to aspirate or not while giving insulin and flu vaccines

Nurses General Nursing

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I have been a nurse since 1974, and I went Thursday to get a flu vaccine at the health dept. and discovered the they did not aspirate when they gave the injection. When I questioned it they informed me, this was the new recommendation by cdc. They also said this applied when giving insulin. They told me the theory was , you did not receive all the vaccine when apirated. Now if cdc advises this, what happens if this vaccine is injected directly into a blood vessel.; and insulin what happens here. I know nursing is changing but I think this is risky.

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I aspirate for all IM's, but not subcu's

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I aspirate for all IM's, but not subcu's
Flu vaccines are given IM. I understand the subcu's. I just feel this is risky on IM injections.
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Specializes in ICU/PCU/Infusion.
I aspirate for all IM's, but not subcu's

:yeahthat:

that's what we've been taught in NS.

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Specializes in TRAUMA,TRANSPLANT,CARDIOTHORACIC.

I believe one of the major reason to aspirate is to ensure you are not into a major/minor vessle,thus making the injection an IV push injection...IVP insulin can be serious...the belly,back or the arms,flank are pretty safe for this reason,plus the insulin needle/syringe itself is basically too short to get into a vessel...I volunteered for a Meningitis scare years ago and gave hundreds in Im injections,all deltoid..and we all aspirated...my A and P is getting farther behind me,but some of us got pretty good back flow when we aspirated,so we tossed that needle and went to the other arm,and i if all was ok,aspirated again,and injected..

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Here are some sources:

http://www.immunize.org/catg.d/p2021f.htm

"ACIP does not recommend aspiration when administering vaccines because no data exist to justify the need for this practice. Intramuscular injections are not given in areas where large vessels are present. Given the size of the needle and the angle at which you inject the vaccine, it is difficult to cannulate a vessel without rupturing it and even more difficult to actually deliver the vaccine intravenously. We are aware of no reports of a vaccine being administered intravenously and causing harm in the absence of aspiration. (10/05)"

From the CDC:

http://www.cdc.gov/mmwr/PDF/rr/rr5102.pdf (page 12)

"Although certain vaccination specialists advocate aspiration

(i.e., the syringe plunger pulled back before injection),

no data exist to document the necessity for this procedure."

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Hi, I am a nursing student and we are taught to aspirate when giving any IM injection, however we gave flu shots over at the health clinic and the instructions were not to aspirate. The reasoning was as stated above and also because the risk of going into a blood vessel when giving an IM into the deltoid is very minimal.

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So, what's the harm of continuing to aspirate if that has been your practice? If they decide there's limited chance of an IV injection, fine, but aspirating causes no harm. I'd continue to do it.

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Here are some sources:

http://www.immunize.org/catg.d/p2021f.htm

"ACIP does not recommend aspiration when administering vaccines because no data exist to justify the need for this practice. Intramuscular injections are not given in areas where large vessels are present. Given the size of the needle and the angle at which you inject the vaccine, it is difficult to cannulate a vessel without rupturing it and even more difficult to actually deliver the vaccine intravenously. We are aware of no reports of a vaccine being administered intravenously and causing harm in the absence of aspiration. (10/05)"

From the CDC:

http://www.cdc.gov/mmwr/PDF/rr/rr5102.pdf (page 12)

"Although certain vaccination specialists advocate aspiration

(i.e., the syringe plunger pulled back before injection),

no data exist to document the necessity for this procedur

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I would rather someone aspirates when giving me an IM injection. This new changing data kinda scares me.

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So, what's the harm of continuing to aspirate if that has been your practice? If they decide there's limited chance of an IV injection, fine, but aspirating causes no harm. I'd continue to do it.

This is what I feel as well, but as a student I do what I am asked (as long as it is appropriate and within my scope) because I am working under another nurses license. Personally I would aspirate because it makes sense to do so and I like getting into the "habit" of doing things correctly because I am "new".

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Specializes in Med/Surg, Geriatrics.

This sounds like a great topic for nursing research.

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