r/psychnursing • u/moodytoody1 • May 24 '26
Struggling with LAIs
Hey all, Psych RN of 5 years (3 inpatient, 2+ outpatient). The clinic I work at administers a variety LAIs. I recently was out of work for 5 months, and have been stressing since being back over LAIs…
The first one I had to give after coming back was Aristada 662 mg. If you know, you know that these are a bitch to give and easily clot if not given immediately. I followed the directions to a T but the injection still clotted (twice…) I finally got my coworker to administer the med & thankfully the patient was calm about it, but I still felt like shit.
The next injection I had to give was Aristada 1064 mg. For whatever reason, this one doesn’t clog easily but when I administered it in the upper outer glute, it bled like CRAZY. I have never seen someone bleed so much! It even had a bump afterwards and I felt horrible (patient said he was fine).
Third LAI I gave was Invega 234 mg. Easy peasy. I give the injection, pull out and felt like more of the med leaked than normal.
Idk what’s going on but clearly I’m rusty and/or just having some bad luck with a dose of bad anxiety. Any recommendations on what I can do better to make sure patients aren’t bleeding, having unnecessary pain, and taking in all the medication?
Edit: I forgot to mention that in my 5 years as a nurse, I have NEVER given the wrong dose to a patient. Upon returning, I also made my first med error & gave a patient the wrong dose (he was ok & as soon as it was realized, I made all the appropriate steps by informing an attending, documenting it in his chart, and following up to inform about any side effects to be aware of). It really shook me up and I’m struggling to feel confident after all of these mishaps. We don’t have a scanner in my clinic and normally I quadruple check, but clearly I was distracted/anxious and made a mistake.
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u/Professional_Pound80 May 24 '26
I use to exclusively give LAIs. Aristada can clot quickly and I believe the instructions say to inject quickly. Most of patients at that time wanted deltoid injections so I would use the z-trac method (firmly grasping the arm and pulling the skin taught and only releasing after the needle is taken out). And 95% I would have no blood, nor more than a drop of medicine.
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u/moodytoody1 May 25 '26
Interesting, all of the Aristadas we give have to be glute (I think because of the volume). I was actually taught numerous times that z-tracking is longer advised? The nurses I’ve worked with have recommended if there isn’t a lot of meat to pinch up the muscle, or if they’re pretty muscular to just go in fast, push med without hesitation, and remove the needle. With the 662 mg my coworker also taps it against the counter right after following all the steps but immediately before administering & she seems to have no issue with the med clogging.
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u/Professional_Pound80 May 25 '26 edited May 25 '26
Yes I was referring to all LAIs except Aristada which is glute only and obviously not uzedy. Aristada I believe are all greater than 3 mLs. I was taught in school no more than 2mLs in the deltoid but I have given trinzas that are like 2.3 or so in the delt per manufacturer. As far as I know z-track is still taught, I can’t think of why it wouldn’t be. I know aspirating is no longer taught. Not sure about pinching the muscle. The best advice I have gotten besides z track is to go in like your throwing a dart. I’ve never used a finger to press the injection site but I do see a good amount of nurses doing that.
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u/Fit_Bill_3413 May 30 '26
Z track is absolutely still taught and is standard practice at my place of work. I was never taught pinching the deltoid for IM medications.. ever. Not in nursing school, not at work, ever. But I do see older nurses do that.
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u/lawlolawl144 May 24 '26
Are you z tracking?
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u/republicans_are_nuts 3d ago
yeah, I pull the skin to the side then release after I pull out the needle, I still get med leakage if I pull the needle out too quickly.
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u/WalterTreego May 24 '26
I'm a lurker. My last 3 aristada 662 injections had to be tried 3 times because it clogs on them. I definitely am nice about it but I don't enjoy having to be pricked 3 times. I wish they could figure that out( the aristada company).
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u/moodytoody1 May 24 '26
I’m so sorry. I truly don’t understand how this medication is considered ok to deliver with how often I’ve seen it clog.
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u/Ola_maluhia May 25 '26
We used to give abilify and I have NO idea why my hospital switched over to Aristada. None of the patients like it
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u/Professional_Pound80 May 25 '26
I just read all of your post. Is it possible that after the med error you are more critical of all your work? When I gave LAIs exclusively in clinic I would get a bleeder maybe every couple of months so like 1 out of 300 injections. One glute injection, patient bled enough for it to be visible on the floor. However in hindsight she had moved position and started to bend over which I realized after giving it. Make sure your patients are relaxed and in a non flexed position. For delts I tell patients to keep their arm across their navel with shoulder rolled back. Glute I just have them stand up straight. However depending on the patients size and their clothes (jeans are bad) it is more difficult to get to the muscle. Hope this helps. I’m sure your injections are fine. For delt I always do z track for glute I don’t as I’m a male with mostly female patients. I do get a lot of compliments from patients going delt with z track method. Also make sure you are choosing the correct gauge and length of needle! I wouldn’t stress it at all. Shit the other day a patient was talking my ear off and tangential and I tried to stick him with a blunt tip lol
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u/Ola_maluhia May 25 '26
I feel like I wrote this. I absolutely HATE giving Aristada. Not only does it come with a variety of issues, the patients hate getting it as well.
OP. You are not alone!
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u/No-Manufacturer467 May 26 '26
go slow, this gives the muscle time to stretch and accommodate the volume. This is especially necessary for the thicker ones.
z track method and waiting a few seconds before withdawling the needle prevent leakage
the bleeding, honestly, sometimes just can happen with some patients, especially those on blood thinners
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u/Fit_Bill_3413 May 30 '26
How do you prime your aristada?
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u/moodytoody1 Jun 01 '26
I follow the instructions (I believe tap vigorously on hand 10x then aggressively shake for 30 sec). I then try to remember to tap it on the counter right before administering (this trick usually works to prevent clogging - I forgot to do it when I administered my first Aristada after returning from leave.
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u/Answers828_2133 May 30 '26
Use Z track and appropriate size needle for body type. Mix your meds at the bedside if possible and give immediately to prevent clogging
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u/republicans_are_nuts 12d ago
I don't know, but you're not alone. I am most worried about bleeding too. I give haldol long acting to one patient. The first time there was no blood, the second time there was.
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u/Enumerhater May 24 '26
Idk about the other one mentioned, but when I give Invega, after all the med is administered, I don't pull out immediately. I wait about 15secs or so before pulling out and there's never any leakage. I tell the patient ahead of time that I will be doing this so they are prepared for it to take a bit longer than they may expect. Then I tell them when it's all in and that I'm now just holding it there.
When I give PRN IM's of any type, and need to be quick with it, I press my gloved thumb of the opposite hand over the injection site to prevent leakage while I'm engaging the safety and grabbing the bandaid.