to aspirate or not while giving insulin and flu vaccines

smk1, LPN · Nov 7, 2006

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

If you are a student, the correct way is always to follow the standards of your program. If you are taught to aspirate for IM then that is what you need to do. Follow this line of thought for all procedures while in school to avoid trouble.

twotrees2 · Nov 17, 2006

That's interesting...I hit a vessel the other night with a SQ heparin shot in a belly. I pulled back and that sucker FILLED with blood - I got a nicer backflow that I usually get with an IV start, lol. I think I'm going to be aspirating my insulin injections despite the recommendation...I work with a nurse who got a backflow on an insulin shot in an arm about a year ago. Granted, the risk is small, and I doubt 2 units would be awful, but what about my out of control people who get 20? Or 30 of lantus? I don't think I'd want to give that IV. I think I'll have to check my policy...I've always aspirated. Hmmmmmm...

i dont see hwo giving sq you could even give it iv - unless someone does not know how to do sq ( get a nice bubble and your sure its sq) there is no way to hit a vessel that i can see. with hepaarin if you pinch the skin ( you can feel the difference between pinching muscle vs skin) and go in the fold you are pinching yo know its going into the skin so how could you hit the vessels which are not in the sq layer? just wondering how it could happen.

twotrees2 · Nov 17, 2006

At my job all of us have heard and discussed the new CDC guidelines about not aspirating. All of the nurses so far have refused to stop aspirating. I have personally gotten blood back during aspiration (granted very rarely, but I was an injection nurse and did upwards of 50 to 100 injections a day at the time.) Not aspirating just doesn't feel like safe practice, no matter what the CDC is saying. By the way, please don't flame me, but at a conference I recently went to the CDC presenter stated that the new guidelines were released because of the worry that more and more MAs were giving injections and that the CDC is concerned about tissue damage from 'too forceful aspiration,' although I have never heard of or seen that before. He said that the risk of injection into a vessel was lower than the risk of tissue damage from aspiration. Now that is not my opinion, I work with MAs that could dance all over some nurses when giving injections. Just food for thought...they also said no more gluteal injections either, everything that went dorso-gluteal is now to go in the hip, ventral-gluteal.

sa much as i hate gluteal ( id hate to be the one to hit the nerve - cross section or not doesnt gaurentee not hitting the damn thing) but i would cringe even more at a hip shot- i have only done ONE hip shot and it went to deep and scraped bone and i will never ever forget the sound ( poor patient thank god they were so sweet with me being a student and all - they werew sore but apologized to me that they moved a bit trying to make excusess for MY mistake) - guess i cuold try it now that i have been doing injections so long now but that noise - just cant get it out of my head yrs later lol.

twotrees2 · Nov 17, 2006

I feel it's wrong not to aspirate. I wonder sometimes about B12 as it's red coloured anyway. Subq I have never aspirated for because this is how I was taught.

i hate b12's - i agree they shoudl change the color lol.

twotrees2 · Nov 17, 2006

So the CDC recommends not aspirating when giving vaccines? That means we're now supposed to stop and think, "Oh, I'm giving a vax so I'm not going to aspirate?" I don't think so! I agree fully with the poster who said that if aspirating is not recommended just because it may be unneccesary, then we might as well do it anyway to be safe. I would hate to forget just once what I'm giving and not aspirate because we are now being told not to with vax, only to find out I should have aspirated and I hit a vessel and caused a problem. Methinks that saying "I thought I was giving a vaccine" is not going to wash when I'm standing in front of the BON after being turned in for harming a pt.

i agree all IM's shoudl be aspirated - the only advantage i see is a tad quicker injection - id rather a second more for safety. but truly ( i wsa out of nursing for 4- 5 ys so maybe something changed) id really like sq aspiration explined to me as i just dont get it........................ if i missed something id be appreciative to be told it as i cant learn new stuff if noone tells me :) tanks for an explanation.

twotrees2 · Nov 17, 2006

I cannot address the aspiration of flu vaccines, but I do know a bit about heparin and insuling injections.
Aspirating heparin or lovenox is unnecessary as long as you stay two inches away from the umbilicus. You are injecting with a short needle at a 90 degree angle into an area that doesn't contain major vessels. The fact that they are anticoagulants can, all by itself, produce a blood return. It is a waste of expensive medication and a valuable injection site to make another attempt bacause you are not familiar with the principles at work and the guidelines sent with the medications. The manufacturers specifically say NOT to aspirate.
Aspirating insulin is also unnecessary. Again, the short needle and the angle of injection make injecting into a major vessel nigh unto impossible.
I've been injecting Lantus into either thigh on a nightly basis for a long time. (I save abdominal sites for Humalog.) On very rare occasions, I will see blood. What research and experience have taught me is that you can hit a small vessel (all that is reachable sub-q) and still not be in any danger of giving that insulin IVP. Even with the high doses I use. The worst thing that happens is a small bruise. I have never noticed any kind of difference in blood sugars or symptomatology following a stick that bleeds.
The literature that is available does recognize that a small vessel might be breached, but nothing equates that sort of through-and-through puncture with the kind of access available through an IV cannula. One of the reasons that we quickly pull a blown IV is that any medication going in through that line is escaping with the fluids into the surrounding tissues. The same principle is in operation with the puncture of a small vessel. Hemodynamic pressure will push blood OUT rather than allow the medication in. That would be true even if the needle ended IN the blood vessel. What is far more likely is that the needle will end up in good ol' sub-q tissue. Either way, the patient is not in danger.
People who need ongoing multiple injections become protective of their available sites. Please do not aspirate out of habit when it is not recommended.

yes this is what i was taught - but am open to anyone who can give me a valid rational for aspirating these 2 - i am all ears for learning if anyone can explain the stance.

twotrees2 · Nov 17, 2006

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?

oh yeah - i hated the feeding syringe- just felt wrong but knew we had to to keep them alive- back as a cna - before i learned sometimes its best to just let go..........................begging them please i dont want to do this help me and eat. .................. ( even though i still have a hard time letting go lol - once y alove em ya hate to let em go )

wrist restraints, vests, chairs with hard tables to keep em from gettingout of bed or chair,, side rails, hypo of haldol to calm a violent resident - all gone and most for the good.

Elvish, BSN, DNP, RN, NP · Nov 17, 2006

I was taught in nursing school (2001 grad) to aspirate on IMs but not on SQs. I have since aspirated on every IM I have ever given, vaccines included. I worked in community health for over 3 years and gave hundreds if not thousands of vaccines. I aspirated on every IM and while I've never gotten a blood return, I will continue to aspirate. Now I work mother/baby and NBN where I give boatloads of HepB and Vit K. Believe me I aspirate every single one of those. If you do your landmarks right, you should be ok, but as one of the other posters says, it would be just my luck, on the one I DIDN'T aspirate, that would be the baby that would get their Vit K IVP. It's a CYA thing.

Yuliya3 · Nov 17, 2006

I worked in amb. clinic for 6 years. Never aspirated any SQs, did not aspirate IM vaccinations ( as per clinic and CDC policy), always aspirated all other IM injections inc. vit. B12 ( I think if I would have hit a major vessil,there would be some color change :) ) . I also gave myself Fragmin inj. ( LMWH - like Lovenox),during my last pregnancy, did not aspirate and still survived .

kimberly518 · Nov 21, 2006

i see no reason not to aspirate. its another precaution that we can use to decrease any additional problems for our patients. and it only takes 1 second at most.

you can so how many thousand times youve given an injection and not enter the vein- use that as your arguement. but you dont know for sure unless you aspirate. its not going to do any additional harm (unless poor techinque is used).

ac45289 · Apr 7, 2009

I feel as though some nurses are still living in the dark ages. Our practice will change over time, and that is a good thing. We need to practice evidence-based medicine. "Because that's the way we've always done it" is an irresponsible and ignorant statement. It seems as though some nurses have decided to pick and choose which CDC guidelines they think are the best, and I think that is dangerous practice. If you do not believe the CDC than take initiative, conduct a study, and prove them wrong. My 2009 nurse practitioner textbook also states that aspiration is not indicated with vaccines.

GrumpyRN63, ADN, RN · Apr 7, 2009

Insulin no, sq not necessary, Flu yes . IM always aspirated, always will. It's the safest way to go, and really takes no time. It's in the pt's best interest, why wouldn't we...