to aspirate or not while giving insulin and flu vaccines

[ginger43]

I have been a nurse since 1974, and I went Thursday to get a flu vaccine at the health dept. and discovered the they did not aspirate when they gave the injection. When I questioned it they informed me, this was the new recommendation by cdc. They also said this applied when giving insulin. They told me the theory was , you did not receive all the vaccine when apirated. Now if cdc advises this, what happens if this vaccine is injected directly into a blood vessel.; and insulin what happens here. I know nursing is changing but I think this is risky.

[dream'n, BSN, RN]

I do not know of any scope of practice for MAs. From what the MAs tell me they work "under the Drs license" and can do whatever they are instructed by the MD to do. As far as I've been told, they can legally do more than some nurses because they have no set, legal scope of practice they have to follow. They have no license to lose, and although some are certified, it is not mandated by law and is strictly voluntary. I haven't closely looked into it, but I believe this is true.

[danh3190]

Here are some sources:

" Given the size of the needle and the angle at which you inject the vaccine, it is difficult to cannulate a vessel without rupturing it and even more difficult to actually deliver the vaccine intravenously. We are aware of no reports of a vaccine being administered intravenously and causing harm in the absence of aspiration. (10/05)"

I managed to cannulate a vessel giving flu shots once. Got a great blood backflow. Don't know if the vaccine would have actually gone in IV or whether I damaged the vessel too much for that. It was an IM injection but I don't remember what needle size we were using that year.

[loriannlpn]

I do not know of any scope of practice for MAs. From what the MAs tell me they work "under the Drs license" and can do whatever they are instructed by the MD to do. As far as I've been told, they can legally do more than some nurses because they have no set, legal scope of practice they have to follow. They have no license to lose, and although some are certified, it is not mandated by law and is strictly voluntary. I haven't closely looked into it, but I believe this is true.

Well, that is scary! No scope of practice. I didnt think that anyone could practice under anyone's licensure... Hmmm good research project.

[loriannlpn]

Interesting, they taught us to aspirate all except for heparin.

I can not remember if it is heparin or lovenox, but they are now coming in premeasured syringes with a air bubble, the air bubble in the syringe act's almost like a Z track method. It is not supposed to be pushed out, and the bubble helps with the concurrent hematoma seen with heparin or lovenox injections.

[RNLisa]

Interesting, they taught us to aspirate all except for heparin.

Yeah, we were taught to aspirate for all but heparin and insulin.

[MS._Jen_RN, ASN, RN]

I can not remember if it is heparin or lovenox, but they are now coming in premeasured syringes with a air bubble, the air bubble in the syringe act's almost like a Z track method. It is not supposed to be pushed out, and the bubble helps with the concurrent hematoma seen with heparin or lovenox injections.

It's Lovenox. Tell all the patients that you d/c on a Lovenox script the above, their home care nurse will thank you. (It's in the mfgr info, but we all know how well people read that.)

~Jen

[majken]

Aspiration prior to injection is intended to reduce the risk of injecting vaccine into a vein or artery. Although aspiration is recommended by some experts, there are few data that support the need to aspirate.

[pedirn06]

Old habits die hard. I was taught to aspirate SQ (1991). However, when completing my RN the first of this year, yes it has changed, you do not have to aspirate SQ.

Remember when we put betadine and sugar in Decubs? Also, remember syringe-feeding?

[kentuckyphil]

I'm an old ER nurse and have given thousands of IM injections. I've never hit a vein of sufficient size to be concerned that the patient will receive a bolus. A tiny amount of blood looks like a larger quantity when it mixes with the clear contents of the syringe.

I've heard a few anecdotal accounts of getting a blood return but I doubt that there's ever been a case of someone being injured by an IM injection inadvertantly cannulating a vein during an IM injection given in a standard injection site. I HAVE seen patients injured (bruising) by poor aspiration technique and it's always more painful for the patient to leave the needle in situ (and likely moving the sharp end around a bit despite good technique) during aspiration.

With a trend toward evidence based nursing, indeed there should be a study done. I often go through the routine of aspirating, but I strongly suspect this is one of those professional practice urban legends that has little foundation in fact. Some nurse or doctor thought this sounded logical maybe 75 years ago and the practice has just been retained out of collective inertia and resistance to change - IMHO :>)

[91C_ARMYLPN]

Call me "old school"...but, I still aspirate when it comes to IM injections. It would be my luck. But, especially, I am concerned for the patient's safety. The CDC states otherwise and that's OK. I am going to continue the way I have always done it.

[BungyRN]

Flu vaccines are given IM. I understand the subcu's. I just feel this is risky on IM injections.

I'm not sure if this is just an Aussie thing, but Fluvax here is recommended as deep sub-cut, not IM. (mind you, it also says "do not inject directly into a vein).

My concern about aspiration is this: risk management does not just measure the relative frequency of the risk, but has to be weighed against the potential damage of an action. I don't know how dangerous an IV Fluvax would be, but I do know that a bruise won't do me much harm. I'm going to continue to aspirate. (Gently!)

Kathy

[hanging in there]

I've yet to give a real shot, so please let me know which way is right, aspirate or not aspirate.