I've read a couple of different opinions on aspirating when giving IM injections. In school we were not taught to aspirate. (The only time we were taught to aspirate was when checking placement/contents of g tube.) Now I work in an office and yesterday an MA was with me when I administered a flu shot and freaked because I didn't aspirate. The MA's I work with say that's completely wrong...you always aspirate.
Is this something new (NOT aspirating?)
Here's a link from immunize.org stating that it isn't necessary.
On the flip side, I had a similar experience to the OP about 2 months ago. At that time, I was precepting a new LPN on my floor and he was going to administer the influenza vaccine to a patient. Before stepping foot in the patient's room, I had him pull up & review the hospital's policy on giving injections. Just like I was taught in school, the policy states that you must aspirate on IM injections. The LPN just looked at me with a confused expression and said something like "We were never taught to aspirate in school because the instructors said the chances of hitting a blood vessel aren't that great". I gently & politely explained to him that, even though it wasn't the way he was taught in school, he had to follow the policy of the hospital. I think this made him so nervous because he "forgot" to do it and before I could even stop him, the vaccine was administered.
The ironic part is that I attended the same school as this LPN and had many of the same instructors as him. I guess things changed in the few years since I graduated.
I am currently in NS, and we were taught to aspirate for IMs. I think I remember the instructors talking about how it isn't completely necessary anymore, but they are still going to teach us to do it that way.
We were also taught to compeltely start over with a new needle and everything if we DO get blood return on aspiration. However, at clincals, the nurses say to just pull back a little and try again. Is this common practice?
I guess different schools have different techniques. I attend a nursing school in California, and when doing an IM injection you always aspirate to make sure you are not administering the medication into a blood vessel, vein or artery. An IM injection is specifically suppose to be injected into the muscle, not a blood vessel, vein, or artery. I would ask the nursing supervisor or person in charge the procedure they prefer to be done there and follow their policy and procedures. The confusing thing about nursing is one nurse can do something one way and another nurse can do it completely different. Who can tell who is doing what right?
i just graduated this month. we were originally taught to aspirate, but recently told that updated guidelines were not to aspirate.
in looking for a reference for this (out of curiousity) i found the one below, which interestingly also says that there is no need to clean the site with alcohol - which i was also taught to do.
here's the reference and relevant quote:
injection technique for immunisation. by: diggle l, practice nurse, 09536612, january 12, 2007, vol. 33, issue 1
cleaning the skin with an alcohol wipe before an injection continues to be practised yet is not necessary. although isopropyl alcohol will reduce the number of bacteria on the skin, research has demonstrated that this makes little difference to the incidence of bacterial infections after injection.( [color=#990099]n3, [color=#990099]n4) current advice is that if the skin at the injection site is dirty, simply washing with soap and water is adequate.( [color=#990099]n5)
another outdated procedure is aspirating immediately before injection.( [color=#990099]n5, [color=#990099]n6) for decades, nurses have drawn back on the syringe plunger before an intramuscular or subcutaneous injection to ensure the needle is not sited within a blood vessel. in a 1930s medical journal article, it was suggested that one could mistakenly enter a vein when administering large doses of penicillin. although critics argued that depositing vaccine in a vein when injecting at a 45° or 90° angle was almost impossible, the procedure of aspirating became widely accepted.
there is no scientific evidence to support aspiration before injecting a vaccine. consequently, the world health organization (who), the american academy of pediatrics and the department of health have stated that this practice, which serves only to prolong the injection procedure, is not necessary."
I'm still in nursing school (5 months to go) and we were taught to aspirate IM's. However, in the clinical setting, when I was giving my first IM, I was talking through it to the instructor and I said I was going to aspirate and she looked at me shrugged her shoulders and said, if thats what they taught you in clinical lab and fundementals, ok.
After the injection I asked her if I had made a mistake w/aspirating. She said, years ago when she was in school they were taught to aspirate. But for years now, she said its not the norm to. But if it was taught to us and in the book, make sure to do it with the other instructors.
I err on the side of caution. I'd rather take the extra 0.3 seconds to aspirate than not to and inject an IM med IV. Thats just me.
I was taught to aspirate back when I went to school for medical assisting, that was in 1994. But, when I went to school for my LPN, just graduated last May 06, we were taught not to aspirate.
Times have changed.
In all my years of giving injections I have only had blood return once and wouldnt you know it was on a 10 year old. I discarded the syringe and started over. "I felt so bad" that I had to stick the patient again.
Im currently a nursing student in my last semester at a school in Alabama and we've always been taught to aspirate. Also, although I havent been giving meds for very long I once aspirated when giving a vaccine IM and got blood return...so it would have been given IV had I not aspirated. I know its rare, but it does happen.
Maybe its just me, but aspirating only takes about a half a second, so I'd just do it and feel better knowing im preventing any complications.
swee2000
258 Posts
I was also taught to aspirate for IM injections.
On the flip side, I had a similar experience to the OP about 2 months ago. At that time, I was precepting a new LPN on my floor and he was going to administer the influenza vaccine to a patient. Before stepping foot in the patient's room, I had him pull up & review the hospital's policy on giving injections. Just like I was taught in school, the policy states that you must aspirate on IM injections. The LPN just looked at me with a confused expression and said something like "We were never taught to aspirate in school because the instructors said the chances of hitting a blood vessel aren't that great". I gently & politely explained to him that, even though it wasn't the way he was taught in school, he had to follow the policy of the hospital. I think this made him so nervous because he "forgot" to do it and before I could even stop him, the vaccine was administered.
The ironic part is that I attended the same school as this LPN and had many of the same instructors as him. I guess things changed in the few years since I graduated.