a syringe that is too large, you may have difficulty drawing up the dose accurately.

NEVER, EVER, EVER use an insulin syringe to draw up anything but insulin!  Insulin syringes are not calibrated to draw up anything else accurately.  If you need to give a volume less than 1 ml, you MUST use a tuberculin syringe.

Wow, great post theala. Thanks!

I think that is good to know!

You were probably expected to use a 1-1/2" needle. Also I would choose a 20 gauge as pain at the injection site with gent is common as a side effect. The increased pressure needed to inject through a smaller bore needle would only increase this discomfort. Theala is probably a better source of info. I would defer to her if she disagreed on this. But I would choose the larger bore and a little more pain on injection over the increase of deep pain from the combination of the gent and high pressures from smaller bores.

But I used to start 16 gauge IVs on almost every patient on the surgery floor in my first job as a RN. I had been an EMT and an ER tech at an institution where techs were trained to also do IVs. This was a Level I trauma center before such levels were established (Bernalillo County Medical center (now UNM Hospital)) in Albuquerque. We simply started large bore IVs in anticipation of administering blood products and/or rapid infusion of large amounts of IV fluids.

I stopped that practice after an experienced RN taking report from me one night asked why I did this routinely. She informed me that very few of our patients at this little rural hospital would likely need such large IVs and it was not comfortable for the patients. Oh well better to err on the side of caution.

I was reading your post Theala and thought it was a good one. It covered everything. As I was reading it though, I realized that there is so much information in there that we must know and I think back to when I was learning it how overwhelmed I felt. Now as an ER nurse for 8 years it is just floating around in my brain waiting for me to use it. Looking back it is amazing that sometime in the last 8 years I went from thinking about it to just knowing it when I needed to.

To all the students out there who seem to be overwhelmed, just remember, we were all there at one time or another. Keep studying and you will make it.

NEVER, EVER, EVER use an insulin syringe to draw up anything but insulin!  Insulin syringes are not calibrated to draw up anything else accurately.  If you need to give a volume less than 1 ml, you MUST use a tuberculin syringe.

I have never heard this. A Mililiter is a mililiter.. and one would assume that an INSULIN syringe is callibrated to and even more exact standard than a tuberculin syringe considering the accuracy needed in dosing insulin. All syringes in the US are now only calibrated for U 100... Years ago when there were different concentrations of insulin.. ie U-80 etc.. the statment you made may have held true.. but it is simply not the case today.

the graduations on an Insulin are calibrated in milliters and decimals of mililiters... it may be marked 100 BUT each mark on the barrel is 0.1 ml that corresponds to 10 units of insulin. They are interchangable.

http://www.google.com/imgres?imgurl=http://syringes.cn/img/insulin-syringes.jpg&imgrefurl=http://syringes.cn/resources.html&h=300&w=460&sz=12&tbnid=RHDkZHnOC7jTYM:&tbnh=83&tbnw=128&prev=/images%3Fq%3Dinsulin%2Bsyringe&usg=__yUvUSvtaMPwJqBSDGT8gfbU8pMY=&ei=sJTbSpnrMY3IMdqD1d4H&sa=X&oi=image_result&resnum=2&ct=image&ved=0CBkQ9QEwAQ

check it out.

Usually the difference is a 27ga needle on a tubuclin syringe vs 29 ga needle on an insulin syringe.

I try not to post unless I am sure I am right.

Our hospital policy (that was written by pharmacy) actually allows us to use insulin syringes for other things.  It is also written to allow TB syringes to be used to add insulin to first bag of an IV insulin drip. (this has to do with  our insulin syringes being one piece, and the other  (tb syringe) allows for different size needles as well as for needleless use).  The policy states that since all of our hospital insulin is U-100; that in these cases the syringes are equal in these regards.  Only if the insulin syringes are U-100 do they become interchangable.

Why in god's name does there need to be a written policy?

See Theala's post, where at the bottom she said to 'never use an insulin syringe'.  Many students have recieved this instruction and so hospitals are writing policies that 'yes, it's OK to use an insulin syringe for things other than insulin'.  You are right in this case they are equal.

Critical thinking skills are not taught in nursing school, nursing instructors by and large do not encourage it at all........ anyone should be able to figure out there is no reason they cannot be interchanged... and should have questioned any instructor that taught otherwise..... Your 50 unit syringe is still calibrated to U100... just move the decimal to the left two places in your mind et viola' mililiters.

There are certain meds, particularly psych meds, that can be thick and need to be drawn up and then given with a large gauge needle or they won't go into the patient. Also without getting caught in numbers, consider the size and muscle mass of the patient. If the patient is cachetic, advocate for no needles, or you may need to use a smaller length needle to get to muscle, and in a large person may need a longer needle. So in all this talk about numbers, don't lose your common sense.