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Posted: Fri Jan 08, 2016 1:48 pm
by MChaplin
unfortunately the vivitrol people have just come out with a new patient information guideline which informs patients of the risk of injection site reactions- it is available for review on their website and they sent me a beautiful color glossy on the importance of IM as opposed to subq injection.....the reactions do happen and can be very nasty and we wouldn't be doing our jobs if we didn't find a way of mentioning them...so now who is going to accept it??? sigh.

Posted: Fri Jan 08, 2016 1:48 pm
by deegee
Hmm, agree that doesn't sound like a subcutaneous reaction. This is one of your patients? Do you have more info on the clinical course so that people can offer thoughts?

Posted: Fri Jan 08, 2016 1:48 pm
by MChaplin
I was taught to Z track injections- a quick google search revealed these nice instructions- http://www.nursingcenter.com/upload/static/592775/take5_ztrack.pdf

Posted: Fri Jan 08, 2016 1:48 pm
by tstinson
I don't think that injecting into the gluteus maximus, medius or minimus would protect against these complications. The most recent complication involved myositis of the buttock muscles (myoglobinuria and greatly increased CPK). This would be an unlikely sequel to a subcutaneous injection.

Posted: Fri Jan 08, 2016 1:48 pm
by entjwb
I do a slide technique for the injection. When needle is about half way in, I slide the tissue by pulling downward and medially. That way the needle tract is not straight and should keep the injected suspension in the muscle.

Posted: Fri Jan 08, 2016 1:48 pm
by deegee
This should not happen with IM injection. Local reactions usually are a result of a superficial injection, i.e. not deep enough, maybe in adipose. I use the 2" needle in all but the thinnest patients.

Posted: Fri Jan 08, 2016 1:48 pm
by kcairns
had one case w abcess requiring I and d

Posted: Fri Jan 08, 2016 1:48 pm
by peterorrin
My vivitrol patients have experienced worse than 'localized tissue reactions.' One patient developed a sterile abscess that had to be surgically excised. Ouch!

Posted: Fri Jan 08, 2016 1:48 pm
by DrBallester
Make sure the injection is deep IM and that the powder is in complete suspension. I use a massager/vibrator (like in the chemistry lab) to mix the suspension.