Aspirating for blood when giving injections to infants?....Have the rules changed?

[DutchgirlRN, ASN, RN]

My grandson got his second set of immunizations today. I was done with work and knew where they were so I stopped in. I got there just in time to see him get the immunizations. He got 4 in 4 different syringes which I realize is normal now-a-days. I don't ever like to make it known that I'm a nurse. It makes some people uncomfortable and I don't ever want to come across as a know-it-all so I just stay quiet on the subject. This young woman, probably early 20's came in with the syringes. The needles looked to be 23G 5/8". She stuck him twice in the front of each thigh. She was not far enough over to the lateral aspect and also did not aspirate for blood. It happened so fast but I watched her with all four injections. She promptly left the room. I was kinda stunned. My daughter was like "Mama" is something wrong? I told her I didn't think the immunizations were given properly. This young woman was very fast, I'll give her that, she was polite, she had no identification on. I'm thinking that I should go back there and discuss it with her or the office manager or the nurse, if they have one. I'm not looking to get her in trouble but gees that's my grandson and all those children are somebody else's. I've only gotten blood back once in 30 years while aspirating giving an IM injection. But hey it happens. What do you think I should do? Check it out? or Do Nothing?

[SouthernLPN2RN, MSN, RN, APRN, NP]

The office I worked in routinely used the front of the thigh because that was where the muscle could be pinched up a little. Not saying it's right or wrong, just the access to the muscle was a little easier that way. We never aspirated. I hope he feels okay!

[Roy Fokker, BSN, RN]

Hmmm, we're always told to aspirate unless we're giving something "special" (Heparin etc.)

[leslie :-D]

i don't know joanna, i see your concern and it's valid. but quite honestly, i don't always aspirate my im's because i'm that sure i'm in a muscle. but if i were giving injections to a population i wasn't familiar with, i would undoubtedly aspirate.

i do remember giving a vit k injection to a newborn, right on his quads. i aspirated, got blood but was told to proceed with the injection because i was definitely in his muscle. so i proceeded. never felt comfortable with their rationale and would withdraw and start anew if that ever happened again. thankfully it hasn't.

leslie

[christymwinn]

Joanna,

I worked in a pediatrics office as well and had to give immunizations on a regular basis. When I first started out, I did aspirate. But as the injections increased to 4 and 5 at a time (yes, 5), I started making it a practice that both of the nurses went in and did the shots at once. After time, I did not aspirate anymore and that was after lengthy discussions with my nurse manager and my DON to make sure that it was a proper procedure.

If I ever had any doubts about my IM's I would aspirate, but I have to agree with southern, that in the front of the thigh is where we gave our shots and you pretty much know where you are there. I hope that helps.

Christine

[DutchgirlRN, ASN, RN]

You guys have made me feel better. I didn't want to go in there complaining if things had changed and obviously they have. He is fine this morning. Very slight temp but has a minor right ear infection also. Thanks for the comments.

[Meerkat]

Hi! Hope the baby is well!

I brought up a similar question a while back when my DD was vax'd. The thing is, she got the air gun vax, which cannot mechanically aspirate for blood. So I question the need for it, especially if the baby has that big old vastus visible.

(By the way, if they ever give you the choice of air gun or syringe, I'd stick with the syringe!)

[Roy Fokker, BSN, RN]

(By the way, if they ever give you the choice of air gun or syringe, I'd stick with the syringe!)

Could you elaborate please? Why choose the syringe over the gun?? :)

[Fun2, BSN, RN]

Ok, this may be out of the normal here, but what happens when there is a defect in "wiring" that you don't know about?

Obviously there could be veins, etc., not in there normal place, and unless you aspirate, how would you know?

BTW, I always aspirated with IM's, but have never had any blood to appear.

[Meerkat]

Could you elaborate please? Why choose the syringe over the gun?? :)

Well, it's just personal I guess. This was at a military hospital, and I do not know if it is standard just in military installations or what, but a tech, not a nurse gave the vax. Not that techs are bad, but I would rather have a nurse administering with a syringe, because he or she hopefully has good siting technique as well as skill in administering in order to minimize pain. Also, just in regard to the equipment, the airgun seemed kinda...well...violent with that THWAP! sound, which also startled my baby. At the very least, the syringe doesn't make that scary sound. Of course, this could just be the protective mother in me that's talking.

[leslie :-D]

i've been told many times that my injections don't hurt. i highly doubt i would get that kind of feedback with an airgun. there's definitely more control when using a syringe.

leslie

[Roy Fokker, BSN, RN]

Well, it's just personal I guess. This was at a military hospital, and I do not know if it is standard just in military installations or what, but a tech, not a nurse gave the vax. Not that techs are bad, but I would rather have a nurse administering with a syringe, because he or she hopefully has good siting technique as well as skill in administering in order to minimize pain. Also, just in regard to the equipment, the airgun seemed kinda...well...violent with that THWAP! sound, which also startled my baby. At the very least, the syringe doesn't make that scary sound. Of course, this could just be the protective mother in me that's talking.

Fair enough! Thanks for the response! :)

Leslie: Thanks! That is one aspect I hadn't considered - control!