To aspirate or not to aspirate?!

[RNStephNicole]

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...

[Aaron86]

sorry to resurrect a dead thread here, but this seems to be the most current one on the subject. i'm just wondering if anyone has come across any research on the topic that doesn't relate to pediatrics and vaccine administration.

i know the british journals of medecine, who, cdc, and us dept of health all say aspiration is not required of im and sc but these are specificly spelled out as vaccination guidelines.

what concerns me is all the confusion between giving a flu shot im and say... dilaudid im.

get the flu vaccine into a vessel and its not going to harm to the patient, however they may get a less effective immune response. in this case, i see how the extra manipulation of the needle could potentially cause way more harm to the patient vs. a reduced benefit of the vaccination.

a dilaudid im dose going iv though... i see that as being an issue.

so, any research nuts out there able to point out to me a non-vaccine study saying aspiration is necessary? i've got experienced nursed saying "yes! definitely aspirate on every im even that flu shot on a 2 year old" while at the same time having another nurse say "no, you don't have to aspirate on any ims anymore"

i suspect the true evidence based best practice lies somewhere there in the middle, but its really hard to support or disprove it looking for research on the subject

[Aaron86]

If anyone is interested, I've been doing some digging into this topic for the last few days and finally found a good article on the topic:

http://www.nursingtimes.net/nursing-practice-clinical-research/are-techniques-used-for-intramuscular-injection-based-on-research-evidence/1952004.article

They do a wonderful job of breaking down the whole article to the main points of interest too.

Page 1-

-The technique for IMI needs to be reviewed in the light of existing evidence.

-Evidence supports the use of Z track technique and stretching the skin of the injection site.

-Evidence supports the use of the ventrogluteal site for all ages.

-The dorsogluteal site should not be used for injection as it poses unnecessary and unacceptable risk for patients.

-Needle length and tissue depth are linked to adverse events as obesity has increased. Patients should be weighed and assessed for the required needle length with needles inserted up to the hub to ensure the full length is used.

(someone touched on this one too, about IM shots ebing given SC because of improper needle length)

• Aspiration should be undertaken with dorsogluteal procedures as needle insertion is close to the gluteal artery but is not necessary with other sites.
  

From the A&P I've been going over, you arn't really at risk for cannulating a vein and depositing an IM drug as IVP.

The whole aspiration practice arose from penicillian and other large molecule drugs being pushed into arteries (scary!) and causing embolism. The sites we use for IM injections today are chosen specificly because they lack those major arteries and nerves we want to avoid (with the exception of dorsogluteal)

Using sites other than dorsogluteal, at 90 degrees if you encounter a small vein its almost always going to be punching through and not going into it.

Yes you could get a blood return, but thats essentially blood that has seeped into the same potential intermuscular space that you are utilizing for drug placement.

Just something to think about.

That said, I'm still going to look deeper before I make a descision on how I will practice.

[celticqueen]

yup! i'm with the rest of the gang here, i always aspirate IM's