to aspirate or not while giving insulin and flu vaccines

danh3190 · Apr 7, 2009

Here are some sources:
http://www.immunize.org/catg.d/p2021f.htm
"ACIP does not recommend aspiration when administering vaccines because no data exist to justify the need for this practice. Intramuscular injections are not given in areas where large vessels are present. 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)"
From the CDC:
http://www.cdc.gov/mmwr/PDF/rr/rr5102.pdf (page 12)
"Although certain vaccination specialists advocate aspiration
(i.e., the syringe plunger pulled back before injection),
no data exist to document the necessity for this procedure."

The lack of data to document the necessity of aspiration doesn't necessarily mean that there is data to show that aspiration shouldn't be done, i.e. that it's harmful or costly or time-consuming. It would be great to have good evidence for everything we do but we don't yet and we act on theoretical possibilities.

I've only gotten one blood return with IM flu shots but it was a good one.

Ayvah, RN · Apr 7, 2009

I think its important to assess the whole scenario - the type of medication and the person included. Some people, for example, have almost no sq fat.

I aspirated blood once while giving an allergy shot. I was wondering if it was just a flash but no, the blood kept coming and coming. Allergy shots that go correctly SQ have a real chance of causing anaphylaxis as it is. Even the most minute chance that it could go IV could have deadly consequences. I will take a bruise anyday over that.

Havin' A Party!, ASN, RN · Apr 8, 2009

... Our practice will change over time, and that is a good thing. We need to practice evidence-based medicine...

Agree.

Too many of us fall into the trap of "I've always done it that way," and become closed-minded about improved techniques, and changing standards of practice.

psurn1 · Sep 29, 2010

I am one for evidence based practice and teach not to aspirate for SQ, however for IM's call me old schooled. Today while observing a student administer the flu vaccine IM in the deltoid, we did aspirate... lo and behold the syringe filled with blood... we removed the needle, and redrew the vaccine in a new syringe and administered. This does not occur often, however it did this time!

CJPellerinMA · Oct 28, 2010

i noticed that someone brought up ma's and what they are taught. i am currently an ma student and when we do our mock vaccines in lab we are taught to aspirate on every injection im id sq. i'm not sure how all ma schools are... i live in louisiana...so other schools in other states may be different...but aspiration is mandatory for us here.

flyingchange · Oct 28, 2010

I have a slightly different perspective on this.

I wonder if not aspirating IMs would change pain perception.

For you nurses that have given a zillion IMs you're probably so good that it wouldn't matter, but for newbies like me who fumble that syringe once it's in muscle? I wonder if the reduced movement would improve the sensation.

janeybirdRN · Sep 30, 2011

I know if you inject air into the bloodstream it can be pretty bad. what if you inject air into a muscle? would 1 mL just cause a lot of pain or could it be worse? I think I saw this happen today with someone I was working with and I didn't know what to do. It was 0.5 mL and there must be an amount somewhere that makes it too much. The patient was male, and had well developed muscles if that means anything. Now I am worrying and don't even know if once it was done there is anything you can do. Is there some type of test to see?

hiddencatRN, BSN, RN · Sep 30, 2011

Hi, I am a nursing student and we are taught to aspirate when giving any IM injection, however we gave flu shots over at the health clinic and the instructions were not to aspirate. The reasoning was as stated above and also because the risk of going into a blood vessel when giving an IM into the deltoid is very minimal.

I hit a blood vessel in a deltoid just the other day while administering IM abx. Got a syringe full of blood. I was pretty shocked: I gave a ton of flu shots last season and never hit a vessel.

I don't understand how aspirating means you wouldn't get all of the vaccine.

Clovery · Sep 30, 2011

I am a nursing student and just passed my injections practical. We were taught that you NEVER aspirate. They actually made us verbalize "do not aspirate". Apparently the major local hospitals have adopted this policy, so that's what they're teaching us.

Aubrianna · Sep 30, 2011

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.

Not that I mean much because I am a newbie. We were taught not to aspirate for any injections in school, though many of our instructors where not so cool with that new policy. I never aspirate on insulin because its subQ. I the newbie have never even heard of that. As a matter of fact, thinking back to my flu shot no aspiration there either. Most of them forget anyway, and I bet that's one of the reasons too. However, we were not taught to aspirate by the place that gathers the information for the NCLEX. Idk.