Do I aspirate too violently?

Published

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

My nurse says it's okay to inject if those particles enter the syringe. Is it okay indeed or should I withdraw the needle and choose another spot?

My nurse says it's okay to inject if those particles enter the syringe. Is it okay indeed or should I withdraw the needle and choose another spot?

I don't get it. Either follow evidence based practice, or do what your instructor says. I don't understand about asking more questions about how to aspirate in a different way, when EBP says you're not supposed to aspirate at all.

Today I gave IM injections without aspirating. It's been quite stressful, but the patient said she hasn't felt anything at all, except for a sting when I inserted the needle. Also, she bled less than I expected. Most patients used to bleed quite a lot after withdrawing the needle. One nurse supervised me during the first 2 IMs, and she said I'm doing okay. I guess I'll ditch aspiration after all, though I'll probably check for blood return every once in a while.

Thank you all for your support! It's much appreciated.

Specializes in ICU, Med-Surg, Float.

I'm confused... Are you sure you're a nurse? Sounds like someone who's into bodybuilding looking for info on where and how to inject.... Sorry for the scepticism 🤔🤔🤔

" 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.

In long term care, Rocephin IM is quite common. You don't have to start an IV and maintain it, which sounds like unnecessary risk for infection, extra work, and inconvenience for a resident that is alert and oriented. Imagine maintaining an IV site for someone with dementia. One resident came to us on IV antibiotics and he kept ripping out his IV. It was nice that he was able to discontinue it for us, but what a hassle when he needed it!

Specializes in NICU.
Today I gave IM injections without aspirating. It's been quite stressful, but the patient said she hasn't felt anything at all, except for a sting when I inserted the needle. Also, she bled less than I expected. Most patients used to bleed quite a lot after withdrawing the needle. One nurse supervised me during the first 2 IMs, and she said I'm doing okay. I guess I'll ditch aspiration after all, though I'll probably check for blood return every once in a while.

Thank you all for your support! It's much appreciated.

What would be the point of doing it "every once in awhile"?

Look, I get it that change is hard, especially from what you were originally taught. But you can't hold onto outdated practices to make yourself feel better. You would be intentionally inflicting extra pain on a patient.

What would be the point of doing it "every once in awhile"?

Look, I get it that change is hard, especially from what you were originally taught. But you can't hold onto outdated practices to make yourself feel better. You would be intentionally inflicting extra pain on a patient.

Well, I asked one of my "regular" patients whether she felt any pain during or after the injections, and she said her shoulder felt numb for a few hours afterwards. Also, she said the pain was radiating into her arm. She gets Risperidone shots every two weeks. Today I've injected her without aspirating, and she said she only felt a bit of stinging when I inserted the needle, but no numbness after withdrawing it. So I guess I was indeed inflicting unnecessary pain on my patients.

Today I've also given a few subcutaneous shots, but those went very smoothly. Interestingly, I'm never afraid of hitting a vein or injecting into one when administering medication via this route.

Bottom line? Unless the medication requires aspiration, I won't be doing it again. I've pointed out to my nurse that aspiration is no longer a good practice when giving IM injections anyway. As for hitting a blood vessel, well, as long as the injection site is carefully chosen and the needle and syringe are the right size, this shouldn't worry me. It will take some time to get used to it though. :nurse:

Specializes in Pediatric Critical Care.

It may comfort you to know that if you hit a large vessel, you will likely see blood in the syringe without even having to aspirated anyway.

It may comfort you to know that if you hit a large vessel, you will likely see blood in the syringe without even having to aspirated anyway.

Sadly, I occasionally hit a blood vessel... It happened to me a few weeks ago, and quite a lot of blood entered the syringe. The patient freaked out when I said I hit a vein... and so did I, to be honest. If I hadn't aspirated, I would have injected the med via the wrong route. The idea is making me very nervous, actually.

Specializes in Pediatrics, Women’s Health.

What setting do you work in that you are constantly giving all of these IM meds?

Specializes in Pediatric Critical Care.

Found a resource for you:

Scroll down about 1/3 of the page for your specific question about what to do if you aspirate blood, but the rest of the page is a good resource also.

Ask the Experts: Administering Vaccines

What setting do you work in that you are constantly giving all of these IM meds?

I have two full-time jobs; one at a hospital, and one at a private clinic. As I'm struggling with IM injections, the head nurse said she'll have me give more of them until I get more comfortable. :) I typically give injections (IM, IV, SubQ) at the hospital, and only occasionally at the private clinic, where I almost always take blood samples only (still in the learning phase, so...). Recently I've started giving subcutaneous injections too, and those are the easiest. I wish all meds could be administered via that route.

Found a resource for you:

Scroll down about 1/3 of the page for your specific question about what to do if you aspirate blood, but the rest of the page is a good resource also.

Ask the Experts: Administering Vaccines

Thanks! I'll read the material right now. Hopefully my technique will improve over time.

+ Join the Discussion