To aspirate or not to aspirate?!

Nurses General Nursing

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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...

I 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!!!

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I 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"An outdated practice is the drawing up of an air bubble into the syringe after the medication has been prepared.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.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
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 [23].

source: [color=http#800080]://uqconnect.net/signfiles/archives/posts00462-464-aspiration.txt

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.

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11 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.

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Specializes in OB/Gyn, L&D, NICU.

The nurse who gave my daughter her vaccinations yesterday was happy to aspirate upon my request :specs:

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I am an immunization specialist with a University in Northern Virginia. You do not have to aspirate, as of 2006. According to the Immunization Action Coalition, www.immunize.org, aspitating is not necessary. This is also backed by the CDC, the Center for Disease Control, www.cdc.gov.

Good luck and aspirating is not necessary.:nurse:

Cathy

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
I am an immunization specialist with a University in Northern Virginia. You do not have to aspirate, as of 2006. According to the Immunization Action Coalition, www.immunize.org, aspitating is not necessary. This is also backed by the CDC, the Center for Disease Control, www.cdc.gov.

Good luck and aspirating is not necessary.:nurse:

Cathy

Thanks for those links! Do you have a more specific link as to the CDC backing this organization? What was their rationale? Does this apply to all injections, or just immunizations? Thanks!

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Specializes in General.
Thanks for those links! Do you have a more specific link as to the CDC backing this organization? What was their rationale? Does this apply to all injections, or just immunizations? Thanks!

Most organization or medical authority provide no complete support on eliminating aspiration on vaccines inj. So, I undoubtly agree that we follow available local policy. :)

I also agree that the discussion is restricted to vaccines injection. For other i.m. injection it is clear to be aspirated before.

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11 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.

Where is the evidence??? Somebody show me some research that proves that there is no risk to the patient should an administered vaccine/medication be injected into a blood vessel. I don't care that the CDC says that aspiration is no longer necessary, where is the evidence to prove that? I appreciate that at least the WHO admits that there is not enough evidence to recommend aspiration or no aspiration. This may sound exreme, but is there any way of knowing for sure that, had the above nurse not aspirated and realized she was in a blood vessel, that the patient would not have been one of the "unexplained" deaths following an injection? As a nurse, I have always aspirated. As a mother, I would appreciate if the decision as to how to administer an injection to my child was not made based on low risk, but on NO risk. Please aspirate until there EVIDENCE to PROVE it is unnecessary.

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Specializes in NICU.
I 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.

This is a different issue. The quote you provide about drawing an air bubble into the syringe is not the same thing as aspirating for blood return after sticking a patient for an IM injection.

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Specializes in Trauma/ED.

Great discussion! I was taught in nursing school to aspirate but learned in CE that the new evidence did not support this practice so now I do not aspirate but always use Z-track method and couple thousand IM's later have never had an issue. I'm betting most of the problems associated with IM injections were not d/t aspirating or not but rather in site choice and technique.

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Specializes in Med/Surg, Academics.

The WHO doesn't make a recommendation one way or the other. The CDC recommends not aspirating with vaccines because of low risk, but I must have missed the converse: is there risk associated with vaccine aspiration in the CDC's report. Are they saying that the one time that a nurse does hit a vein, there is no associated complication? Are they saying that correct site selection will completely prevent hitting a vein?

I'm confused by the CDC's rationale for recommending no aspiration. Can anyone help explain?

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