To aspirate or not to aspirate?!

Nurses General Nursing

Published

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...

Specializes in GSICU, med/surg.

I think money is a strong motivator for those that thing aspiration is not needed. Its because they KNOW a vein will be hit, its statistically going to happen if you inject enough people, and medication is wasted. Well boo hoo to them, do what you were taught and stick to your guns ALWAYS ASPRIRATE. Its your license after all, shame on them for telling you otherwise!!

Up Vote Up Vote ×
i decided to check out a reference posted earlier...

http://www.immunize.org/genr.d/issue297.htm

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."

interesting, huh?

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!

this is only for immunizations (not aspirating) not other medications.

otessa

Up Vote Up Vote ×

Apparently when injecting anticoagulants (heparin, lovenox, clexane, enoxaparan) it is recommended NOT to aspirate as it may cause bleeding at the site. Aspiration with anticoags can harm the patient by causing tissue damage.

Up Vote Up Vote ×

Um I think they are talking about IM, not Sub Q.

Up Vote Up Vote ×

I'm still trying to decide what I think about this. A few days ago I had to give a vaccine to a 7 year old and he was totally worked up (and big, over 100 pounds, his dad had to really hold him down for me to give him the shot and that I'm sure made it all worse), but I got a blood return for the first time ever! Then yesterday, I took my own 7 year old in for a hep A vaccine. She didn't aspirate and it was over in a second, no trauma, no soreness today. Now he's much less afraid of shots. I guess my big question is what will happen if you do get into a blood vessel and inject the vaccine IV. Will it still produce an immune response? Could it cause an embolism?

Up Vote Up Vote ×
Specializes in Oncology.
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.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

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.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
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?

Up Vote Up Vote ×
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...)

:nurse:

Up Vote Up Vote ×
Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.

Up Vote Up Vote ×

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.

Up Vote Up Vote ×
Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.

Up Vote Up Vote ×
+ Add a Comment