My note to us:
For INTRA-MUSCLE:
Needle length can be physically at any length you have in store. For common sized patients, I do not hunt for a special size. I often use the size that is as long as possible, but I do not use all of metal length I see. I use enough of needle to get to muscle layer.
Why? Reason 1: because each human will have different muscle size.
Why? Reason 2: because each human will have different fat layer.
Well trained professional will decide how much of that metal you allow to enter the muscle of patient.
I have seen frail old senior with skin on bone, virtually no muscle mass and no fat layer. For this patient, I enter just little enough to reach muscle layer.
I have seen healthy old senior with thin fat layer and thick muscle layer. For this patient, I enter just little enough to reach muscle layer.
I have seen obese patient with thick fat layer and thick muscle layer. For this patient, I enter skin, then slowly push metal to past fat layer enough to reach muscle layer and I am slow to avoid hitting bone.
I have seen morbidly obese patient with thick fat layer. For this patient, I enter skin, then slowly push metal to past fat layer enough to reach muscle layer and I am slow to avoid hitting bone.
Our job, as a well trained professional, is to: decide how much of that metal you use to get to muscle of patient.
So, for common sized patients, I do not run around hunting for special length needle like a pharmacist I saw.
Also, don't use all the metal length into all human and hit bone like I heard of another pharmacist.
Use just enough metal length of needle to get to muscle layer.
About finding deltoid area:
Be aware that an emergency room doctor was disabled because a hospital nurse injected too high into the joint.
Be aware that another patient needed surgery because a bone chip fragment was made by excessive force.
I agree with what poster called ZELMAN wrote:
for most common sized patients, you can follow the common rule that:
".......deltoid to be an equilateral triangle
with the top being a horizontal line
1-1.5 inches below the top of the shoulder/arm............."
Then, adjust as you see super short or super tall persons because the deltoid length will be sized along with the body.
For intra-muscle, my key is to find the thickest muscle area.
Also, I beg all of us to please not use cotton ball to dry alcohol. Why?
If bandage was wrapped individually for sterile quality, cotton ball should also be wrapped.
When was the last time you saw wrapped cotton ball? Never.
Do you have sterile hand to touch the cotton ball? No.
Why do you use dirty cotton ball after sterilizing skin and before cutting patient's skin and injecting medication? To dry alcohol.
But that is non-sterile cotton ball !!! and you use that after alcohol and before cutting the skin of my kids? how outragous ! You know kids have developing immune system that are not that strong as adults
In fact, the way I learned MicroBiology taught me to treat such non-wrapped cotton ball as dirty because those balls are touched again and again by non-sterile fingers and therefore cross contamination happened.
I air dry the skin for about 30 seconds. During that time, I talk just enough information about vaccine and what to do after vaccine:
For this flu vaccine, what you get is "broken pieces of enemy" so you can practice the battle ahead of time. You are getting samples of enemy so you can practice fighting before the enemy comes or before someone coughs around you...
You may have a little sore or fever tonight and that is normal because your body is trying to practice fighting with these samples of the enemy. The fever is very often low and low fever is actually good for our body to fight. If you want to stop muscle sore or the uncomfortable fever, you can take Motrin or Advil or Ibuprofen....
After we are done with vaccine, please stay around for 15 minutes. Thank you very much.
Now, please give me 5 long deep breaths......
(I wait until after third blow out then inject. That's how the Children's Hospital inject for cancer kids, with the help of a special robot that plays with kids.....Amazing technology out there)
That's enough time for ALCOHOL to AIR DRY . Please think three times before you use that non-sterile cotton ball after sterilizing with alcohol. Thank you very much.
If you have to dry alcohol, well, then, please open a sterile bandage and use the middle sponge portion to dry alcohol. Now, that's sterile and that's good patient care. Thank you very much again. I will care more because you care.
