Painful injections

[sorcerer]

Yesterday I gave my first IM injection in a real patient and the
experience really shook me up.

I'm a nursing student doing a clinical rotation in the emergency
department. The patient was 19 with acute pharyngitis that was thought
to be Streptococcal. Since she had nausea & difficulty swallowing the
doctor ordered an IM penicillin injection and my instructor asked me
to do it. I was somewhat nervous because it was my first time and I
hadn't practised for some months (on oranges and never on real skin).
After drawing up the medication, maping out the landmark
(dorsogluteal) I went for it. I used the dart like action but the
needle didn't pierce the skin. I pushed harder and it went through. As
I started injecting the patient quietly yelled ouch and visibly tensed
her muscles up. I was surprised at the amount of force needed on the
syringe driver to get the pencillin through. After half the medication
was in, the patient asked how much longer and said she couldn't bare
the pain much longer. I nervously continued and wondered what I was
doing wrong. By the end the patient was in tears. My instructor who
was watching all the time, said I did everything correct and gave me a
few tips to improve next time. But it was distressing to me that
amount of pain it caused my patient and I'm really nervous about doing
any more.

Has anyone else had a similar fear / difficulty with their first
injection? Any advise for overcoming this?

-Peter

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[EMRrn]

Peter..

PCN is very thick and very painful...it wasn't you, it was the medication..as far as the initial stick , you will get better!! Erin

 

[alexPDX]

In many European countries IM penicillin is always given with procaine or another anesthetic because of the incredible pain it causes. Do you know if there is any simmilar protocol in the US?

 

[EMRrn]

alexPDX

I have to say, I don't know. Our PCN came in a tubex but I sup you could draw it out and mix it once you found what is compatible. I can count on one hand the times I have given PCN IM. I have always mixed Rocephin with an anesthetic. I had PCN IV when I was in labor since my membranes had been leaking a couple of days and it is also very painful IV...it hurt all the way up my arm.

 

[deleted6669]

DID YOU WARM IT UP FIRST? PARENTERAL PCN COMERS OUT OF THE FRIDGE AND SHOULD BE WARMED UNDER HOT WATER FIRST....

 

[EMRrn]

emedpa

I don't know if they warmed it or not before I got it..I had it running for the majority of my labor..being the "good" nurse patient that I am every time the L and D nurse left the room I would turn the pump down..smart probably not but it really hurt like a B****, that coupled with the pit which makes for the labor from hell..I was in no mood. My vein was pink all the way up my arm..no other sensitvity type sx tho. Not a fun experience.

 

[fab4fan]

sorcerer: Sometimes you can have difficulty piercing the skin if the pt has had numerous IM's...frequent IM's can cause scar tissue. Make sure you palpate the area you're going to use; don't inject in an area that is toughened.

If you had to draw up the injection, make sure you change needles. Let the med warm up a bit first before administering.

Also, see if your hosp. does allow you to use some type of anesthetic when giving IM abx...most places will let you do this, but you need to have an order to add it to the med.

Another trick I use is to tell the pt to wiggle his toes; it helps to distract the pt, and keeps the pt from tensing up the muscles. It makes the injection less painful, and if the muscle is relaxed there is less trauma, and the med is absorbed better.

I remember how nervous I was the first couple times I gave an IM. Don't worry...it won't be long before this is a breeze for you.