IM injection

hello, i'm a new grad, so there's been a lot of things i'm having to deal with. an issue came about the other day at my place of work re: administration of rocephin IM injection. dr ordered 1g rocephin which we are to reconstitute with 3.3ml of 1% lidocaine in totaling a volume of 4ml to give to resident, producing a concentration of 0.25g/ml. as i have never had to reconstitute before, i turned to the rn, as i know an im site is unable to tolerate more than 3ml. the rn told me to give the res only 3ml of the reconstituted solution. however, in my mind, then the res would not be receiving the ordered dose as prescribed by doctor (having only received 750mg of said rocephin). i don't know if the rn is just not as adamant about giving the prescribed dose as me or i'm missing something. in my opinion, the dose would have to be split up with 3ml given to one im site (vastus lateralis, ventroglutel) and the remaining 1ml given to another im site (deltoid). any ideas?
This is an excellent question. After reconstituting this med, I would draw up 2 seperate 2 ml doses, and give them in opposite legs, or one leg and one arm. If there was a package insert, read it for more info, or talk to the pharmacist. Giving only 3 ml is not the answer.

merlee is correct- to give the proper dosage under the MD orders requires 2 separate im shots. Also if the total volume to be injected is 4mls, then u can give 2 two mls im shots.

That is an excellent question. Things that pop up in clinical situations...

I used to work in pediatrics and we would split the dose into two needles (as evenly as possible) and give them at a separate site appropriate to age. Rocephin sucks and it's hard to work with, but the patient definitely needs the full dose!

I give Rocephin all the time in a peds setting and usually we reconstitute 1g with 2.1ml sterile water. Then draw it up in equal doses and give in different sites (usually both thighs). When that is reconsituted it is 350mg/1ml concentration. I don't usually use lidocaine so I can't remember the exact dose but I thought it was the same as lidocaine. I have never seen it reconstituted with that much before. That being said, I only give 1 ml per site if using arms/legs.

I'm a newbie also... Given that Rocephin is such a pain (literally) to administer IM, is there a reason it isn't always administered IV instead? I'd sure rather have only one IV needle stick with a much more diluted drug than two IM sticks with the drug more concentrated. I'm sure there must be a good reason...

We give it in the office where there is no IV access. I've given it on the floor when a pt hasn't had IV access and we couldn't wait for a PICC.

thanks everyone!!! this confirms exactly what i was thinking. i work in a nursing home with nurses having worked 20 years in said nursing home. lets just say- they're set in their ways. iv isn't possible in such setting. i enjoy the idea of using opposite sites (left and right vastus lateralis), though many of the res don't take too kind to it, so that's why i was thinking deltoid and vastus.

There are some new theories that 5 cc can be given IM at one time, however, I disagree sticking to the 3 cc big muscle rule. The nurse is wrong in not giving the whole 4 cc's of reconstituted med.....the patient is NOT getting the entire dose. I'd give 2cc's per site....