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?

[Davey Do]

18 hours ago, hherrn said:

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

Metaphorically and realistically speaking, beating a dead horse is pointless, hhern. It's... "superfluous".

Bruce Springsteen, in his geat song, "Reason to Believe" sings an updated version:

"Seen a man standin' over a dead dog lyin' by the highway in a ditch.
He's lookin' down kinda puzzled pokin' that dog with a stick.
Got his car door flung open he's standin' out on Highway 31.
Like if he stood there long enough that dog'd get up and run…"

Still, some believe that if they pursue an exercise in futility, unexpected results will occur.

[kbrn2002, ADN, RN]

I went to school long enough ago that the teaching was to aspirate. I don't give a ton of IM injections but I had never hit a vessel and was more than happy to stop that practice when the recommendations on aspiration changed. That quick as can be in and out seems to cause the least pain both during and after the injection.

[nursej22, MSN, RN]

I was taught to aspirate but I don’t remember the 5-10 second thing. The rare injection I give anymore is immunization.

But I have been puzzled by the likelihood of actually canulating an unseen, nondistended vessel . To me, getting the entire bevel into a vein I can see is tricky enough, and that is with a needle going parallel, not perpendicular to the vein.

[Everline]

I give a lot of IM injections. I do not aspirate. I try to give injections as quickly as possible.

[pixierose, BSN, RN]

10 hours ago, hherrn said:

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?

Thank you for this.

In psych, we give quite a few IM injections. This is a hot button issue in the psych hospital I work at. Recent evidence based research demonstrates that most people do not aspirate for the 5-10 seconds needed ... and this I have found to be true in real life. More like a quick 1-2 seconds if that.

We cannot have IVs on this unit.

I’ve gotten reprimanded by my preceptor and a physician in the past, but the main hospital has the current practice in their policies - NOT to aspirate.

In nursing school we were taught not to aspirate. I’ll keep following the most up-to-date research ... not “that’s how we always do it.” And if someone points me to recent research advocating for aspiration ... then consider me schooled.

[Guest219794]

9 hours ago, Davey Do said:

Metaphorically and realistically speaking, beating a dead horse is pointless, hhern. It's... "superfluous".

Bruce Springsteen, in his geat song, "Reason to Believe" sings an updated version:

"Seen a man standin' over a dead dog lyin' by the highway in a ditch.
He's lookin' down kinda puzzled pokin' that dog with a stick.
Got his car door flung open he's standin' out on Highway 31.
Like if he stood there long enough that dog'd get up and run…"

Still, some believe that if they pursue an exercise in futility, unexpected results will occur.

Excellent point- superfluous is a much better characterization of beating a dead horse.

But, you had me at Springsteen. I grew up in Jersey.

[Redhead,RN, BSN]

I will always aspirate the way I was taught. As a clinic nurse, I hit vessels twice giving flu shots. That's two people whose lives could have been forever changed had I not. I also had another patient who received a flu shot at a Minute Clinic and that night he had a stroke. Could have been coincidental, but CVS nurses don't aspirate.

[Guest219794]

22 hours ago, nursej22 said:

I was taught to aspirate but I don’t remember the 5-10 second thing. The rare injection I give anymore is immunization.

You probably were not taught to go for 5-10 seconds, meaning you, like most of us, were not taught to aspirate. Apparently, the proper technique takes time, which almost none of us have ever done.

What we were taught what to briefly tug on the plunger, and call aspiration. Then rub it. (Rubbing was before my time, but I used to see it.)

[BSN-to-MSN, ADN, BSN, RN]

Nope, it is not taught or recommended anymore.

[nursej22, MSN, RN]

On 6/15/2019 at 8:17 PM, Redhead,RN said:

I will always aspirate the way I was taught. As a clinic nurse, I hit vessels twice giving flu shots. That's two people whose lives could have been forever changed had I not. I also had another patient who received a flu shot at a Minute Clinic and that night he had a stroke. Could have been coincidental, but CVS nurses don't aspirate.

I don't understand this.

Do you have any references for "lives changed forever"?

ACIP, the Advisory Committee on Immunization Practices does not recommend aspiration for immunizations.

I can't even fathom how a .5 cc injection is going to cause a CVA, unless perhaps it was injected directly into a carotid artery.

[G Miller]

we were told do not aspirate for the flu shots

[HFRN13, BSN, RN]

I don't give IM injections anymore but I was taught to aspirate 20 years ago. Never hit a vessel. I can tell you I had a vaccine by a new lpn last year and she didn't aspirate. When she withdrew the needle I started bleeding profusely.