To aspirate or not to aspirate?! To aspirate or not to aspirate?! - pg.6 | allnurses

To aspirate or not to aspirate?! - page 6

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

  1. Visit  blondy2061h profile page
    #65 0
    Quote from So.very.blessed
    EXACTLY!! Attention any new nurses who are going to be giving Flu shots.... as cxq174 says, I also saw MANY flu shots administered SubQ, partly because we were given too short of needles (5/8") which is inappropriate for obese patients. But the other reason was poor technique not uncovering the deltoid muscle.

    A SubQ injection of flu vaccine is painful. I have seen site inflammation the next day, and I knew immediately what happened. It really hurts! If a patient can't expose their deltoid muscle in public, be sure you have a spot that is private. If not, don't give the vaccine.
    I'm almost positive I got my flu shot subq because of too short of a needle. One of my coworkers gave it to me and when I questioned it he got quite defensive saying, "Don't you think I know what I'm doing?" Okay, whatever.
  2. Visit  klone profile page
    #66 0
    Generally speaking, CDC and WHO do not change their recommendations without evidence. The fact that they say it's NOT necessary to aspirate for immunizations carries a lot of weight with me. I know that our employee health nurses, when giving us our flu shots, did not aspirate.

    Anyway, for those who are saying "where is the evidence?" here are a couple studies I found on pubmed:

    http://www.ncbi.nlm.nih.gov/pubmed/19781436

    http://www.ncbi.nlm.nih.gov/pubmed/17686797

    I could not find any studies that explored the risks of IM vaccinations being unintentionally introduced IV.

    And please note that we're ONLY talking about *vaccines*, not medications. Of course one should always aspirate for medication administration.
  3. Visit  klone profile page
    #67 0
    Quote from nursel56
    I 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.

    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.
    Actually, the published research I've been able to find on different administration techniques DO find that aspiration is more painful to pediatric patients, and the recommendation from these studies is not to aspirate, based on patient discomfort.

    Perhaps her the foundation of her opinion came from current CDC guidelines, not just from the air?
  4. Visit  So.very.blessed profile page
    #68 0
    Quote from blondy2061h
    I'm almost positive I got my flu shot subq because of too short of a needle. One of my coworkers gave it to me and when I questioned it he got quite defensive saying, "Don't you think I know what I'm doing?" Okay, whatever.
    You probably did get it sub-q. Not to worry, yes it worked fine re: immune response, but it HURT!!! (as you know) Years ago when I gave flu shots with one organization here in Michigan, they also gave us syringes with 5/8" needles... just long enough to wave at the deltoid muscle on my heavy patients. I saw the results the next day... erythema, pain, it really was nasty...

    This last season I gave flu shots with Mollen Immunization Clinic at WalMart. Our syringes had 1" needles, and they used the coolest syringes ... "BakSnap"... worked wonderfully. I was obsessive to be sure that I administered into the deltoid, so anytime a patient was wearing a tight sleeve, I made guys pull their arms out of the sleeve, and I ALWAYS took females into the bathroom to be sure I was administering in the deltoid. Several patients tried to talk me out of "my obsession", but I wouldn't budge, and described the pain of a subQ flu shot.

    So, PLEASE everyone be sure that you are hitting the deltoid administering IM. And, no, I did not aspirate and all went well (and I'm an old RN...)

  5. Visit  nursel56 profile page
    #69 0
    QUOTE=klone;4242788]Actually, the published research I've been able to find on different administration techniques DO find that aspiration is more painful to pediatric patients, and the recommendation from these studies is not to aspirate, based on patient discomfort. Perhaps her the foundation of her opinion came from current CDC guidelines, not just from the air?
    Below is the post I was responding to:
    QUOTE=PEBBLES1;3803424]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.
    I think she pretty clearly stated her reason. I haven't changed my opinion that doing or not doing something "because it hurts the person more", and that in her opinion, their is no reason to aspirate. Maybe it's me, but I see a faulty thinking process there.

    I didn't delve into the study that proves aspirating hurts more (I'll take it to work and look at it on my "break" )-- but off the top of my head, and after having given hundreds of pediatric immunization injections I would say that a) D-T hurts because of it's composition, there are many factors that come into play when giving injections to children, and most of them aren't old enough to accurately differentiate and communicate exactly what sub-factor it is that is causing them pain.

    I'm certainly not one to ignore evidence-based practices, but in the case of Pebbles, I don't think she was studying the CDC guidelines.
  6. Visit  MaxB profile page
    #70 1
    For years I have attepted to find the answer to this question. Aspiration is not necessary for immunizations, the reasoning provided by several physicians within the CDC's immunization program is that if a vaccine is injected into a vein, so what (no risk exists due to the nature of the biological). In addition, there is no guarantee, even if you do aspirate, that you are not in a vessel. Also, many nurses do not slowly aspirate, if done to fast it is not effective. The main concern is intra-arterial administration of large molecular drugs like PCN (which may be a reason to aspirate, but remember there are no guarantees, proper landmark ID when selecting your site is KEY). There are other inherent risks associated with IM injections, and they happen much more frequently. Nerve injury and abcess formation, preventable by selecting appropriate needle size and Injection site, and injecting the medication more slowly. Yet nurses refuse to change from giving injections in the dorsogluteal site to the ventrogluteal site (DG has been completely removed from nursing textbooks) and push medications as fast as possible.
    Also, aspiration is not required when giving a SQ injection.
  7. Visit  nursel56 profile page
    #71 0
    Quote from klone
    Generally speaking, CDC and WHO do not change their recommendations without evidence. The fact that they say it's NOT necessary to aspirate for immunizations carries a lot of weight with me. I know that our employee health nurses, when giving us our flu shots, did not aspirate.

    Anyway, for those who are saying "where is the evidence?" here are a couple studies I found on pubmed:

    http://www.ncbi.nlm.nih.gov/pubmed/19781436

    http://www.ncbi.nlm.nih.gov/pubmed/17686797

    I could not find any studies that explored the risks of IM vaccinations being unintentionally introduced IV.

    And please note that we're ONLY talking about *vaccines*, not medications. Of course one should always aspirate for medication administration.
    The first one is a review of prior studies and based on the parent, the nurse or the doctor observing and evaluating how much pain the child is experiencing and the second one is based on how long the infant cried when 1 injection was slow injection, slow aspiration, and slow withdrawal compared to the quick jab and be done with it without aspirating. The way we did it was something in between the two. You learn to aspirate pretty fast when you do the same motion over and over in one big endless blur of DPT shots.

    I don't think it's possible to know how much pain a baby is feeling and why he's feeling it based on so many variables and no way for the baby to say, "dude, my pain level is 10+ when you aspirate that thing so cut it out!!" or "oww-hey!!!you hit a nerve there, cowboy" Yeah, silly. I know.

    We never aspirated allergy shots or other subQs, though, and I've never drawn blood back when aspirating. So my problem is a deeply ingrained fear not unlike waiting for an hour to go swimming after a meal so I don't get a horrible cramp and drown or catching my death of a cold from going to bed with wet hair after a shampoo.
  8. Visit  Aaron86 profile page
    #72 0
    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
  9. Visit  Aaron86 profile page
    #73 0
    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-...952004.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.
  10. Visit  celticqueen profile page
    #74 0
    yup! i'm with the rest of the gang here, i always aspirate IM's

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