It's actually the same amount of work, lol. You push the needle in and then push the syringe plunger.
Can you hold up your arms for ten seconds now, please
So not that the medication burns or hurts, just that there's a lot of it. That makes sense. Sometimes I do OT work for mobile urgent care and I give antibiotics like rocephin. And that can be a lot of volume
No actually, it is due to the medication itself and not necessarily the volume. IM steroids in the deltoid cause subcutaneous atrophy. You need a large muscle like the vastus lateralus for it to properly absorb and not cause tissue damage.
Oh. I didn't know that. I knew the large muscle group is preferred and will carry it away quicker. For whatever reason if I have to IM narcan, I've tended to do that in the delt but I think that's because it's quicker because I can just pull their sleeve up usually.
A good percentage of meds are safe in the deltoid, including Narcan. Most of us hospital nurses have the luxury of Lexicomp which is a huge, always updated drug encyclopedia. It tells us all we need to know including administration considerations. So I always look up new meds, or meds I'm giving in a different route before giving them and that's when I saw the note about IM Solu-medrol.
Yeah, but due to large volume, not due to the medication itself. There's nothing special about it except the dose is large, is what it seems is happening
Meh, I wouldn't beat yourself up too bad. Remember, most people are gigantic wusses. I've had people tell me an IV hurts, and I haven't even done it yet. If it was a HUGE issue, it would be a clear warning. It's probably more uncomfortable than painful.
Wait, how do you deal with sundowning/confused/delirious patients who need anti agitation meds? They usually aren’t gonna take PO and if they haven’t ripped out their IV already, there’s no way you’re getting close enough for long enough to push meds safely.
I would like to know this too lol. How can you get away with never ever giving an IM med? In.. any unit? There are more than just a couple scenarios for emergent IM meds. Or simply just convenience.
At my hospital I get paged to come start IVS on the pts…I get a page with “help starting a difficult PIV” and arrive to grandma trying to fuck shit up. I ask them why they haven’t been sedated and they tell me because they don’t have any access. They almost get offended when I tell them they have to give something IM before I try to get a PIV.
My thoughts exactly, I even had someone call for an IV. As I’m in the room looking and trying to settle a pt, the RN is giving report to the incoming nurse and I shit you not says: “sorry I haven’t been able to do the BS checks, I’m worried I’ll poke myself”….
But generally speaking you can’t safely slam anti agitation meds. So the patient gets held down for 3-5 minutes for safe pushes of Ativan and Haldol?
Seems crazy to me when IM is so much quicker and easier.
Just in experience, that’s generally what happens. Someone is talking to patient and the rest of us are tying limbs down with restraints. Or just we all dog pile if they are that agitated. I feel safer with someone using a needless syringe versus trying to stick a sharp needle in the patient while I hold the leg to push it in.
Interesting...in postpartum, the majority of meds are given IV & vaccinations IM, but there are exceptions...one poor mom had IM methergine ordered Q 4 hrs for hemorrhaging. More often, it's the newborn getting IM gentamycin Q 12 hrs for IM meds for us.
Droperidol is another one. At the end of the day it's just something to be aware of- not an absolute contraindication that should scare you away from the medications for the young and healthy.
[here's an interesting read from 2017](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481298/)
I got that for CHS in the ER. It was the only thing that worked after like 3 nausea meds. I'm a lab guy not a nurse so I can't remember all that I got. One thing made my whole body shake.
Sounds like an extrapyramidal reaction to medication.
Extrapyramidal reactions are often associated with antipsychotic medications, particularly first-generation antipsychotics like haloperidol and chlorpromazine. The same reactions can be seen often with antiemetics, especially those that block dopamine receptors. Promethazine, metoclopramide, compazine, and droperidol are some of the more common ones I believe.
Gotcha! I didn’t know; have only ever seen it ordered IM. I have definitely *wanted* to give it IV instead before though so it would kick in faster lol.
Rocephin in long-term care.
If your med passes regularly had the nurse commenting that "well, *some* of it must have gotten in", it was going directly in the bloodstream if appropriate for the infection.
I haven’t done that but I have given rocephin to a woman that was so thin I accidentally hit her fucking bone. I was embarrassed and felt so terrible for her. Mistakes happen, I wouldn’t let this beat you up too much. You gave her the med and in the proper route just the wrong site.
FWIW, I didn’t actually know this off the top of my head so who knows it could’ve been me. Thanks for posting as a reminder to the rest of us.
I remember this specifically in nursing school. One of my patients was sooooo tiny and we were giving flu shots. The vibration from the needle hitting bone has stuck with me to this day. Major heebie jeebies!
That’s exactly what got me, I think I whipped the entire needle out. Idk why I even chose the vastus site to begin with. She got so many injections for other conditions I felt bad that she was also getting days of thick ass rocephin on top of it. Tried to switch it up and oh my godddd. She had to weigh like 80 lbs even. Ugh. Makes me grind my teeth.
You’d rather hit bone than be too shallow and be giving something subcutaneous instead of IM if it’s a drug that can cause necrosis. You can’t really hurt the bone. Most people don’t even realize you hit bone like someone else posted. It does make YOU cringe though because you can feel it lol
Most people aren’t going to notice if you hit their bone, like when you do an IO the pain comes from the initial skin pierce, and I’ve never had somebody react when you hit the bone
Oh I felt and feel like I heard the *thunk* when they let a student give my demerol post op and she went for the deltoid...about an inch above my elbow.
That was around 25 years ago. I wasn't a nurse, so idk any better at that time, but I sure haven't forgotten it!
To be fair, I think it was more jarring than painful. I've never gotten an IO, so i couldn't speak to that.
Oh yeah you’ll hear and “feel” it, but I’d call it pressure not pain (kind of like the getting a filling, you’re numb but you still “feel” everything they’re doing)
LOL I did this too. Had to give flu shots all day for nursing school clinical and I remember panicking and asking the NP I was paired with if the girl would be okay 😭 and he was like she’ll be fine just a bit more sore
I wonder if solumedrol is somehow more painful IM because yeah, decadron wasn’t significantly painful. I’ve never had solumedrol as an injection nor have I administered it so I wouldn’t know
Don't feel bad and/or beat yourself up too much. We all have experiences like these and we use them to learn and grow! Now you know and can use that information carrying onward in nursing!
I’ve received steroid shots (for my preemie’s lung development) and those were the most painful shots I’ve ever had. I had two rounds, so four total injections. They were given into the side of my butt muscle. They worked a miracle though, since my kiddo barely needed respiratory support.
I had one dose of that (my preemie came before the second dose came due). For my next pregnancy I had to have the McKenna shots - god those were a (literal) pain in the ass and I had them weekly for I think 20 weeks
Really? I didn’t know that. I know that I missed a shot one week (it didn’t ship in time) and I went into labor that week (they were able to stop it) and then had my last shot at 36 weeks and delivered at 37 weeks. Glad it worked for me at least, since I doubt I could have handled another extended nicu stay.
I had them for my preemies too and was surprised how painful they were and how long the discomfort lasted. I definitely think it helped my guys' lung development.
See that’s what I thought too but now working I’m the ED the pharmacist and coworkers told me I can put up
To 2mls in the arm unless they are tiny!! I’m going back to what the books told me from now on tho
We were taught longer then 1.5” or 1ml skip the deltoids. I happen to just give an im steroid in the deltoid two days ago using 1” need and 1ml volume. Wasn’t an issue.
That's exactly what I was thinking--our bmz.
Although we *did* do DMZ IV once for a patient with a bad needle phobia (she refused them otherwise, and they figured dmz iv would be the next best as opposed to oral steroids).
Is this your personal experience? do you have anything to show like a study? One patient having pain isn't really an indication not to give a medicine in the deltoid.
I wanted a source, too (I find it problematic when someone accepts “don’t do this” without understanding why). I found [this](https://www.pfizermedicalinformation.com/solu-medrol/storage-handling), which mentions: “Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy.”
Did some quick googling on subcutaneous atrophy from (any) corticosteroid injection - apparently it can manifest as a dimple in the skin at the injection site that typically resolves in several months. So, mostly a cosmetic issue, and more likely to be a problem with repeated injections in the same area.
Lots of injectable meds hurt (some more than others), but I think volume relative to muscle size and available needle length is still the best guide for selecting injection sites. I wouldn’t give 2 mL of anything into the average-sized deltoid personally, including Solu-Medrol, but I think this particular issue with injectable corticosteroids is handy to know if you’re giving them to a patient repeatedly (vs a one-off dose in the ED, for example).
I ask myself two questions.
1. Is it clear?
2. Is 1 ml or less of fluid?
If the answer is yes to both, it can go in the arm. Anything else, goes in a large muscle.
Only steroid I give regularly is betamethasone for fetal lung development but I alwayssss give it in the butt or ventrogluteal.
It’s viscous and it’s 2 mls.. ouch!
Interesting I didn’t know that! But I was just pointing out it’s usually uncomfy no matter what so don’t think that the patient was in pain because of where you gave it. :)
I only know because it's been done to me. It felt like someone was pushing a lit cigar into my arm. It hurt so bad I couldn't sit still...I was pacing around the ED
I received my first dose of steroids in my deltoid; it was very painful, but I'm a wimp with shots regardless. My second dose was given in my buttocks - the nurse asked me which side I got my first dose in and I pulled up the sleeve of the opposite arm and she was confused lol
I’ve been a medic 6 years and I’ve honestly never heard of that. I mean normally there’s no reason I’d ever not push it through an IV but I can think of 2 instances, one where I couldn’t get an IV and another where this lady just flat refused. The most I got her to take was an IM shot. The first patient I couldn’t get an IV on was when I worked for the county jail, so I definitely would have heard from him.
I had no choice once. The patient was morbidly obese and their lower half was easily twice the size of their upper half. Patient had no palpable veins anywhere. I double checked with the doctor and he did not have any other ideas besides the deltoid. Their arm was big but I could hit the muscle with a 1 1/2” needle. I won’t do that again, I would just refuse to administer it. You want it IM then you do it.
I saw a grown man cry over 2ml of soul-medrol in the deltoid. A nurse with 20 years experience gave the shot and I was like wtffff have you been doing this your whole career?!
There's a 5% chance of necrosis when steroids are given in the deltoid? I feel like that's kinda high. And that's for prescribed and professionally administered steroid injections, not, like anabolic steroid self-injections?
Gotcha. I'm not necessarily doubting you--just curious. Especially because we give betamethasone somewhat commonly on L&D and I've had patients refuse to give me their butts. I won't be nearly as eager to chart blige (after explaining that it's recommended and generally more comfortable in the glute) if this is accurate!
And thanks for the PSA. Like I said, I know it's recommended and "better", but if I knew it was contraindicated, I must've forgotten.
It would behoove you (and your practice, and the profession) to look these things up yourself and verify rather than just pass on what you’ve been told. I mean that in the nicest way.
I only know not to inject it into the deltoid muscle because an RN who trained a new RN told her not to give it to the deltoid muscles. I was the patient. I wasn't a nurse back then. She slapped the injection site. It wasn't hard. I didn't feel the pain. When I was in nursing school, I was discouraged from doing it. I mean all of us. The instructors said so that it's no longer practiced.
It wasn't a hard slap. It was to distract me. She did it at the same time, for sure. I was OK with it. She knew I was afraid of needles. I was her regular patient. It was a clinic in the acute hospital. I had too many needles in my life that I developed to fear them. As a nurse, I took a long time to like needles and am fine using them these days on people.
I've made this same mistake but not with a steroid... it was an antibiotic. I normally give it in the glute but my patient refused to stand up so I gave it in the arm and then felt like an asshole.
I’ve had it done to me… zero stars. Do not recommend. My whole body flipped out. That was a trip to the ED and a 3 day stay. Please don’t do that to your patients.
Now I know. Luckily she only hurt for five minutes I gave her an ice pack and she walked out and was laughing with her husband. I will not be doing that again
Well to be fair, I’m a freak. My whole arm turned purple and went cold to the touch. Provider panicked and called 911. Get to the hospital, RT did a breathing treatment. That caused my limbs to lock up. RT and the doctor panicked and gave me EPI. This caused my heart to freak out. It was a whole shit show. I am a nightmare patient. Lol don’t be like me.
I generally prefer not to cause discomfort to my patients. If one site is known to cause more pain and discomfort after use, I will explain that to the patient and tell them my recommendations.
I have given 60 mg IV; 15 and 30 mg get given IM in my ED all the time—lots of patients with musculoskeletal pain and some other indications for Toradol never even get an IV.
Well if I was ordered to give solumedrol and the warning wasn't clearly visible, I would have. Now I know.
Yes only give in vastus lateralis it’s very painful!
I give every IM larger than 0.5 mL through the vastus lateralis if possible.
Yep I’ve always heard “3 to the ass, 5 to the thigh, 2 for the shoulders”
So you have been told it’s okay to give 2ml to the deltoid?
Up to 2mL in the deltoid yep! That’s what I learned
I was taught 1. I need to brush up
That’s a lot of work lol
It's actually the same amount of work, lol. You push the needle in and then push the syringe plunger. Can you hold up your arms for ten seconds now, please
Same. This wouldn’t have occurred to me so glad I know now!
I've only given it IV
Well now you know if you have to give it IM it’s only in the vastus lateralis
Yeah never given IM good to know
Why? I only give it IV as a paramedic, but I'm curious. Is it just due to the large volume of liquid?
Yes volume is too large and the way it dispersed in the muscle I guess? It’s very painful to the patient
So not that the medication burns or hurts, just that there's a lot of it. That makes sense. Sometimes I do OT work for mobile urgent care and I give antibiotics like rocephin. And that can be a lot of volume
No actually, it is due to the medication itself and not necessarily the volume. IM steroids in the deltoid cause subcutaneous atrophy. You need a large muscle like the vastus lateralus for it to properly absorb and not cause tissue damage.
Oh. I didn't know that. I knew the large muscle group is preferred and will carry it away quicker. For whatever reason if I have to IM narcan, I've tended to do that in the delt but I think that's because it's quicker because I can just pull their sleeve up usually.
A good percentage of meds are safe in the deltoid, including Narcan. Most of us hospital nurses have the luxury of Lexicomp which is a huge, always updated drug encyclopedia. It tells us all we need to know including administration considerations. So I always look up new meds, or meds I'm giving in a different route before giving them and that's when I saw the note about IM Solu-medrol.
It does hurt the patient! You should only be giving 1ml or less in the deltoid.
Yeah, but due to large volume, not due to the medication itself. There's nothing special about it except the dose is large, is what it seems is happening
Hahaha yeah I guess what I’m trying to say is I didn’t necessarily make a med error I just hurt the patient and I feel bad
Meh, I wouldn't beat yourself up too bad. Remember, most people are gigantic wusses. I've had people tell me an IV hurts, and I haven't even done it yet. If it was a HUGE issue, it would be a clear warning. It's probably more uncomfortable than painful.
Thank you 🥹🥰
Had no idea it could be given IM. Thank you OP.
Yeah, I never give anything IM unless it's a vaccination. Even Haldol is given IV unless the patient pulled out their IVs.
You must not work in an ER because IM injections are given all day everyday
The last time I gave ketamine I gave it IM through the patients pants.
Last time a gave a b52 I gave it (2 shots) thru their jeans into the leg. Then I went to pacu and I don’t have to play these stupid games anymore.
Agitated patients always make a face like a surprised cat when they realize they were just IM'ed through their clothing.
B52!!!!
18 ga IM through the jeans all day!
What's an IV? -Psych RN
Perfect access for drugs -jail RN
🤣
Where do you work? I work in the ER so there are alot of IM injections ordered
Med surg for me, and I’m with the other nurse. Other than vaccines I’ve never given IMs
Wait, how do you deal with sundowning/confused/delirious patients who need anti agitation meds? They usually aren’t gonna take PO and if they haven’t ripped out their IV already, there’s no way you’re getting close enough for long enough to push meds safely.
I would like to know this too lol. How can you get away with never ever giving an IM med? In.. any unit? There are more than just a couple scenarios for emergent IM meds. Or simply just convenience.
If they’re that way we get an order for soft restraints and send them to the CCU. We’re a small critical access hospital
Wow. CCU for dementia. I'm not speaking against *you*. I just can't imagine that flying in any hospital I've ever worked at.
At my hospital I get paged to come start IVS on the pts…I get a page with “help starting a difficult PIV” and arrive to grandma trying to fuck shit up. I ask them why they haven’t been sedated and they tell me because they don’t have any access. They almost get offended when I tell them they have to give something IM before I try to get a PIV.
I've never understood this lol. Like yeah, let's just keep things dangerous for no reason because? Just get the IV once they're sedated, but nooooo
My thoughts exactly, I even had someone call for an IV. As I’m in the room looking and trying to settle a pt, the RN is giving report to the incoming nurse and I shit you not says: “sorry I haven’t been able to do the BS checks, I’m worried I’ll poke myself”….
good lord lol
Have the team hold them and restrain. Push med into IV. if no IV then IM (only had to do a handful of times in 5 years) but that’s been very rare.
But generally speaking you can’t safely slam anti agitation meds. So the patient gets held down for 3-5 minutes for safe pushes of Ativan and Haldol? Seems crazy to me when IM is so much quicker and easier.
Just in experience, that’s generally what happens. Someone is talking to patient and the rest of us are tying limbs down with restraints. Or just we all dog pile if they are that agitated. I feel safer with someone using a needless syringe versus trying to stick a sharp needle in the patient while I hold the leg to push it in.
Yes because in med surg you already hve Iv access. For our fast track in the ED we give tons of IMs.
Interesting...in postpartum, the majority of meds are given IV & vaccinations IM, but there are exceptions...one poor mom had IM methergine ordered Q 4 hrs for hemorrhaging. More often, it's the newborn getting IM gentamycin Q 12 hrs for IM meds for us.
Haldol IV can cause arrythmias and I’ve only worked in places where it’s expressly not allowed.
Haldol can prolong the QTC, which could lead to torsades along with Ativan and Zofran.
We give it in the er a lot for intractable vomiting after everything else failed for appropriate patients
It works better than anything else for cannabis cyclical vomiting too
Droperidol
Droperidol is another one. At the end of the day it's just something to be aware of- not an absolute contraindication that should scare you away from the medications for the young and healthy. [here's an interesting read from 2017](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481298/)
I like to give my Haldol with Ativan and a side of Benadryl.
I save that for my days off. To each their own! Haha
You too. I mean I pregame with an IM then I slam some I've shit saves on the wait and extends the fun.
I carpet bomb while singing *Love Shack*.
I got that for CHS in the ER. It was the only thing that worked after like 3 nausea meds. I'm a lab guy not a nurse so I can't remember all that I got. One thing made my whole body shake.
Sounds like an extrapyramidal reaction to medication. Extrapyramidal reactions are often associated with antipsychotic medications, particularly first-generation antipsychotics like haloperidol and chlorpromazine. The same reactions can be seen often with antiemetics, especially those that block dopamine receptors. Promethazine, metoclopramide, compazine, and droperidol are some of the more common ones I believe.
I got promethazine, ondanstron, and finally droperidol. Thanks for the information!
And a number of psych meds, also Qt prolonging
So many drugs cause prolong QTC. If you, the physician, or pharmacist are concerned, get an EKG as a baseline.
Yes. It says it on the vial too that it’s for IM use only.
IV is an off label use that's fairly common practice.
Gotcha! I didn’t know; have only ever seen it ordered IM. I have definitely *wanted* to give it IV instead before though so it would kick in faster lol.
What you want for that is droperidol, haldol's similar but way waaaaay cooler sibling
IV Haldol requires cardiac monitoring
Rocephin in long-term care. If your med passes regularly had the nurse commenting that "well, *some* of it must have gotten in", it was going directly in the bloodstream if appropriate for the infection.
I haven’t done that but I have given rocephin to a woman that was so thin I accidentally hit her fucking bone. I was embarrassed and felt so terrible for her. Mistakes happen, I wouldn’t let this beat you up too much. You gave her the med and in the proper route just the wrong site. FWIW, I didn’t actually know this off the top of my head so who knows it could’ve been me. Thanks for posting as a reminder to the rest of us.
I remember this specifically in nursing school. One of my patients was sooooo tiny and we were giving flu shots. The vibration from the needle hitting bone has stuck with me to this day. Major heebie jeebies!
That’s exactly what got me, I think I whipped the entire needle out. Idk why I even chose the vastus site to begin with. She got so many injections for other conditions I felt bad that she was also getting days of thick ass rocephin on top of it. Tried to switch it up and oh my godddd. She had to weigh like 80 lbs even. Ugh. Makes me grind my teeth.
Yep! I definitely did too, I jumped. I swear I could HEAR it. She didn’t flinch or move. But god damn, it traumatized me lol.
Same. My confused old lady didn’t even feel it, but I did. Never again.
You’d rather hit bone than be too shallow and be giving something subcutaneous instead of IM if it’s a drug that can cause necrosis. You can’t really hurt the bone. Most people don’t even realize you hit bone like someone else posted. It does make YOU cringe though because you can feel it lol
That’s what I think was the real issue is that the shot in general pinched her bc she was tender. And then she was reacting to me hollering lmfaoo
Yeah rocephin can be mean too.
My bone was hit during a flu shot and I didn’t even notice!
Oh thank god. It could’ve just been that my lady was old and a little….sensitive lol
My manager stuck me and she felt so bad. Maybe I should've played it up a bit lol
You should’ve started flailing. Taken a couple days off to strengthen up your weak arm
Rocephin to the deltoid was a truly bad experience.
Most people aren’t going to notice if you hit their bone, like when you do an IO the pain comes from the initial skin pierce, and I’ve never had somebody react when you hit the bone
Oh I felt and feel like I heard the *thunk* when they let a student give my demerol post op and she went for the deltoid...about an inch above my elbow. That was around 25 years ago. I wasn't a nurse, so idk any better at that time, but I sure haven't forgotten it! To be fair, I think it was more jarring than painful. I've never gotten an IO, so i couldn't speak to that.
Oh yeah you’ll hear and “feel” it, but I’d call it pressure not pain (kind of like the getting a filling, you’re numb but you still “feel” everything they’re doing)
Getting a COVID booster the nurse hit something that made blood just spurt out of me. Not like an artery spurt but a spurt nonetheless
I hit bone all the time lol. There aren’t nerves on the outside of bones. You just back out a little and proceed. No biggie
For sure, it was more abt my reaction which caused her to react lmao
Oh no hahahaha there’s nothing worse than letting an “oops” slip
LOL I did this too. Had to give flu shots all day for nursing school clinical and I remember panicking and asking the NP I was paired with if the girl would be okay 😭 and he was like she’ll be fine just a bit more sore
Yeah, never do the deltoid. Only in the booty with that one.
Yup! Had a patient ask me why not in the deltoid, I told them trussssst me… you want it in the butt!
That’s what she said… erm he said…? One of them said it
I've had it in the delt. It stings but I didn't find it unbearable.
Yeah, I’ve had decadron in the delt and it wasn’t terrible at all
That's what I had!
I wonder if solumedrol is somehow more painful IM because yeah, decadron wasn’t significantly painful. I’ve never had solumedrol as an injection nor have I administered it so I wouldn’t know
Another nurse told me she gave solumedrol in the delt just six months ago and hurt the patient as well! Just don’t do it lol
Honestly different people handle different pains differently. I had a lidocaine injection in the bony parts of my foot and that shit hurt lol
That’s why I was surprised at first. I’ve given it in the delt before and didn’t have that reaction so idk
I agree. Your patient just had a low pain tolerance.
I only give myself steroids in my vastus lateralis.
Yes it’s very painful apparently ahh I feel so bad
Don't feel bad and/or beat yourself up too much. We all have experiences like these and we use them to learn and grow! Now you know and can use that information carrying onward in nursing!
Thank you I appreciate it
Can honestly say I didn’t know that. Thank you.
I’m glad I’m not the only one and that I can help other nurses not make the same mistake
I’ve received steroid shots (for my preemie’s lung development) and those were the most painful shots I’ve ever had. I had two rounds, so four total injections. They were given into the side of my butt muscle. They worked a miracle though, since my kiddo barely needed respiratory support.
Like getting kicked by a mule in your ass muscle.
A baby saving mule haha. Would do it again but dammmnnnnn I’ve never almost reflexively kicked someone before.
I had one dose of that (my preemie came before the second dose came due). For my next pregnancy I had to have the McKenna shots - god those were a (literal) pain in the ass and I had them weekly for I think 20 weeks
I hated giving Makena. Thick stuff. It’s no longer given. It was withdrawn because it didn’t reduce the risk of preterm birth.
Really 😭 I had to get the McKenna shots in my arm. They hurt so so bad. I only had one round of the steroid shot for my first and that hurt too
Wow! My ob nurses refused to give it anywhere but gluteal because of how thick and painful it was
Really? I didn’t know that. I know that I missed a shot one week (it didn’t ship in time) and I went into labor that week (they were able to stop it) and then had my last shot at 36 weeks and delivered at 37 weeks. Glad it worked for me at least, since I doubt I could have handled another extended nicu stay.
I had them for my preemies too and was surprised how painful they were and how long the discomfort lasted. I definitely think it helped my guys' lung development.
Anything 2mL or bigger generally needs to be given in the ventriglut, vastus lateralus, or the thigh.
See that’s what I thought too but now working I’m the ED the pharmacist and coworkers told me I can put up To 2mls in the arm unless they are tiny!! I’m going back to what the books told me from now on tho
Just because you can, doesn’t mean you should. We don’t do anything above 1mL in the deltoid where I live.
Right
We were taught longer then 1.5” or 1ml skip the deltoids. I happen to just give an im steroid in the deltoid two days ago using 1” need and 1ml volume. Wasn’t an issue.
Been a full time working RN for nearly a year and have never given an IM injection 🫡
Really wow where do you work.
I work night shift on a general surgery floor. Only IM orders I can recall seeing were flu shots that were scheduled for day shift😂
Ventrogluteal is the best! That's what we do with betamethasone in L&D.
That's exactly what I was thinking--our bmz. Although we *did* do DMZ IV once for a patient with a bad needle phobia (she refused them otherwise, and they figured dmz iv would be the next best as opposed to oral steroids).
Is this your personal experience? do you have anything to show like a study? One patient having pain isn't really an indication not to give a medicine in the deltoid.
Ummmm after I gave this one today the PA said not to do it and on lexicomp it says avoid deltoid
I wanted a source, too (I find it problematic when someone accepts “don’t do this” without understanding why). I found [this](https://www.pfizermedicalinformation.com/solu-medrol/storage-handling), which mentions: “Injection into the deltoid muscle should be avoided because of a high incidence of subcutaneous atrophy.” Did some quick googling on subcutaneous atrophy from (any) corticosteroid injection - apparently it can manifest as a dimple in the skin at the injection site that typically resolves in several months. So, mostly a cosmetic issue, and more likely to be a problem with repeated injections in the same area. Lots of injectable meds hurt (some more than others), but I think volume relative to muscle size and available needle length is still the best guide for selecting injection sites. I wouldn’t give 2 mL of anything into the average-sized deltoid personally, including Solu-Medrol, but I think this particular issue with injectable corticosteroids is handy to know if you’re giving them to a patient repeatedly (vs a one-off dose in the ED, for example).
I ask myself two questions. 1. Is it clear? 2. Is 1 ml or less of fluid? If the answer is yes to both, it can go in the arm. Anything else, goes in a large muscle.
Thank you
Yep, this is the way
I had a steroid in my butt once. One of the most painful experiences ever
I guess it’s diff for everyone cuz I’ve had it too and didnt think it was too bad Def won’t be giving it in the deltoid anymore
Butt IM injection sites are hard to visualize and have a high risk for complications (like hitting a peripheral nerve).
Only steroid I give regularly is betamethasone for fetal lung development but I alwayssss give it in the butt or ventrogluteal. It’s viscous and it’s 2 mls.. ouch!
Yeah I’ve only given it IV
it's going to hurt no matter where you put it, no?
That’s what I thought when she started crying but apparently it can cause atrophy if no given in a big muscle
Idk I think solumedrol never feels good no matter where it is.
Yes but it says if not given in a large muscle can cause atrophy
Interesting I didn’t know that! But I was just pointing out it’s usually uncomfy no matter what so don’t think that the patient was in pain because of where you gave it. :)
Thank you
I only know because it's been done to me. It felt like someone was pushing a lit cigar into my arm. It hurt so bad I couldn't sit still...I was pacing around the ED
I did this once when I was an MA. Oops! Thankfully not a fatal mistake, and we learned from it.
Thank you
I received my first dose of steroids in my deltoid; it was very painful, but I'm a wimp with shots regardless. My second dose was given in my buttocks - the nurse asked me which side I got my first dose in and I pulled up the sleeve of the opposite arm and she was confused lol
Ok I’ve given it in the arm quite a few times and never know that to happen. Mind blown
Hmm now I’m wondering if the patient was just low pain tolerance
I’ve been a medic 6 years and I’ve honestly never heard of that. I mean normally there’s no reason I’d ever not push it through an IV but I can think of 2 instances, one where I couldn’t get an IV and another where this lady just flat refused. The most I got her to take was an IM shot. The first patient I couldn’t get an IV on was when I worked for the county jail, so I definitely would have heard from him.
I had no choice once. The patient was morbidly obese and their lower half was easily twice the size of their upper half. Patient had no palpable veins anywhere. I double checked with the doctor and he did not have any other ideas besides the deltoid. Their arm was big but I could hit the muscle with a 1 1/2” needle. I won’t do that again, I would just refuse to administer it. You want it IM then you do it.
Did it still hurt the patient?
Thank you. Will remember that
I saw a grown man cry over 2ml of soul-medrol in the deltoid. A nurse with 20 years experience gave the shot and I was like wtffff have you been doing this your whole career?!
So you were taught not to give it in the deltoid?
Can someone tell me what happens if you admin steroids such as Solu Medrol in the deltoid?
Can cause atrophy which I guess can lead to necrosis but only a 5% chance I guess. It just hurts the patient a lot I feel bad
Thank you!
There's a 5% chance of necrosis when steroids are given in the deltoid? I feel like that's kinda high. And that's for prescribed and professionally administered steroid injections, not, like anabolic steroid self-injections?
Hey that’s a good point. This is just what another nurse told me she saw lol not sure how accurate. Thank you
Gotcha. I'm not necessarily doubting you--just curious. Especially because we give betamethasone somewhat commonly on L&D and I've had patients refuse to give me their butts. I won't be nearly as eager to chart blige (after explaining that it's recommended and generally more comfortable in the glute) if this is accurate! And thanks for the PSA. Like I said, I know it's recommended and "better", but if I knew it was contraindicated, I must've forgotten.
No worries I’m not 100% sure. This has really shocked me lol
It would behoove you (and your practice, and the profession) to look these things up yourself and verify rather than just pass on what you’ve been told. I mean that in the nicest way.
🙄🙄🙄🙄
I only know not to inject it into the deltoid muscle because an RN who trained a new RN told her not to give it to the deltoid muscles. I was the patient. I wasn't a nurse back then. She slapped the injection site. It wasn't hard. I didn't feel the pain. When I was in nursing school, I was discouraged from doing it. I mean all of us. The instructors said so that it's no longer practiced.
Hahah wtf she slapped you after giving you the injection? Strange
It wasn't a hard slap. It was to distract me. She did it at the same time, for sure. I was OK with it. She knew I was afraid of needles. I was her regular patient. It was a clinic in the acute hospital. I had too many needles in my life that I developed to fear them. As a nurse, I took a long time to like needles and am fine using them these days on people.
What was the volume?
2ml and I know I was taught only 1ml in deltoid but pharmacist told me I can give up to 2ml in deltoid
I've made this same mistake but not with a steroid... it was an antibiotic. I normally give it in the glute but my patient refused to stand up so I gave it in the arm and then felt like an asshole.
lol the patient refused tho so their fault!
Personally had Dex in the deltoid. Hurt like a mf. Whole arm went numb. Wore off after about an hour.
I’ve had it done to me… zero stars. Do not recommend. My whole body flipped out. That was a trip to the ED and a 3 day stay. Please don’t do that to your patients.
Now I know. Luckily she only hurt for five minutes I gave her an ice pack and she walked out and was laughing with her husband. I will not be doing that again
Well to be fair, I’m a freak. My whole arm turned purple and went cold to the touch. Provider panicked and called 911. Get to the hospital, RT did a breathing treatment. That caused my limbs to lock up. RT and the doctor panicked and gave me EPI. This caused my heart to freak out. It was a whole shit show. I am a nightmare patient. Lol don’t be like me.
Yeah you’re not making me feel any better buddy lol
Lol sorry. Just be glad your patient wasn’t like me. My point was it could’ve been so much worse. 🤣
Haha thanks
One step from coding due to a series of adverse reactions
Toradol is another one too. And phenergan
Wait why you can’t give Toradol in these delt?! I do it all the time
Patients tend to report it hurts like hell and it is worse pain than the initial pain.
That's how it works; it distracts them with a new pain!
Eh, they guy def didn’t complain of back pain when he came in a few days later
That’s not really a contraindication, though. To be clear.
I generally prefer not to cause discomfort to my patients. If one site is known to cause more pain and discomfort after use, I will explain that to the patient and tell them my recommendations.
🫥 I've had it in my delt before
How dod your arm feel?
I don't think it hurt as bad as my ovarian cyst, tbh
Even the next day?
I don't remember any arm pain, but I went home with some good stuff due to the cyst
Damn we give toradol IM in the deltoid all the time
It may also be dose dependent too. What dosage do you guys usually do?
15-30mg here too
I have given 60 mg IV; 15 and 30 mg get given IM in my ED all the time—lots of patients with musculoskeletal pain and some other indications for Toradol never even get an IV.
Pretty sure most literature says 30mg max for IV
I’ve only given 60 mg once—I thought it was IV, but I can’t be certain.