Do I aspirate too violently?

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Hello everybody,

I'm a new nurse and I know I'm supposed to know how to do it already, but... I think I aspirate a bit too violently when checking for blood return (intramuscular injection). My preceptor says aspiration is a must for IM injections, and I'm quite scared at the thought of accidentally injecting medication into a blood vessel, so I always aspirate, even in delts.

Whenever I give IM injections, I aspirate 2-3 times, just to make sure. We were taught to aspirate for about 5-10 seconds. Curiously, blood enters the syringe only the second or third time I draw up the plunger... If I was to hit a vein, I'd be in the danger of giving the injection on the wrong route if I aspirated only once. Is this normal? Isn't blood supposed to enter the syringe from the first aspiration? I aspirate quite violently, so can this be the issue? I mean, perhaps my violent aspiration is causing damage to the muscle tissue.

Also, sometimes I've noticed some kind of "particles" entering the syringe. My preceptor says it's coagulated blood. Does it mean I've hit a blood vessel as well? Can I inject the medication anyway as long as it's not "regular" blood (bright red and liquid, so to speak)?

Sorry for the many questions, but I'd like to hear multiple opinions. :D

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Specializes in Critical Care.

Aspirating prior to IM injections is actually not recommended, the only exception being the dorsogluteal which should be avoided anyway. There's no benefit to aspirating in other sites, and the additional manipulation and the aspiration itself can cause unnecessary tissue damage at the site.

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Just a nursing student here, but that sounds NOTHING like how we were taught to aspirate. We just pull back for maybe 1 second, and only 1 time. Why would you need to pull back 5-10 sec or multiple times?

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Specializes in Critical Care.
Just a nursing student here, but that sounds NOTHING like how we were taught to aspirate. We just pull back for maybe 1 second, and only 1 time. Why would you need to pull back 5-10 sec or multiple times?

Back when it was still considered good practice to aspirate, that was the amount of time you were supposed to aspirate for (5 seconds).

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EBP you should no longer be aspirating. This info is available on the CDC website, as well as several articles you can site to inform your class that this is no longer done.

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Specializes in Medsurg/ICU, Mental Health, Home Health.

Zyprexa Relprevv the Zyprexa depot injection, requires aspiration prior to administration.

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Thanks everyone for sharing your opinions/experiences.

In regards to the aspiration, well, my preceptor says I need to aspirate as a safety measure for every IM injection. Most of the older nurses don't; they just inject the medication. I know that injecting into a blood vessel can be harmful to the patient, depending on what's being injected, so I don't want to put their safety at a risk. I'm not confident enough to give an IM injection without aspirating.

By the way, what are the risks of injecting in the same spot? For example, if a patient needs regular IM injections in the delts, and the medication is oily, it will dissipate very slowly. So the next time I inject him/her in the delt, the medication I've injected the previous day may still be there if the new spot is very close to the old one. Is this correct? So if I aspirate, the old med might enter the syringe if it hasn't completely absorbed. It's quite confusing for me. My nurse says I should always alternate the delts to avoid this, but I was just curious.

Thank you!

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Specializes in ICU.
Thanks everyone for sharing your opinions/experiences.

In regards to the aspiration, well, my preceptor says I need to aspirate as a safety measure for every IM injection. Most of the older nurses don't; they just inject the medication. I know that injecting into a blood vessel can be harmful to the patient, depending on what's being injected, so I don't want to put their safety at a risk. I'm not confident enough to give an IM injection without aspirating.

By the way, what are the risks of injecting in the same spot? For example, if a patient needs regular IM injections in the delts, and the medication is oily, it will dissipate very slowly. So the next time I inject him/her in the delt, the medication I've injected the previous day may still be there if the new spot is very close to the old one. Is this correct? So if I aspirate, the old med might enter the syringe if it hasn't completely absorbed. It's quite confusing for me. My nurse says I should always alternate the delts to avoid this, but I was just curious.

Thank you!

Daily IM's? What medication are you injecting?

Also, could "maybe I am aspirating too violently" be solved by aspirating less violently? If you have to aspirate at all. The nurses above have said that aspiration is not best practice anyway, on examination of the available evidence. It isn't a confidence or experience thing.

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Specializes in ICU.
Back when it was still considered good practice to aspirate, that was the amount of time you were supposed to aspirate for (5 seconds).

But multiple times??? Why would that be done?

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Daily IM's? What medication are you injecting?

Also, could "maybe I am aspirating too violently" be solved by aspirating less violently? If you have to aspirate at all. The nurses above have said that aspiration is not best practice anyway, on examination of the available evidence. It isn't a confidence or experience thing.

No particular medication; it was just a question. But as a side note, one of my patients was ordered daily Rocephin injections for 5 days. The injection sites were as follows: right delt, left delt, right glute (ventrogluteal), left glute (ventrogluteal), and left delt once again. The problem was with the last injection (second one in the left delt). When I aspirated, I noticed some sort of "particles" entering the syringe. My nurse said it was coagulated blood. It didn't look like blood at all (when I hit a vein, bright red blood enters the syringe). However, I've only noticed 1-2 particles and no actual blood. Is this normal? Does it mean I've hit a blood vessel? Or maybe there was still some med left from the previous injection. Can I inject medication anyway if anything like that happens in the future?

FYI, I occasionally hit a small vessel so aspiration does help. I remember hitting one in a delt once. I freaked out because I knew the chances of hitting one in the delt are slim to none.

But multiple times??? Why would that be done?

I think I'm a bit too scared of hitting a blood vessel. One of my fellows unknowingly injected med into a vein and it resulted in a big, ugly bruise! Curiously, the first time I aspirate nothing enters the syringe except air, but the second or third time I see blood. Is this normal? If I hit a blood vessel and aspirate just once but nothing enters the syringe, I might accidentally inject in the wrong place!

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Specializes in ICU.
No particular medication; it was just a question. But as a side note, one of my patients was ordered daily Rocephin injections for 5 days. The injection sites were as follows: right delt, left delt, right glute (ventrogluteal), left glute (ventrogluteal), and left delt once again. The problem was with the last injection (second one in the left delt). When I aspirated, I noticed some sort of "particles" entering the syringe. My nurse said it was coagulated blood. It didn't look like blood at all (when I hit a vein, bright red blood enters the syringe). However, I've only noticed 1-2 particles and no actual blood. Is this normal? Does it mean I've hit a blood vessel? Or maybe there was still some med left from the previous injection. Can I inject medication anyway if anything like that happens in the future?

FYI, I occasionally hit a small vessel so aspiration does help. I remember hitting one in a delt once. I freaked out because I knew the chances of hitting one in the delt are slim to none.

I think I'm a bit too scared of hitting a blood vessel. One of my fellows unknowingly injected med into a vein and it resulted in a big, ugly bruise! Curiously, the first time I aspirate nothing enters the syringe except air, but the second or third time I see blood. Is this normal? If I hit a blood vessel and aspirate just once but nothing enters the syringe, I might accidentally inject in the wrong place!

Are you a student or a qualified nurse btw? I don't understand why "your nurse" can't explain the answers to these questions, especially regarding "particles". And I don't understand why you'd ask about daily, and rather specifically "oily" IM's, if there wasn't a situation where they'd be necessary. A big ugly bruise isn't the most negative clinical implication of an IM injection into a blood vessel. I don't know why you are aspirating violently or multiple times. And how come they had Rocephin IM rather than IV? Why so many IM injections in general? They are to be avoided as they are painful.

I do sound confrontational, I am aware of that and I apologise if it is just your writing style, but you don't sound like you have a clinical background. American nurses seem very on the ball clinically and I haven't read posts like this from qualified nurses, even new ones.

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Specializes in Utilization Management.

Think about this from the patient's perspective - you're giving them an IM injection, which is uncomfortable all by itself, but then you're digging around for an additional 15-30 seconds because, for some reason, you are under the impression that you have to aspirate multiple times. This is causing damage to the tissue surrounding the needle, causing bleeding. Then you STILL have to inject the medication itself. Sorry, but if I was that patient, that would be that last IM injection you ever gave me.

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