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.
I can't believe we're still having this ridiculous discussion.
OP, aspirating for the majority of meds given the IM route is not only no longer taught,but it is completely unfounded from a scientific perspective--it is NOT evidence-based practice. So whatever you think you're protecting your patients from by aspirating with every IM drug, STOP. It's in your head. (note the CDC, which indicates that vaccines given IM, should you hit a vessel, wouldn't actually be given inadvertently via IV as the vessels in the muscle would blow before you could inject an IM injection IV).
Sorry but if I was that patient, that would be that last IM injection you ever gave me.[/quote']
I was with Boog from the start. I just didn't realize how much until now.
Specializes in Oncology; medical specialty website.
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.
So after getting positive feedback, you still think you're going to check for blood return every once in a while?
Whyohwhyohwhyohwhyohwhyohwhyohwhyohwhy?
I don't understand why you keep referring to "my nurse." Is this person your instructor or in some sort of supervisory role?
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!
Ahh, I didn't know and have never given an IM abx injection. And never worked in LTC. With my alert and orientated patients, they've always had iv access in situ and we simply didn't get infection issues. I've always just maintained iv lines in patients with dementia/confusion quite easily through use of a regularly changed, checked and clean bandage/dressing. I wouldn't fancy repeatedly giving an IM injection to someone with dementia either. Swings and roundabouts, I guess.
SoldierNurse22, BSN, RN
4 Articles; 2,058 Posts
I can't believe we're still having this ridiculous discussion.
OP, aspirating for the majority of meds given the IM route is not only no longer taught,but it is completely unfounded from a scientific perspective--it is NOT evidence-based practice. So whatever you think you're protecting your patients from by aspirating with every IM drug, STOP. It's in your head. (note the CDC, which indicates that vaccines given IM, should you hit a vessel, wouldn't actually be given inadvertently via IV as the vessels in the muscle would blow before you could inject an IM injection IV).