To aspirate or not to aspirate?! - page 4
by RNStephNicole 52,810 Views | 74 Comments
I work at a Peds office and I am constantly administering immunizations (lucky me)! I am a recent new grad, and remember being taught to aspirate, however I have noticed very few nurses who actually do this. I am continuing to... Read More
- 5Aug 12, '09 by lcprncBeing in charge of the community flu shot program, I have done research on this topic and developed our policy. I have seen the recommendations a few years ago and stopped aspirating prior to injecting influenza vaccinations. Here it is. Hope it helps:
ASPIRATION BEFORE INJECTION
Previous versions of the General Recommendations have recommended aspiration (i.e., gently pulling back on the plunger to check for blood before injection) prior to injection, particularly before intramuscular injection. No data exist to document the necessity of this procedure. The 2002 General Recommendations on Immunization does not recommend aspiration before injection.
- 0Aug 13, '09 by nursel56 GuideQuote from B Yahnke RN BNJust wondering what you mean by "faster is better"? I'd be interested to see where you did your research on this. Thanks!Wow your responses are overwhelming in favor of aspiration. I do not aspirate for vaccine administration. I have found research that has shown faster is better and aspiration is not nessessary. The places chosen for vaccine administration-vastis lateralis and deltoid are considered safer as they are not near any major vessels. However, research also states that if one chooses to aspirate and blood is drawn, to discard med/vaccine and do it again.
- 2Aug 13, '09 by Mas Catoeraspirating or applying negative pressure in im injection is mechanically my habit for decades although got the blood only once in years. all i concern is just if the drug may have totally different effect given by im or iv.
but i've been thinking about the insulin injection. might have different consideration as insulin is injected with a much shorter needle (i.e. 5/16 to ½ -inch) into the subcutaneous tissue, which does not contain major blood vessels. to avoid hitting a vein, gently pinch up a two-inch or three-inch area of skin. as reasoned by: judy kohn, rn, bsn, cde
for the vaccines i agree not to aspirate.
the current recommendation is not to aspirate during administration of im
or sc vaccines based on the following rationale.
1) recommended sites for immunizations do not have major blood vessels;
hence the risk of accidentally injecting the vaccine into a blood vessel
is thought to be minimal .
2) ad syringes have been given [used] in mass campaigns for im injections
without any reported adverse effects [18, 10] or injury from failure to
aspirate [18, 21, 22]. all complications reported in literature of intra-
arterial injection involved penicillin and other medications and not
vaccines . “it is safe to assume that immunization as a class of im
injection poses less risk to the patient” than other medications
particularly antibiotics [6, 18, 23, 24]. hence according to clements
, “the practice of aspiration during vaccinations is not evidence-
3) aspiration can result in wastage of vaccine .
4) aspiration prolongs the time that the needle is inside the patient
hence increasing the pain experienced by the recipient .
5) less control is exercised during two handed aspiration using a
conventional syringe, which may lead to local injury. during a one handed
vaccination without aspiration, the vaccinator can use the other hand to
control the child .
6) at present, at the public health level, the use of auto-disable
syringes represents best practice to protect the health of the public
despite the fact ad syringes do not allow aspiration for the recommended
5-10 seconds. the increased risk presented by eliminating aspiration from
routine vaccine administration technique can be mitigated to an extent by
a thorough understanding of the anatomy and landmarks of recommended
injection sites .
the who appreciates that there is not enough evidence to support the
exclusion of aspiration [6,18] at present. as a result, who is neither
able to support nor offer alternative actions in relation to aspiration
undertaken during the administration of vaccines. until such time as clear
evidence becomes available to indicate which method is preferable,
vaccinators should make locally appropriate choices 18]. in addition, it
is suggested that in individual clinical practice using non-ad syringes,
aspiration should continue to be a part of the standard technique for im
injection administration .
- 0Aug 13, '09 by miraclelukeUltimately, who is responsible for that person you are giving the injection to? You are! So my advice is to remember what you learned and why you learned to do it that way and continue the procedure of giving an injection the way it was taught to you in school! That is the safest and surest practice! The other nurses you are observing not doing this are only responsible for themselves and if something should happen to that little patient they gave an injection to, they would be the ones responsible, right? Protect yourself and instead of following the leader, do what you think is appropriate based on your knowledge and nursing practice that was taught to you and what you know is correct procedure.:wink2: Good Luck!
- 0Aug 13, '09 by dhinson45Quote from RNStephNicoleI say yes, always chance of that vein, no matter how small. That's what I was taught since 1973.I work at a Peds office and I am constantly administering immunizations (lucky me)! I am a recent new grad, and remember being taught to aspirate, however I have noticed very few nurses who actually do this. I am continuing to aspirate because I figure it's what I was taught in school, however, when my kindergardeners are screaming, kicking, and fighting the 4 shots I need to give them I begin to question, do I really NEED to be doing this?! Im curious to hear what everyone thinks...
- 1Aug 14, '09 by PEBBLES1I am a new grad also but, I have been a Medical Assistant for years and I was taught to aspirate in both schools. However, I don't aspirate because it hurts the person more. In my opinion, their is not reason to aspirate. My motto is to stick and move, I get in and get out and my patients feel less pain.
- 3Aug 14, '09 by HazeKompi decided to check out a reference posted earlier...
here is what blew me away:
the centers for disease control and prevention (cdc) has issued an online summary of the seven major changes made by the advisory committee on immunization practices (acip) in the new "general recommendations on immunization,"
"previous versions of the general recommendations have recommended aspiration (i.e., gently pulling back on the plunger to check for blood before injection) prior to injection, particularly before intramuscular injection. no data exist to document the necessity of this procedure. the 2002 cdc general recommendations on immunization does not recommend aspiration before injection."
after thirty years of aspirating all im injections, i read that the cdc has been stating it is not necessary as of >5 years ago!
guess it's time for this old nurse to do some more reading!