Injections- still pull back?

mrdoc2005 · May 4, 2005

most of the new immunizations state that but that is all I have seen

madwife2002, BSN, RN · May 4, 2005

I havent heard or read that but would be interested to know. It will be a habit hard to stop after all these years of IM injections.

TiffyRN, BSN, PhD · May 4, 2005

After many years of giving IM/SQ injections I've always checked for blood return (except heparin-type meds). Imagine my shock one night when my syringe filled with blood!!! I was giving phenergan 50mg, which probably would have hurt like a &%$# if it had gone undiluted like that in a vein (besides the fact it wasn't ordered IVP). Anyway, that sold me for life.

nursepotter05, RN · May 4, 2005

I was taught to pull back, so I will pull back. I have not heard that the rule has changed.

CarVsTree · May 4, 2005

I'm a nursing student and according to my school it has NOT changed.

What would the rationale be? I saw a horse seize and die once cause its owner gave an IM PCN injection (not the IV form, the white foamy stuff) w/o pulling back and it hit a vein. Not a pretty sight.

2ndCareerRN · May 4, 2005

Imagine my shock one night when my syringe filled with blood!!! I was giving phenergan 50mg, which probably would have hurt like a &%$# if it had gone undiluted like that in a vein (besides the fact it wasn't ordered IVP). Anyway, that sold me for life.

ITA. That happened to me with an IM injection of Toradol. It drew back very easy.

bob

Long Term Care Columnist / Guide · May 4, 2005

In over 10 years of giving injections, I've never once aspirated blood, but I still map out my landmarks on each and every patient AND I pull back every single time (except, of course, for heparin-type meds and insulin). I've never seen anything in the literature that indicates otherwise, and even if I were to, I'd still aspirate, because the alternative is possibly injecting directly into a blood vessel, and most of the drugs we give IM are ones that you definitely don't want going directly into the circulation! Can you imagine a drug like IM Rocephin being accidentally injected into a small vessel, and the damage it could do? No way........I'll just keeping mapping out my injection sites and pulling back, thank you very much. :)

VickyRN, MSN, DNP, RN · May 4, 2005

At our nursing school we teach to aspirate before giving all IM medications. Our students are instructed not to aspirate for heparin or insulin, but these are given subcutaneously, not IM.

Tweety, BSN, RN · May 4, 2005

Like Tiffy, the one time I pulled back and got a blood return sold me for life. I was giving Demerol and Phenergan. It's the one and only time it happed, but now that I'm not doing charge and carrying a full patient loads the odds are going back up it will happen again. It's automatic for me now anyway, whether it's necessary or not.

Pediatric Critical Care Columnist · May 4, 2005

Last week my son had his quarterly Botox injections done and for the first time ever I found a humungous hematoma on his leg the next day. There had been no flashback in the syringe but there was a small amount of bleeding after the needle was removed. I'm a little upset that it happened, since Botox given systemically can be fatal. Thankfully I'm not seeing any indication that he is heading for resp failure...

bobnurse · May 4, 2005

Ive had blood aspirate once into my syringe.....GIving insulin...I believe it was regular and nph or something to that, not sure.......Im just glad it wasnt given IV.....