IM injections, to aspirate or not?

[Pia Mater]

I am a 1st semester ADN student. We were told that we should aspirate when giving IM injections, using the Z track method, wait 10 seconds after med is in before removing needle. That is the method we were taught.

We were giving flu vax today in clinicals today. We were at a LTC facility, and another clinical group from my school was there as well. They were talking amongst themselves, and I overheard them saying that they were told that they do not have to aspirate when doing an IM injection. I did not catch the reasoning they gave for not doing it, but I found it odd that they are in the same school as us and are being taught different techniques. Now I know that there are more than one way of doing things, but usually in school they are so strict about these things.

What were you taught? Do you aspirate for blood when giving an IM injection?

[SunshineDaisy, ASN, RN]

we were also taught to asperate when doing IM injections.

[nurseprnRN, BSN, RN]

it's "aspirate," related to the same word for breathing (in), respire, and you should always do it for ims to assure yourself that you are not in a blood vessel. it hardly ever happens that you are, but the consequences can be so bad with some substances that you just don't want to take the chance.

i never heard of waiting 10 seconds to remove the needle, though. do you know how long that is? what rationale do they give you, and does it make physiological sense?

[turnforthenurse, MSN, NP]

In school I was taught to always aspirate - it is to make sure that you are not in a blood vessel before injecting the medication. I have read that schools are now teaching not to aspirate because supposedly there is no added benefit and it causes more discomfort for the patient. I always aspirate, though.

And yes, 10 seconds is a long time...in the real nursing world, that surely doesn't happen! I'm wondering what the rationale is for that, too...

[NewSN13]

We were taught to aspirate, also, but when I did a flu clinic, the nurses there told us it wasn't necessary. The CDC's recommendation on flu shots:

Because there are no large blood vessels in the recommended sites, aspiration before injection of vaccines (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary. A study published in Archives of Disease in Childhood in 2007 found that when a vaccine was administered and withdrawn rapidly without aspiration there was less evidence of pain than when the vaccine was injected and withdrawn slowly with aspiration. Also, some safety-engineered syringes do not allow for aspiration.

http://www.cdc.gov/vaccines/Pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf

[Pia Mater]

Thank you for the spelling correction, spell check wasn't working for me.

Our teachers taught us to wait 10 seconds before removing the needle to allow the medication time to be absorbed.

[anonymousstudent]

I was also taught to aspirate, but have had every CI I've given one with tell me not too.

As far as the 10 second rule, I was told to only do this if the medication was very viscous or irritating.

[Al.ginger]

According to CDC you do not need to aspirate for IM injection. OUr instractors said that theu were taught aspirate but things change

[Pia Mater]

Thanks for the CDC info, it was very interesting. Yes, I see where they say not to aspirate. Also, I see no mention of Z track either.

I assume they are teaching it the other way because Potter and Perry say so. :)

[BacktotheBeach, ADN, BSN, RN]

The 10 second stay in is related to the Z track method. I am a current student and we are told to stay in for the entire ten seconds and tell the patient why!

[tothepointeLVN, LVN]

Aspiration just causes discomfort for a patient. Instead of asking the rationale for not aspirating we should question the rationale for doing so.

Also yes there are somethings you'd want to take more caution when injecting but we are nurses with critical thinking skills does that mean we have to do that on every single injection.

[Clovery]

We learned this semester to NEVER aspirate and not to use the dorsogluteal site. The hospital group in which we do most of our clinicals has a no aspiration policy. This is relatively new, as my clinical manual from 2009 teaches aspiration. There was a thread about this last month, elsewhere on this forum, and someone posted the following rationale for not aspirating:

"Aspiration of the syringe plunger once the needle has been inserted into the muscle is an accepted part of IMI procedure but there is no evidence of the need to do this. Justification includes to ensure the drug does not enter the capillaries (Hunter, 2008) or to avoid inadvertent IV administration (Workman, 1999).

Aspiration may be relevant to detect possible penetration of gluteal artery when the dorsogluteal muscle is used - this would indicate incorrect initial land-marking. However, official guidance (DH, 2006; WHO, 2004) does not recommend routine use of the dorsogluteal muscle, and this should be sufficient to justify changing practice. If this site were removed from routine practice, aspiration could be removed from the procedure, simplifying it and reducing the risk of adverse events. Pharmaceutical developments including reduced volume and less caustic injectates, along with prescribing changes, now support its removal from selected injection sites.

Some auto-disable devices (syringes where the needle retracts automatically after IMI administration to prevent needle-stick injuries) are triggered by the 'aspiration' type manoeuvre, so the technique has already changed in many countries.

References

Malkin, B. (2008). Are techniques used for intramuscular injection based on research evidence? This article debates the evidence surrounding the nursing procedure of administering intramuscular injections. Nursing Times, 104(50-51), 48-51. Retrieved from EBSCOhost."

https://allnurses.com/med-savvy/im-injection-621475.html#post5739533