IM injections- to aspirate or not?

[dah512]

I may be beating an old horse with a stick on this question, but the last thread I found was from 2010....and well... we all know medicine can change drastically over almost 10 years. SO... in school I was taught to NOT aspirate (draw back to see blood flash back) before injecting in an intramuscular injection. Our teacher said there is not evidence to support the use of it. Is our school right? I found that the CDC does not recommend this practice for vaccinations... but what about just plain old medication administration? What do yall do and what are your thoughts?

[lovingtheunloved, ASN, RN]

I was taught to aspirate...though I believe current practice is not to.

[Jory, MSN, APRN, CNM]

Current practice is not to aspirate, but refuse not to when I worked the floor..mainly because the very first injection I ever gave was phenergan and low and behold...I hit a vessel.

The practice is based on statistics...is it RARE you'll hit one? Yup...but if you do...oh boy.

[Guest219794]

I follow current practice guidelines, and don't aspirate. Even those who "aspirate" don't actually aspirate. As I understand it, proper aspiration involves pulling back for 5-10 seconds. When I see people "aspirate", it is for maybe 1 second.

BTW- I think the expression is "beating a dead horse", which is pointless. And weird. Beating an old horse is just plain cruel.

[LovingLife123]

I don’t give a ton of IM injections. But, I’ve never aspirated. It’s not current practice to do so.

[Workitinurfava, BSN, RN]

No, I thought it was clinically proven to be unnecessary this day in age.

[TriciaJ, RN]

I thought we were to still aspirate the glute but not the deltoid.

[CommunityRNBSN, BSN, RN]

My first day on the job, i ran into this, because I was giving Bicillin (glute). I didn’t aspirate, my preceptor said we should, so then the two of us went looking for guidance. Our clinic has no policy on it, and the references I found on the CDC said: “While aspirating is not recommended for vaccinations, it may be appropriate for some therapeutic injections. Consult your practice for detailed guidelines.” But I never found anything about when it IS appropriate or WHICH injections.

[Guest219794]

1 hour ago, CommunityRNBSN said:

My first day on the job, i ran into this, because I was giving Bicillin (glute). I didn’t aspirate, my preceptor said we should, so then the two of us went looking for guidance. Our clinic has no policy on it, and the references I found on the CDC said: “While aspirating is not recommended for vaccinations, it may be appropriate for some therapeutic injections. Consult your practice for detailed guidelines.” But I never found anything about when it IS appropriate or WHICH injections.

I think the reason you can find no clear recommendations on when to aspirate is that there is no conclusive evidence supporting the practice. The biggest driver for the practice seems to be "I was taught that way".

But, when you review articles/studies, a couple of things are consistent-

• Proper aspiration is seldom done. Anecdotally, I have never seen anybody aspirate for 5-10 seconds. Anybody here actually aspirate for that long?
• Rapid IM (No aspiration) is less painful.
• Nursing educators are overwhelmingly advising against the technique.
• Appropriate site and needle selection combined with good technique are far more important than any theoretical risk of not aspirating.

These folks present a well researched, well written rationale for not aspirating. Documents like this are easy to find.

Are there any well researched policies or guideline advocating aspiration?

[FolksBtrippin, BSN, RN]

I do not aspirate.

[JKL33]

Anatomically the DG site is the one that poses most risk, and is usually not recommended over the deltoid, VG, and VL anyway.

From a (completely not exhaustive) literature search, it looks like the thought is that if a medication poses some kind of safety risk from being administered IV instead of IM, then it is reasonable to aspirate prior to injecting it. And if that concern exists, then aspiration should take place for 5-10 sec prior to injecting.

As far as what kind of concerns could exist about IM vs. IV administration...examples: Differences in dosing or preparation or viscosity of the medication, etc. The meds I see mentioned most frequently as examples were things like Dilaudid, Ativan, Bicillin.

[Davey Do]

I aspirate before giving an IM injection. In perhaps a thousand injections I've done in over 35 years of nursing, I've aspirated blood maybe twice.

I truly remember only one where blood was aspirated when attempting an IM injection of Zyprexa in the gluteus. I removed the needle, and got a new setup, and performed the injection.

Aspiration was the method by which I was taught, I see other nurses do it this way, and am comfortable with the technique.