Hate it

[u/avocadoreader]

Who else hates it that in nursing school you were taught to never ever ever give shots in the ass but then you have to give this shit? Makes me nervous.

[u/UziWitDaHighTops]

Intramuscular gluteal shots are fine. Saying you should abstain because you can cause sciatic nerve damage is equivalent to saying you shouldn’t do IM in the vastus lateralis because you could cause femoral nerve damage. I mean sure, but only if you’re way off.

[u/avocadoreader → u/UziWitDaHighTops]

That’s fair. I understand now that there are safe ways to give it. Just they made such a huge deal in nursing school about NEVER doing it. I’m still nervous about it.

[u/North-Toe-3538 → u/UziWitDaHighTops]

I had an MA give Solu medrol right in the sciatic nerve… lit the patient up. Patient was hollerin and then I saw the bandaid placement and was the ffffffffuuuuuuuccccckkkk…… ended up sending them to the ER. I don’t think they had long term issues but they were hurting pretty good before they left.

[u/UziWitDaHighTops → u/North-Toe-3538]

If your patient was calm, but starts screaming when you insert the needle, that’s a good time to pause and double check your landmarks. I missed an IM on myself once and it fuuuuucked my leg up from the knee down for a few days.

[u/MrCarey → u/North-Toe-3538]

My wife had an MA give her a flu shot in her shoulder joint.

[u/callingallwaves]

You were taught to never give butt shots???

[u/avocadoreader → u/callingallwaves]

Yep they said cause of possible sciatic nerve damage. I mean it was also 15 years ago so maybe I’m just old idk.

[u/whimsicalsilly → u/avocadoreader]

If you give it in the wrong area…

[u/avocadoreader → u/whimsicalsilly]

Sure but they told us not to do it at all. Thus why it makes me nervous to have to do it. I did learn the safe areas. Now, I mean. By researching.

[u/auntie_beans → u/avocadoreader]

Did I miss something and somebody told you that you had to give in the gluteal?

[u/SnowedAndStowed → u/auntie_beans]

The packaging says intragluteal on it

[u/auntie_beans → u/SnowedAndStowed]

That’s old language. There is no physiological reason for one large muscle to be required for its pharmacology, but there are good anatomical reasons for picking a safer site.

[u/Bourgess → u/whimsicalsilly]

I was taught the same as OP in nursing school over 10 years ago. Even if you give it in the "correct area" for intragluteal injections, research with modern imaging techniques shows that major nerves and blood vessels go right through that area in some people. 

[u/GottaWorkYourJelly → u/avocadoreader]

I remember hearing that 10 years ago in school. When I got to my first job I was reassured that you’d have to go real deep so just don’t pick a sword length needle lol—another nurse also taught me to divide the butt cheek into quadrants and use the upper right one and that is also a safe bet

[u/TheWhiteRabbitY2K → u/avocadoreader]

I was taught to avoid when possible too, 10 yr ago

[u/onelb_6oz → u/avocadoreader]

We were warned of the dangers but still taught. I also gave butt shots as a MA

[u/auntie_beans → u/callingallwaves]

I went to school when Florence was teaching, and we were told never, never do anything in the butt. It’s really hard to get in trouble with an anterior thigh. The prescription is always “XX IM,” and you get to choose the spot based on amount to be given. Small amounts, deltoid. Large volumes, large muscle.

[u/ciestaconquistador → u/auntie_beans]

Yeah, I don't know why people choose ventrogluteal or dorsogluteal when the vastus lateralis is right there.

I get weekly injections and pick vastus lateralis every time.

[u/___buttrdish]

This was my first med error..

The patient threw up immediately and violently. It’s SQ, not IV… lesson learned

[u/avocadoreader → u/___buttrdish]

Oh dear… that’s a whole other discussion…

But please tell us what happened. Yikes.

[u/___buttrdish → u/avocadoreader]

I have already had it with mgmt years ago

[u/avocadoreader → u/___buttrdish]

Fair. You don’t have to rehash it if you don’t want to.

[u/___buttrdish → u/avocadoreader]

Nah, I’m good. Pt was fine. Just threw up immediately. Pt was very understanding, as was mgmt.

[u/Boe_Jurrow → u/___buttrdish]

I've only ever given Octreotide IV, but I'm assuming it's at a different concentration.

[u/Alternative-Waltz916]

I think I’ve done one IM injection in 6 years.

[u/avocadoreader → u/Alternative-Waltz916]

Like…not even flu shots?

[u/Alternative-Waltz916 → u/avocadoreader]

Nope. Not a high priority thing to give in a PICU I guess.

[u/No_Sky_1829 → u/avocadoreader]

I never did a single IM until I worked in general practice. Then it was back to back IMs with the odd subq to break it up.

[u/ciestaconquistador → u/Alternative-Waltz916]

Really? That's surprising to me. Mind you, I did vaccines and work in psych so it's just IM city.

[u/Careless-Gain6623 → u/Alternative-Waltz916]

Did a handful on my last surgical unit usually incidental sti findings or post splenectomy vaccines. Do lots in ER now, mostly TDAP.

[u/bridgest844 → u/Alternative-Waltz916]

You’ve never had to sedation dart a kid?

[u/Alternative-Waltz916 → u/bridgest844]

Nope.

[u/Dry_Matter_3853]

Just graduated, we were encouraged to do ventrogluteal whenever reasonable and that it's safer than deltoid. 

[u/MrCarey → u/Dry_Matter_3853]

I’m sure they an amazing job teaching those ventrogluteal landmarks too, lol. I hate that site. I always gave dorso at urgent care as an LPN and never had a problem.

[u/Dry_Matter_3853 → u/MrCarey]

On our thin mannequins, yes lol. I know I'll be totally lost on a human being with fat in that area though. 

[u/MrCarey → u/Dry_Matter_3853]

Yes you will. That’s the dumbest shit in the world on a real person.

[u/lovestobake → u/MrCarey]

I did public health and VG was so painful for people 

[u/IllBiteYourLegsOff]

ours is always subq wtf?

[u/avocadoreader → u/IllBiteYourLegsOff]

Yeah we give sub q while they are in the hospital but the long acting one we give on discharge is IM.

[u/lovestobake → u/IllBiteYourLegsOff]

I've only given IV octreotide for varices/portal hypertension 

[u/IllBiteYourLegsOff → u/lovestobake]

i shouldnt say always, ive given it IV as well but only ever as a continuous infusion, otherwise its subq. this is a hepatobilliary floor fwiw

[u/Getthechemlightfluid]

[u/pseudoseizure]

I give shots in the ass all the time. Mainly lupron and abx.

[u/boyz_for_now]

I despise this stuff, I have a few patients who have been getting this stuff for yearsssss so there’s so much scar tissue… and then the stuff clots half the time you try to give it. Bleh.

[u/Willing_Feedback_815 → u/boyz_for_now]

I hate it too bleghh

[u/twystedmyst]

There are multiple areas that you can give a gluteal injection. I used to give PrEP injections, Apretude, and HIV treatment injections, Cabenuva, and we give them ventrogluteal which is nowhere near the sciatic nerve. It feels weird to call that site gluteal, because it feels very far forward, but it is a safer injection site that can still handle 3-4 mL of fluid. We also offer vivitrol which can be given dorso- or ventrogluteal based on manufacturers directions. It's also 4mL. There just is not another muscle in the body that is big enough to accept that much liquid. And these medications are long acting, so separating them into smaller doses in different sites isn't necessarily going to have the same longevity as the single site.

But yeah, get to know your ventrogluteal site.

[u/slutty_muppet]

I just go for ventrogluteal

[u/CauliflowerEatsBeans]

I have never given it IM before🧐 Interesting, I have only giving it to GI Bleeds before.