Question about IM vs IV injection, when to aspirate, what to look for

[jeshicuhx3]

Hello everyone!

I am in nursing school right now, and my father has diabetes.

We recently went over our prescription drug coverage for the year,

so his doctor decided to have him do weekly IM injections at the top of his glutes.

Since he can't do it himself, obviously, they showed me the procedure for doing it.

However, I have a couple of questions (that I forgot to ask at the time).

I've done some research, and some sites say that you don't have to aspirate before doing an IM injection, and some sites say that you have to aspirate, and when you do, if you draw back blood that means you hit a vein/artery. So my first question is thus: do I aspirate or not? And if so, I make sure that no blood draws back, right?

When they showed me how to do it, I don't recall her aspirating, she just quickly "jabbed" the needle in (that's the best way I could describe it, it kinda shocked me since I'm not that far into my training lol).

My third question is this: for IV injections, if you draw back blood, that always means you are in a vein, correct? And there is no chance that you hit a muscle, right?

All responses are greatly appreciated!! I'm about to apply to TWU in February, and I'm so excited! I have a 3.9 GPA (just .1 more point would be so great! lol), and I have 3 more years until I have my BSN!!! :] Science is my life, and I can NOT wait until I can become a neonatal nurse and take care of newborns :] I'm also excited that I have the chance to practice certain things like injecting medication for my parents (my mother has MS and I sometimes help her injecting her daily meds). I also have a 3 year old, so cleaning boo-boos and taking care of her (giving her medicines when she is sick) is something I love. I don't necessarily enjoy her being sick, but it makes me feel good to have the knowledge of how to take care of her when she is sick or hurt.

Sorry to ramble, but I just wanted to give a little background information so people aren't like, "how do you not know this if you're in nursing school?" I haven't quite gotten to the point of doing clinicals yet, or anything like that. However, I am a fast learner, and it's always better to ask questions if you don't know something.

Anyways, if someone could clear up this confusion for me, that would be great!

I put the 3 questions I had in bold, so that it is easier for everyone to see them in my long, rambling thread, lol.

Thanks again everyone for the help!

Jess

[dodiewayne]

I always aspirate any IM injection. This is how I was taught. Yes if you draw back blood your in a vein. Pull out- prepare med again as that one is contaminated and do again. As far as IV meds...I am a LVN and cant IV push meds...that has to be done by RN...unless certified within your company and certification is only good with that company...but also put license in jeopardy per TX BON because according to them its not within my scope of practice. ..ugg. Good luck with nursing school...you have chosen an awesome and rewarding career!

[jeshicuhx3]

Thank you so much!! I've always loved science, but it wasn't until the birth of my 3 year old daughter that I realized that I wanted to become a Neonatal Nurse... I'm not sure if I will be doing many injections unless I work in the NICU, but I'm sure I will have to learn it during clinicals. I am so very excited! I can't wait for clinicals!!! I love helping people... my family and friends always come to me with health advice, and I tell them what I know but I also recommend they talk to their family doctor instead of just taking my word for it, as I am not an expert... yet! ;]

Thanks for your reply!

So the only question I still have left is about the IV injections... blood ALWAYS means you're in a vein right? And when you're doing IM, you should aspirate and look for air, and if there's blood, you start over because it's contaminated with blood.... right?

Just want to make sure I have it all down now.. once I learn something, I never forget! Lol

Oh, how I love science!!! I could talk about it for days lol

-Jess

[applewhitern, BSN, RN]

I was taught, back in the dark ages, to aspirate. That said, I read here on AllNurses, that it is no longer recommended to aspirate and check for blood.

[rumwynnieRN]

I graduated last December and yes, you check for blood (or well, you're suppose to, some nurses won't and it works for them).

May I ask what medication this is? And did you mean ventrogluteal like near his hip rather than his actual glutes? The injection site has changed (and I've found some of my coworkers and some of the doctors aren't aware of it).

I hope I didn't come off as catty -_-; If I did, I apologize x.x;

[ChipNurse]

I was taught to aspirate in all IM injections except the deltoid. When I go to flush an IV or PICC I always draw back to see if I get a blood return. Also, sometimes with a peripheral line, you won't get a blood return because a fibrin clot will occlude the catheter.

[BrandonLPN, LPN]

I was taught, back in the dark ages, to aspirate. That said, I read here on AllNurses, that it is no longer recommended to aspirate and check for blood.

I've heard that it's outdated, too.

But I'm still gonna do it, until a higher-up explicitly tells me otherwise. I learned it that way in school, and our policy says to aspirate with every IM. I can't see as there's any harm.

And if GrnTea or anyone says anything, I'll just say it's because "that's the way we've always done it around here." :)

[StudentForever77]

What I learned is that if you get a blood return, you're in a vessel (doesnt necessarily mean it's a vein) and if you continue on to inject, you're no longer giving an IM... youre shooting it into the bloodstream...which would not be the right route anymore.

The only exception to aspiration is immunizations. You just inject those....This is a recent change as you used to aspirate those too. I recently asked for the rationale supporting this but I can't seem to find anyone who knows (and im too busy to look it up lol)... I think a textbook cited the CDC...Pretty vague, I know.

All other IM injections require you to aspirate. Blood return= no go...do over.

As a disclaimer, I'm sure there are always some unique circumstances with particular drugs or patients. .. I'm stating the most current basics of IM.

[BrandonLPN, LPN]

OK, I got curious and bored.

Here's the results of one study I found online:

Although the authors were most interested in aspiration’s effects on

injection-related pain, other injection technique evidence-based

information was also gathered. Literature review conclusions were:

• A rapid IM injection technique without aspiration results in less

pain.

• Aspiration does not confirm correct needle placement.

• As a result, aspiration is not a recommended procedure for IM

injections in any age group.

The bit about aspiration not confirming correct needle placement puzzled me. If one aspirates blood, I was taught that means the needle hit a vein.

I aspirated some blood once. Doesn't that indicate I hit a vein? Wouldn't the patient have been harmed if I injected the medicine directly into his blood stream?

Or is it possible all I aspirated was capillary blood or something? Since I wasn't sure, I withdrew the needle, discarded it and drew up a new syringe and gave another injection as per policy.

I give a lot of IM rocephin at my job, so I feel I should continue to aspirate...

[roser13, ASN, RN]

When you say "IV injections," I think you're referring to giving a medication intravenously? Those meds are traditionally given through a port in a pre-existing line that is giving maintenance fluids or directly into a saline/heparin lock. In other words, a med is rarely just injected straight into a vein - usually just emergently.

But yes, when the initial IV is started, you would know that you're in a vein when you receive a flashback of blood thru the stylet.

[classicdame, MSN, EdD]

True story: Our Infection Control nurse provides literally hundreds of flu vaccines. He told me he always aspirates, and never in all his long years had a blood return until the ONE time he did. He was glad he had kept up that practice as the vaccine is not recommended to be IV. Just saying

[jeshicuhx3]

Thanks everyone! When they showed me how to do the injection, she just jabbed it in and slowly pushed the plunger... no aspiration at all. And it is at the top of the glutes... I find his hip with the tips of my fingers then do the injection in the crook of my thumb and pointer