New Nurse-IM injections question

Hi All,

I am a new nurse that just started a new job. It's in a chiro office so it's a lot of administrative stuff but I will also be doing alot of b12 injections. They had me giving 3mls of B12 in the deltoid today. I came home to brush up on my injections skills and realized I should not be giving more than 1ml in the deltoid! I'm assuming their past nurses have been doing this also or I'm sure it would have been brought up...Anyways, my question is-Is is OK to give 3mls in the deltoid? No one complained of it hurting today. Also, isn't b12 supposed to be given in a z track method? How the heck do you do the z-track method on the deltoid easily? Thanks in advance for any help!
You bring up good, valid points, but consult the P and P manual for the office.

I personally do not give any more than 1 mL in the deltoid. Anything larger than 1 mL should go into the gluteal. The B12 shots I give in the hospital are no more than 1 mL. Consult your text books.

I rarely give IMs in the deltoid, and if I do, not more than 1 ml. It hurts more in the deltoid. I always use the Z track method so the medication is deposited and sealed within the tissues. Usually, I administer I'm in the thigh or the hip. Consult your manual and ask your supervisor what their policy is.

I personally am not comfortable with giving such a large amount in the deltoid. Perhaps if you split it up between the two deltoids so each gets 1.5 mL, maybe. 3 mL in one deltoid? No.I prefer the vastus lateralis (thigh) for giving larger doses. I always Z-track no matter the muscle...yes, it's tougher to do with the deltoid but it can be done with some practice. You'd use your fingers instead of the side of your hand, as you might use when doing it in a larger muscle.

Does it leak out when you withdraw the needle from the delt?

I'm curious what you mean by "They had me giving 3mLs of B12 in the deltoid." Someone was making you give the medication in the deltoid? You're correct that 3mLs is too much volume to give into the deltoid. Check your facility's policy regarding IM medication administration and plan on giving injections in the vastus lateralis or gluteal muscle.

Quote from Ashley, PICU RNI'm curious what you mean by "They had me giving 3mLs of B12 in the deltoid." Someone was making you give the medication in the deltoid? You're correct that 3mLs is too much volume to give into the deltoid. Check your facility's policy regarding IM medication administration and plan on giving injections in the vastus lateralis or gluteal muscle.

I'm wondering why you'd be giving B-12 injections at a chiropractor's office...do they do labs to check the levels first?mc3

They have an HCG weight loss program and thr shots are in conjunction with that. They also offer the b12 if people just want it for the boost. An MD is associated with the office as they also own/run a non narcotic pain management program though he is not physically at the location I work at. I know they are places in the area such as "Any Lab Test Now" facilities that you can go to in the area that offer b12 shots and you don't need a script for it so I don't think there is any legal issues with administering it.

The hcg weight loss program participants have labs done at another facility before starting, but no labs are done on the people who just want the b12.

Oh, OK. Thanks!mc3

i experienced the same case with you...my senior asked me give im diclofenac 3 mls in deltoid...after go back and i realized i should not be giving more than 1ml in the deltoid! what would happen to the patients ? i really worried!!!