IM Gluteal Bicillin Injection: To aspirate or not?

[bcb1200]

Hi Everyone:

I'm hoping you can all provide some guidance.

In the interest of full disclosure, I would like to state that I am NOT a nurse, nor am I in the medical profession.

However, I've received some advice from a nurse that has me concerned and I'm hoping for some feedback.

I'm currently being treated for mid-stage Lyme disease. I have been prescribed 1.2M units of Bicillin as an IM injection 3x / week.

I met with a nurse at a local doctors office yesterday. She did the first injection and showed my wife how to do subsequent injections at home. (How to identify injection sites in the Gluteal muscle, etc.)

I asked if she could show us how to aspirate the syringe (to check for blood) before the injection as it was my understanding this was mandatory to ensure we won't inject the thick, large-molecule Bicillin into a vein. (Which could kill me.)

She said firmly "NO", and went on to say that "with a Deep IM injection, it is not necessary to aspirate before injecting because the majority of the blood vessels are closer to the skin versus deep within muscle." She went on to describe how the long, 1.5" needle would likely pass through any veigns and go directly into muscle tissue. She said aspiration is needed before a subcutaneous injection, but not before deep IM.

This differs from EVERYTHING I have read, including the insert that comes with the Bicillin, "how to" videos from doctors on youtube, etc, and it has caused quite a bit of controversy in our household. My wife, who is willing to give the shots, but is not typically comfortable with these types of things in general, is now very hesitant to aspirate because she wasn't trained to do so, and she believes the nurse is much more experienced in doing them (she does them almost daily) versus what I've read on the web. Furthermore, we have a friend who is also getting IM injections, and their nurse (a different one) who is doing the injections also says aspiration isn't needed.

For me, while I have the utmost confidence in my wife's abilities, I would like her to aspirate as a precaution. Better to be safe than sorry.

Checking online, there seems to be disagreement on whether or not it is necessary. Most vaccine administration guides say aspiration isn't necessary any longer. But others state it is for large-molecule IM injections (like Bicillin.) Kaiser Permanente did a whole analysis on whether is needed (using researched data) and the general result was "no" except for penicillin injections where one "may" want to consider it.

I also have read that it isn't needed if we use the ventral gluteal site versus the dorsal gluteal site. I'm not sure which we are using. My wife was taught to locate the injection site by drawing an imaginary line down from my armpit and across from the top of my butt crack. So it is very outer, upper gluteal. I think this is dorsal.

Thanks for your help.

[CrunchRN, ADN, RN]

We are not allowed to give medical advice, but here are my observations.........

It won't hurt anything to aspirate and if it will make you feel better seems like a no brainer.

By the way, admirable job of researching the issue!

I can't tell you if she is doing dorsal or ventral gluteal based on your description, but an intelligent person life yourself can easily find information on how to find the vebtral gluteal site. I have preferred using that safer site for all patients for the last 12 years.......

[bcb1200]

Thanks. ANd just to clarify...I'm not looking for medical advice (I know you can't provide it.)

But, if you were my nurse giving me the injection, would you aspirate or not?

Incidentally, I got a reply from my doctor who is recommending aspiration.

[CrunchRN, ADN, RN]

Yes, but I am old school, and you would also get it in the ventral site.

[traumaRUs, MSN, APRN]

You've got the answer from your physician, that's what we advise you to do: follow his advice.