To aspirate or not to aspirate?! - page 4
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... Read More
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!
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8Aug 14, '09 by So.very.blessedI'm right there with you! I was shocked when I first heard this, but I'm more concerned about the overwhelming responses I have read about "change".... WE ARE EDUCATED NURSES! We must always practice based upon evidenced based process/research.
When I (and probably you, HazeKomp) graduated (1979 for me), the "Nursing Process" was just being implemented. This was VERY difficult for the "old nurses" (and "old nursing assistants") to change their practice based on research instead of "we've always done it that way". Care Plans? Who needs them???
I'm an old OB nurse.... Do you want to know how many new moms I taught to lay their newborns prone??? Now (current research) has found that this increases the incidence of SIDS (instead of preventing aspiration as was my goal). I have worried so if I ever caused a baby to die from SIDS... Yes, it was "standard of care" at the time, and now "standard of care has changed based on new data, so we all must change our practice!
No, aspirating will not kill anyone. But, minds greater than I have made this recommendation, and we ALL must make this change and update our practice. Additionally, notice the date? 2002.... Anyone heard of any catastrophic occurences from this new practice the last 7 years? I haven't (but I haven't researched it either...) I will be administering my IM flu shots this fall without aspirating....
Speaking of "standard of care".... If anything ever were to happen and you were not following "standard of care" in your practice, the DEFENSE LAWYER of the injured patient would be singing all the way to the bank!! (I also was a certified legal nurse consultant.)
Change is OK when it's based upon research!
2Aug 14, '09 by nursel56 GuideQuote from PEBBLES1I don't think it's a very good idea to change a procedure you were taught in Nursing School and Medical Assisting School because YOU think it "hurts the person more" when you aspirate. Or because, for whatever reason, it is your opinion that this or that is not the correct way to do a procedure.I 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.
Anyway, pain from an injection isn't caused by aspirating. It just bothers me that you are changing things because of what your opinion is. It opens up a really dangerous can of worms.
2Aug 14, '09 by nursemarionWhen I am told in an inservice that we no longer aspirate I will stop. We have been told what drugs NOT to aspirate with, but we have not been told to NEVER aspirate. If it won't hurt and it protects my patient and I, then I will do it. The CDC may say it is not necessary, but they have not said to stop. Of course I am not in Peds and things may be different there. I have hit blood vessels before and I don't know what harm could come from IV injection of some meds, therefore I will continue to aspirate for now.
2Aug 14, '09 by Mas CatoerWell then. We should smartly combine the evidence based theory, experience, the circumstances, and ultimately the local policy. When things are supported by strong reasoning, it should be able to drive us to take a good view of it. Keep learning while working is a great thing to do. There is always a new cheese out there..
Love nursing... :-)
2Aug 15, '09 by nursel56 Guide. . . yes!! God help us if our brains are so ossified we grump around about "the old way" There was that quotation on the masthead of a Nursing Journal "times change and we must change with them"---- after that change has been shown to improve over the old way by evidence-based practice.
1Aug 15, '09 by Jules AQuote from Mas CatoerYup, I love new cheese!Well then. We should smartly combine the evidence based theory, experience, the circumstances, and ultimately the local policy. When things are supported by strong reasoning, it should be able to drive us to take a good view of it. Keep learning while working is a great thing to do. There is always a new cheese out there..
Love nursing... :-)
1Aug 15, '09 by miraclelukeAgain, What I have been reading holds true then, "That in Nursing we never stop learning and the day we do, should be the day we consider getting out of the profession! Always keep your ears and eyes open Nurses to everything that comes down the pike towards you to offer you a new way of doing it if it improves the situation, but question it if you are not sure and make sure you research it to back it up!" Good Luck Nurses!
1Aug 16, '09 by DMFAUSTI just wanted to reassure you -I have been working in a peds clinic for some time now and I do not aspirate -and you are right the cdc does state that there is no need to aspirate before an immunization injection so I guess it solely depends on if you prefer to or not -personally I think it is worse for the patient -especially a 4-5 year old that is kicking and screaming -it is best to get it done asap!!!
1Aug 16, '09 by Freedom42I am a December grad. We were taught not to aspirate. Here's what my fundamentals book says (Taylor, Lillis, Lemone, Lynn):
"An outdated practice is the drawing up of an air bubble into the syringe after the medication has been prepared. This is not supported by research and should not be used (Nicoll & Hesby, 2002).
"Many of the drugs given intramuscularly can cause irritation to subcutaneous tissues when backflow into the tissues occurs along the injection track. The Z-track technique is recommended for all IM injections to ensure medication does not leack back along the needle track and into the subcutaneous tissue (Nicoll & Hesby, 2002)."
Here's the actual citation:
Nicoll, L. & Hesby, A. (2002). Intramuscular injection: An integrative research review and guideline for evidence-based practice. Applied Nursing Research, 16(2), 149-162.
2Aug 17, '09 by nursel56 Guidethe 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 .
i'm perfectly willing to change the way i've given im injections if need be, but for the purposes of this discussion i would say that 1) the discussion is restricted to vaccines, not every injectable im med (see above) 2) there doesn't seem to be consensus yet among authorities ie who and cdc 3) the rationale of saving a split second of extra pain isn't worth the risk to me 4) restraining a "screaming, kicking child" with one hand while you give the injection with the other is a good way to break a needle (almost happened to me--never again!) 5) anecdotal evidence from other nurses (see previous posts):wink2:
regarding the air bubble and needle track. i'm pretty sure they're talking about intentionally adding an air bubble to the med in the syringe, which must be very outdated, 'cause i wasn't taught to do that, and that was a loonngg time ago. the z-track is another separate issue.
i guess i was lucky when i worked in peds, we always had enough people to hold the child stilll enough that their movements would not change the way a procedure would be done.
3Aug 21, '09 by Danger_s11 years as RN Nurse here, I always had the Doubt, is it was really necessary to apirate ? Since I'd never hit a vessel. Well on a injection in the Deltoid 3 years ago I had enough return to fill a chemestry tube. SO PLEASE, ASPIRATE ! I was glad I followed what they thought me in Nursing School.