IM Blood Return

mhull · Mar 19, 2005

From what I was taught it means you are in a vessel. If you ever get that, throw medicine and all away then start from fresh. I guess because giving a bolus of the medicine is not how it is suppost to be given. Some IM's meds are not for IV use, and if you are in a vessel that is actually how you would be giving it. I hope that makes sense.

Michelle,LPN

future RN--2006

I'm a new nurse and know that I should know this, however I'm surprised at how difficult it is (even searching my textbooks and the internet) to get a straight answer to what sounds like a simple question. Here's the question - What does it mean when you get blood return during an IM injection? Why is it important to not inject? It's not been an issue ...it's just that I want to know. I know there's a simple straightforward answer and sometimes a somewhat anonymous forum like this is conducive to asking a "simple question" rather than letting your colleagues know you're uncertain. If there's a good online source that would be helpful, too. Thanks!

suzanne4, RN · Mar 19, 2005

Exactly, IM means intramuscularly, not in a blood supply. Some medications could be quite damaging if they get into a blood vessel.

Boston1 · Mar 19, 2005

I appreciate your post. I guess, where I get confused...and I know this is an extrememly naive understanding...but it's all getting into the systemic circulation at some point, isn't it? I admit, I don't understand...I know to discard, etc...but I don't understand the potential harm. Thanks, again.

From what I was taught it means you are in a vessel. If you ever get that, throw medicine and all away then start from fresh. I guess because giving a bolus of the medicine is not how it is suppost to be given. Some IM's meds are not for IV use, and if you are in a vessel that is actually how you would be giving it. I hope that makes sense.
Michelle,LPN
future RN--2006

Boston1 · Mar 19, 2005

I appreciate your post. I guess, where I get confused...and I know this is an extrememly naive understanding...but it's all getting into the systemic circulation at some point, isn't it? I admit, I don't understand...I know to discard, etc...but I don't understand the potential harm. Unless it is a matter of, for example, compromising the integrity of the vessel itself which then comes with it's own risks, not necessarily related to the drug being administered by the wrong route. Thanks, again. )

Exactly, IM means intramuscularly, not in a blood supply. Some medications could be quite damaging if they get into a blood vessel.

jnette, ASN, EMT-I · Mar 19, 2005

Boston...intramuscular meds are absorbed more slowly than when given IV.

Each med has its method and site of administration according to how fast or slow the med is to be absorbed by the body....and the meds dispertion plays into this as well.

Does this help?

sharann, BSN, RN · Mar 20, 2005

Like Jeanette said, if you give a drug , such as Demerol for example you would give it as ordered. If the order was for Demerol 75mg IM, and you were in a vessel(IV) then the patient could get all 75mg really FAST as opposed to over a period of hours absorbed. They could suffer resiratory depression and might even stop breathing. If they got it IM, the drug is delivered over a longer period of time, instead of all at once.

suzanne4, RN · Mar 20, 2005

A simple way to think of it...................when a provider orders that you give an injection of morphine or demerol.............if given IM, the dose is usually every 4 to 6 hours, if given IV, then the dose should be every one to two hours becaus.e it won'tlast as long.

The route of action is the important thing, not that it will end up in the systemic circulation but how long that it takes to get there.

Same as with extended-release medications.......they are made to last from 12 hours to 24 hours, depending on the drug. They usually have a protective coating that slows their breakdown, so that drug is only released every so many hours................that is why you never, never crush the pill to put it in a feeding tube or make it easier for the patient to swallow, otherwise you have just given the patient an overdose without even realizing it...........

Hope that this helps.............

**canoehead, BSN, RN** · Mar 20, 2005

If you get blood back when you aspirate you remove the syringe and reinject at another site. You don't have to throw away the med, and blood is absorbed easily into muscle. The only drawback would be to make sure you're able to see well enough to aspirate effectively with the second injection.

PMHNP10 · Mar 20, 2005

The only drawback would be to make sure you're able to see well enough to aspirate effectively with the second injection.

Which IMHO is exactly why you would want to dispose of the med and syringe and start over. You certainly take a risk in not seeing blood come into a syringe which already has blood in it.

Boston1 · Mar 20, 2005

Thank you so much for all the posts. If I'm understanding what is being written to me - then purely as a hypothetical, to help me understand - tell me if this is true.

If I get blood back that means I'm in a vessel (probably an artery), which purely in theory, purely hypothetically would be alright if I was going to administer the IV dose (usually a lower dose than an IM dose), however what makes the scenario of being in a vessel and administering an IM dose dangerous is that I would be giving a WRONG IV dose.

Theoretically, if blood return occurs, it would be alright to administer, via injection, an IV dose into the vessel. I don't intend to do that I'm just trying to understand.

At the risk of sounding confusing there are potentially at least two things going on when one gets blood return in the course of preparing to administer an IM injection. WRONG ROUTE and WRONG DOSE. Again, just belaboring (as I'm sometimes want to do to make sure I understand), in theory, one could make both of these WRONGS right by administering the IV dose. Again, I don't intend to do that - but I think I've got a better understanding thanks to all these posts. Does it sound that way to you, or anyone? :)

Looking forward to some validation of my new understanding - or correction if that's what's needed.

John

A simple way to think of it...................when a provider orders that you give an injection of morphine or demerol.............if given IM, the dose is usually every 4 to 6 hours, if given IV, then the dose should be every one to two hours becaus.e it won'tlast as long.
The route of action is the important thing, not that it will end up in the systemic circulation but how long that it takes to get there.
Same as with extended-release medications.......they are made to last from 12 hours to 24 hours, depending on the drug. They usually have a protective coating that slows their breakdown, so that drug is only released every so many hours................that is why you never, never crush the pill to put it in a feeding tube or make it easier for the patient to swallow, otherwise you have just given the patient an overdose without even realizing it...........
Hope that this helps.............

twinbee25 · Mar 20, 2005

If you get blood back when you aspirate you remove the syringe and reinject at another site. You don't have to throw away the med, and blood is absorbed easily into muscle. The only drawback would be to make sure you're able to see well enough to aspirate effectively with the second injection.

hi,

we have been taught, (and its also in textbooks today), is when you get blood during aspiration for an IM injection, you are to throw that away, and start all over with new needle, syringe, and medication. I am currently in an ADN program and we have just learned about IM injections.

I am guessing that this is a different technique than what was taught in nursing in the past, and my guess is that it is based on evidence-based research...could also have to do with cutting down on med errors.

I have yet to give an injection, but if I do draw up blood when I aspirate during an IM injection, I will start completely over with new needle, syringe and med. :)