IM Injections

[mcneillmama3]

I am a Registered Nurse and have been practicing nursing for the past 12 years in different arenas: coronary care units, long term care, and now long term care insurance case management. I work flu clinics on the side in October and November. This is where I need some advice.

When I was in nursing school and throughout my career, I was always taught to aspirate for blood return when giving an IM injection(except for Z track injections) Is this still true? When I went through this year's flu shot orientation, I was told that this was not done anymore and that aspirating could cause tissue trauma.

I also have a question regarding BD's Integra Retractable needles. On the BD training website it shows and states that it is perfectly safe and acceptable to retract the needle as soon as you have administered the injection and while the needle is still in the patient's arm. This prevents the nurse from an accidental needle stick while removing the needle from the patient's deltoid. I was told that this was dangerous to the patient.

My question is how is activating the retractable needle while it is in the patient's arm any different from a nurse removing the needle herself? Either way the needle is withdrawn from the patient's muscle-either by the mechanical safety device or by a nurse removing the needle without activating the safety device. I thought the entire premise was to ensure that a nurse doesn't suffer an accidental needle stick which is possible if you were to remove the needle from the client and then press the plunger to retract the needle. This makes no sense at all.

If there are any seasoned nurses out there who could help me with this, I would greatly appreciate it.

[Lacie, BSN, RN]

After 30 years I still landmark every injection. It only takes one mistake to result in some serious damage and I'm not willing to take that chance. Takes a few seconds and it's done.

I dont wait 10 secs, new one on me. Too ensure all med is distributed is why you add a little air after drawing up to ensure all med is cleared from the needle. Immediately apply pressure with massage post removal of the needle to assist in distribution and prevent back flow.

[NotFlo]

1. No aspirating for vaccines per CDC guidelines.

2. We are taught and strenuously encouraged (and have seemingly endless inservices) to ALWAYS retract the needle while it's still in the patient, most definitely NOT to take it out and then activate the safety. Taking the needle out and then retracting it defeats the whole purpose of these very expensive safety needles.

[ChiSmile6]

I'm sorry, I'm confused, what do you mean 'allow to retract while in the pt'

[chenoaspirit, ASN, RN]

while the needle is still in the patient, you press the retraction feature to allow the needle to retract, as opposed to pulling out the needle and THEN pressing the retraction feature and retracting the needle.

I will continue to aspirate. It doesnt hurt to aspirate, I feel more comfortable doing so and I was taught to do so. I have never had a return of blood when aspirating.

[justiceforjoy]

I wonder if we're talking about different needles? The retractable ones we have activate the retraction as soon as the plunger is down all the way. Instead of releasing our thumb to allow the retraction to take place, we pull back the needle just enough to exit the skin, then let it retract). In this case, the needle prick we're avoiding is the one that happens between bedside and sharps container. Either way, it's good to see different views of it and it looks like I could do some research to see what all has changed since the start of this year (when we learned about injections).

re: Land marking. Thanks for your responses! It's really nice to know that land marking is so important to nurses. It's too early to say for me, but I can't imagine not doing it.

[mcneillmama3, BSN, RN]

I agree. I thought that reply to my original post sounded strange also because the books say to inject the medication slowly, and remove the needle quickly. Why would you leave a needle in a patients muscle for longer than the amount of time it takes to inject the med and remove needle quickly?

I haven't found any reference to that technique in any medication administration textbooks.

I bought a used copy of Medication Administration made Incredibly Easy. This is one of the Lippencott series books. My book is pretty current and it shows to aspirate on IM injections except for Z Track Injections(as the med involved in a Z Track injection would be painful if it leaked back in to the tissues or could stain the tissues as well)

[mcneillmama3, BSN, RN]

This does help. thanks for taking the time to consult the CDC. I am sure that was a job!

[mcneillmama3, BSN, RN]

There are different brands of retractable safety needles on the market, so you need to research the brand you are using on the manufacturers website. Most manufacturers have pocket instructions you can download and print on a variety of equipment we use: Here are examples of websites with video tutorials:

BD Integra, BakSnap, Inviro Medical(they will send you several syringes you can practice with). CAD Pumps by Prestige, Most of your insulin pens(like Eli Lilly) can be found online, most of your IV pumps can be found online, Kangaroo feeding pumps, Cardio Chek Cholesterol noninvasive test. Baxter medical(the IV pump maker) has several free continuing education modules online regarding their equipment and healthcare related topics)

I go online all the time and print out instructions and carry them with me on my job. Although I do not work in a clinical setting anymore, I work in insurance care planning, I still come in to contact with clients in their homes that will ask me questions and it is nice to keep a little folder with me of information.

[nursepotter05, RN]

I always aspirate and i have gotten a syringe full of blood back twice when giving an im to the deltoid. i am an er nurse, who gives a crap load of im injections. So, it does happen. I know I would want the nurse to aspirate when giving me an injection. I don't know the answer to retracting the needle in the patient's arm. From a safety standpoint, i can see retracting while still in the arm, but in reality, i would probably retract immediately after pulling out.

[ChiSmile6]

I gave an arixtra injection the other day and was surprised when I pulled out the needle and the needle shield was already in place! I think it is a great feature although I do not know if I accidently activated it without knowing or it just did it itself...has anyone seen this?