Injections- still pull back?

mandykal, ADN, RN · May 4, 2005

In a staff meeting a few weeks ago, one of the nurses said that pulling back to check for blood is no longer necessary. I cannot find any documentation to that effect. Does anyone know?

I see that you posted "No longer necessary." But that there says that you still can asp....and I think you still should. How else would you know if you are administering it IVP?..... Orders that will require to aspirate is IM & SQ unless you're administering heparin. If you don't aspirate and you administer it into a vein, you just changed the route to IVP without a doctors order.

Although, the odds of you injecting into a vein are still slim, nurses still should practice what is safe and reasonable, always.

elkpark · May 4, 2005

I agree with the other posters. What could have changed that aspirating would no longer be necessary? Can we see veins through people's skin now? Did someone reformulate all the medications out there so that it doesn't matter anymore whether they're given IM or rapid IV push?

I'll tell you, there is no sensation on earth like routinely aspirating a syringe and having the plunger slide back v. freely and blood gush into the syringe -- it only has to happen once to make you a true believer!

Dixielee, BSN, RN · May 4, 2005

Have to agree with other posters. In 31 years of giving IM injections, only one time did I get blood. Shocked the heck out of me too. I can't remember what I was giving, but it is sort of like adding water to the foley balloon first, something you do automatically. BTW, I also have only had one foley balloon not hold water, but I will do it anyway....just in case.

Judee Smudee, ADN, RN · May 4, 2005

Somewhere I read a study that demonstrated is was not necessary. HOWEVER, so far as I know no institution as of this time has changed it's policy. If any of you know of an institution that has changed it's policy please let me know what that policy states. No particular reason just curious. :coollook:

menetopali · May 4, 2005

CDC put out an opinion that aspirating IM injections is not needed, but does not discourage it's practice. I believe the exact phrase was "Although this practice is advocated by some experts, and most nurses are taught to aspirate before injection, there is no evidence that this procedure is necessary." here's the link to a transcript of the broadcast:

http://www.cdc.gov/nip/ed/Encounters02/enc02_admin.pdf

also note that at the end of the conversation when clarification was sought, the practitioner was left to make the final decision. It should also be noted that CDC is reffering to vaccine administration in this broadcast and on their web site:

http://www.cdc.gov/nip/ed/epivac-05-faqs.htm

some medications indicate the need to aspirate in the PDR, some specifically contraindicate aspiration, and many do not address the question.

Katnip, RN · May 4, 2005

I don't know what the problem is, or why people don't want to bother to aspirate before injection. It takes less than a second to do it, and could avoid potential problems.

I'll just keep on aspirating, thank you.

hollyster · May 4, 2005

I will always check for blood return. I went to the dr. for a botox test shot for a chronic low back spasm. He did the test injection with lidocaine the next thing I know my lips were getting numb and the room was going black. The last thing I remember saying was "give me Epi now !!! I woke up on the floor he had given me a direct bolus of lidocaine because he did not aspirate. I have not been back to him since. I wonder to this day if I would of made it if I had not told them to give me epi. :uhoh21:

Marie_LPN, RN, LPN, RN · May 5, 2005

I aspirate. Always have, always will.

Antikigirl, ASN, RN · May 5, 2005

I guess I am like the majority...I was taught to aspirate for blood, but once I met reality I learned what meds to make sure you do it with and what you can't/don't necessarily need to.

Like B12 injections! Oh yeah..red fluid check for blood? Not going to happen..LOL! So I map very carefully and know even if I did hit blood..I just gave the B 12 a little faster than ordered vs a pill they could take anyway if the MD had changed forms...

The majority of the time I aspirate out of habit...but there are a few I don't even bother...

NancyJo · May 5, 2005

Just a few weeks ago I went with a student and their instructor for an IM injection. Student questioned need for aspirating for blood as she had read something about no longer needing to. The instructor did have her pull back, so at least here they are still teaching them to. Like the other posters ahead of me, it only took one time for me also. That's one thing I will always do.

k_cole21 · May 5, 2005

i recently had a student tell me they were being taught not to aspirate on newborns....thankfully only 1 instructor was teaching that and the rest still taught to aspirate.

P_RN, ADN, RN · May 5, 2005

In 30+ years I had it happen once! Once was very convincing.

As someone said, it only takes a microsecond to do it so why not. Always have, always will.