Injections- still pull back?

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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?

Specializes in oncology, surgical stepdown, ACLS & OCN.
I always wonder if i could see the blood when I pull back on a B-12 injection since the B-12 is red, any comments or experiances with this??

It is funny that you should ask, the one time it happened to me, I was giving a B12 injection, that was about 15 years ago, the only way I could tell was that the blood in the syringe was not clear like the B12 medication was and it looked darker. That happened when I was still an LPN and I was in school

finishing up my RN and working part time as an LPN in a nursing home. That was the only time it ever happened to me. I now work in a hospital as an RN

haven't given a B12 shot for a very long time, but that was a good question.

:)

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It is funny that you should ask, the one time it happened to me, I was giving a B12 injection, that was about 15 years ago, the only way I could tell was that the blood in the syringe was not clear like the B12 medication was and it looked darker. That happened when I was still an LPN and I was in school

finishing up my RN and working part time as an LPN in a nursing home. That was the only time it ever happened to me. I now work in a hospital as an RN

haven't given a B12 shot for a very long time, but that was a good question.

:)

Scooter, thankyou for your reply

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I'm going to continue to pull back. Never yet had a flash but it doesn't hurt anyone to do it.

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There is research showing that aspiration when performing IM injections is not necessary. There is research that shows it does not cause harm to aspirate with injections either.

It is the nurse's choice.

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Specializes in Psych.
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.

I don't understand your tagline: "mental health nursing is over." Does that mean you are finished w/that clincal rotation, or do you have some insight into the future of psych nursing that I have missed? Just curious.

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Specializes in Psych.
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.....

WOW! I had always been told that pullback for subq wasn't necessary and it sounds like some of the previous posters are operating the same way. Is this a mistake?

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So to the people who aspirated blood- then what did you do?

I can't remember the last IM I gave- just havent had to. If its a narc do you then have to find an RN to witness the waste and start over or do you find a new site and inject ? Change the needle?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
So to the people who aspirated blood- then what did you do?

I can't remember the last IM I gave- just havent had to. If its a narc do you then have to find an RN to witness the waste and start over or do you find a new site and inject ? Change the needle?

I am stunned; is this not being taught in school anymore or part of the "check off system" for medication administration in any hospital for new orientees? Wow, times have changed in 7 short years, I guess? Well as far as I am concerned, you MUST aspirate for IM injections to avoid dangers of wrong-route medication adminstration.

So yes, that is exactly what you do. You discontinue the injection--- wasting the medication with another licensed nurse (if it's a controlled medication), get a new syringe/needle and sign out the med, and do it over. That is then assuring you give it by the right route, (that would be IM)---- not in a vein or other blood vessel. And you do not give meds contaminated with the patient's blood IM, another no-no.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
There is research showing that aspiration when performing IM injections is not necessary. There is research that shows it does not cause harm to aspirate with injections either.

It is the nurse's choice.

still, if you give a medication via another route than is ordered, that is a medication error. What happened to the 5 rights? If there is not a "nurses' choice" in the doctor's order for the route to give a medication, you have committed a medication error if you give it IV instead of IM. The research won't cover that for me, will it?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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.

Ok, lets say this is all correct. It still leaves out the "5 rights". And, what if you can't remember each and every med that you MUST aspirate for? It makes sense to me to follow the same practice the same way and consistently........why tempt trouble and/or potential for harmful or fatal med errors?

finally, Is right ROUTE not still part of the "5 Rights" in Med Administration???? when did this change? If it did, I missed it.

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Specializes in Psych.
I always wonder if i could see the blood when I pull back on a B-12 injection since the B-12 is red, any comments or experiances with this??

Here's my 2cents: Even though they are both red, blood and B12 DO NOT look the same, B12 is clear, blood is generally a darker red and near opaque looking in a syringe. Also, if you have just inserted the needle and have not yet injected anything from the syringe(which should be the case if you are aspirating BEFORE injecting), any red that you see coming INTO the needle will be blood.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Here's my 2cents: Even though they are both red, blood and B12 DO NOT look the same, B12 is clear, blood is generally a darker red and near opaque looking in a syringe. Also, if you have just inserted the needle and have not yet injected anything from the syringe(which should be the case if you are aspirating BEFORE injecting), any red that you see coming INTO the needle will be blood.
that makes sense.
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