Do you aspirate before giving an IM deltoid injection? - page 4

by seasalt1023 90,665 Views | 44 Comments

I am hoping someone can clear up this issue for me! I am finishing up my last semester in an ADN program. Graduation is December 16th! :) In school we are taught when giving IM injections to aspirate first to check for blood... Read More


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    I have changed many of my practices based on research and EBP. Just because I was taught to do it one way during nursing school and I have done it that way for 10 years, does not mean that I don't need to improve my practice. It is my duty to the patient to stay current. This includes no aspiration prior to an IM injection, which is something we are teaching to all of our nursing students at the university where I work.
    applewhitern likes this.
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    My first semester of nursing school, when we were taught injections, we were told to aspirate. After that semester, we were told not to. And I haven't since.
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    We were taught to aspirate when doing vaccines, unless using a one-time use syringe. The other thing we were taught was not to be too aggressive with aspirating. This limits unnecessary tissue damage from damaging cells by applying too much vacuum to them. I know that EBP says you don't have to aspirate, but every so often you could very easily end up in an artery or a vein, so... some aspiration should detect that. Will I aspirate in the future? Yes, just not very aggressively.
    RN_BSN09 likes this.
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    Go with what your hospital policy says... that is what will cover you. The nursing schools that attend my work say not to aspirate anymore, and I too was taught to always aspirate with IM. We are no longer aspirating when giving Hep B to infants, but our policy currently says to aspirate for adults, so that is what we are doing until they decide to change the policy.
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    I aspirated blood once during an IM deltoid injection. It was the only time it's ever happened. And I give a lot of IM injections. I was pretty shocked. Up until that point I was beginning to think the aspiration of blood was something of an old wives tale.

    So if it IS possible to hit a blood vessel, how can EBP say aspirating is not necessary? I was smack dab right on the deltoid muscle and I sure as heck got blood when I pulled back. It's obviously rare, but it happens.

    If I hadn't aspirated, as current EBP apparently indicates, I would have injected medication intended intramuscularly directly into someone's blood stream. EBP can be proven wrong. Once upon a time it WAS EBP to a aspirate, after all.
    Last edit by BrandonLPN on Mar 11, '13
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    We weren't taught to aspirate in school and if EBP says no aspiration then that's good enough for me.
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    No you don't have to aspirate for a flu shot anymore. I would guess that in the unlikely event of it being administered IV it wouldn't really harm a person? However, this recommendation is specific towards vaccines (and for SQ I've read not to aspirate for heparin/insulin). I have aspirated blood before, from an IM injection and from a SQ injection shockingly enough(an allergy shot so I was very glad I aspirated), so will continue to aspirate non vaccines/insulin/heparin unless I see evidence otherwise.
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    Quote from Ayvah
    However, this recommendation is specific towards vaccines (and for SQ I've read not to aspirate for heparin/insulin). I have aspirated blood before, from an IM injection and from a SQ injection shockingly enough
    I've never heard of aspirating for anything other than IM. When you administer SubQ you are admin into the fatty tissue... no veins or arteries are in subcutaneous tissue like they are in the muscular tissue, so if there is bleeding it's from damaging capillaries...
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    In general, yes (for IM). But the flu program tells you not to with its injections. Not sure why but they are pretty specific about it not being necessary with their immunizations.
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    When I was orienting to my job, I was giving insulin and my preceptor said "you don't aspirate for SubQ?" I said "we only learned to aspirate for IM." She just said "ok." So yeah, she might aspirate for SubQ but I don't.


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