IM injections, to aspirate or not?

[Pia Mater]

I am a 1st semester ADN student. We were told that we should aspirate when giving IM injections, using the Z track method, wait 10 seconds after med is in before removing needle. That is the method we were taught.

We were giving flu vax today in clinicals today. We were at a LTC facility, and another clinical group from my school was there as well. They were talking amongst themselves, and I overheard them saying that they were told that they do not have to aspirate when doing an IM injection. I did not catch the reasoning they gave for not doing it, but I found it odd that they are in the same school as us and are being taught different techniques. Now I know that there are more than one way of doing things, but usually in school they are so strict about these things.

What were you taught? Do you aspirate for blood when giving an IM injection?

[JROregon, ASN, BSN, RN]

My 2 cents .... the flu shot is only 0.5 mL of solution in the deltoid muscle. Such a tiny amount, you wouldn't need to use the z-track method. The Z-track only needs to be used with large quantities of poorly absorbed fluid (oily or irritating). The Z-track methods prevents those large amounts from coming right back out of the puncture you've made. Those Perry and Potter books kinda stink.

[SeeTheMoon]

We are taught to aspirate. Not necessary for deltoid IM though. We were taught the 10 sec rule for z track as well. Ditto to the response that the cause is for assurance of med absorption, especially if the med is caustic to the skin and/or subq.

[tothepointeLVN, LVN]

We learned this semester to NEVER aspirate and not to use the dorsogluteal site. The hospital group in which we do most of our clinicals has a no aspiration policy. This is relatively new, as my clinical manual from 2009 teaches aspiration. There was a thread about this last month, elsewhere on this forum, and someone posted the following rationale for not aspirating:

"Aspiration of the syringe plunger once the needle has been inserted into the muscle is an accepted part of IMI procedure but there is no evidence of the need to do this. Justification includes to ensure the drug does not enter the capillaries (Hunter, 2008) or to avoid inadvertent IV administration (Workman, 1999).

Aspiration may be relevant to detect possible penetration of gluteal artery when the dorsogluteal muscle is used - this would indicate incorrect initial land-marking. However, official guidance (DH, 2006; WHO, 2004) does not recommend routine use of the dorsogluteal muscle, and this should be sufficient to justify changing practice. If this site were removed from routine practice, aspiration could be removed from the procedure, simplifying it and reducing the risk of adverse events. Pharmaceutical developments including reduced volume and less caustic injectates, along with prescribing changes, now support its removal from selected injection sites.

Some auto-disable devices (syringes where the needle retracts automatically after IMI administration to prevent needle-stick injuries) are triggered by the 'aspiration' type manoeuvre, so the technique has already changed in many countries.

References

Malkin, B. (2008). Are techniques used for intramuscular injection based on research evidence? This article debates the evidence surrounding the nursing procedure of administering intramuscular injections. Nursing Times, 104(50-51), 48-51. Retrieved from EBSCOhost."

https://allnurses.com/med-savvy/im-injection-621475.html#post5739533

Thank you I will be printing this out. I often find when addressing older nurses about this issue they always feel that it's the new nurses not being sufficiently trained vs the fact that things change and we should alway endeavor to practice evidence based nursing. It couldn't be that we actually *gasp* know something