Injections- still pull back?

sbic56, BSN, RN · May 10, 2005

Ok, this is probably going to be a very scary post to all of you nurses out there because I am a new nurse...acctually pinning is on wednesday and I graduate saturday :balloons: :balloons: but I have never pulled back on any syringe. Maybe it is because I usually give everything IV, but I have given insulin, and heparin and lovenox, and such but I have never have pulled back. Am I practicing wrong? or am I just not understanding something.
I know my school told me to aspirate IM injections but recently I was told we don't give IM injections unless it is necessary because it kills the muscles. Insulin is not an IM its SQ So I am confused....:chuckle wow..and I thought I had it all figured out! lol :chuckle

You're OK with giving insulin w/o aspirating. It is not wrong to aspirate as there is that very slight risk of the insulin going in a vein, but aspirating can cause bruising and affect distribution of the insulin, so there is no definitive answer to which way is best. You should pinch up to be sure you are giving it SQ and not IM.

You are correct to not aspirate Heparin as that will surely cause bruising and affect delivery of the med and increase discomfort at the injection site.

Oh...and congratulations on your upcoming graduation!!

sherylchaynes · May 10, 2005

I was taught to all always pull back, because some meds were not to be given IVP. This can be dangerous for the patient and in some cases life threatening. It doesn't harm anyone to pull back so why not go ahead and continue doing it.

scooterRN52 · May 11, 2005

I just learned this in class and they said that we have to aspirate injections. The only ones that you don't are insulins and heparins.

I went to nursing school in 1988, we were taught to aspirate all injections except insulins and heparins. I wouldn't thiink of not aspirating w/ an IM, giving an IM into the vein changes everything, and it can hurt the patient.

It goes against the 5 Rights and against the doctors order, so it is a med

error if you continue the injection after aspirating blood. :)

LisaG21 · May 11, 2005

hey just one more question,

I was teaching someone's daugter to give her a lovenox shot, and it was my first time teaching so i was nervous and when she did it she dind't stick the needle in far enough and it made and induration. I didn't want to say stop cause I didn't want to scare her because she wasn't to keen about giving it in the first place but I was just wondering if it does anything. I let the patient go home :chuckle right after and told her it was fine it will absorb just make sure you stick the needle in all the way next time. I always wonder now if she still has both legs :chuckle (I know she does) or if I can really cause some damage.

Ethel · May 11, 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?

:uhoh21: I was once on the receiving end of an IM injection which the person forgot to pull back. I was thus given the whole 100mg of Pethidine ivi which resulted in me having a respiratory arrest and nearly dying. So I am truely sold on the idea of aspirating before giving anything IM.

brigitte23w · May 14, 2005

I am a nursing student who just went through the injection testing about 6 weeks ago - the book still states that you need to pull back on IM - and it was taught and tested that way too......

cannoli · May 14, 2005

I've aspirated blood twice over the years.

One was penicillin and streptomycin, it used to be mixed together in one syringe, and it was white in color.

The other, I think, was Talwin which was clear.

You discard and start all over.

I hadn't thought about it but I haven't given an IM in a long time.

Melody1968 · May 14, 2005

"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"
Hi - my v first post - I have to ask a stupid question - why don't you pull back for heparin or insulin?

They are given SQ not iM.

PNS · May 14, 2005

I am currently in my last 2 months of nursing school. We were taught to aspirate on IM's, but not SQ's (we were taught to pinch the skin on SQ's). We also gave each other shots in class, including IM's (ouch)!

What do you say to patient's when you aspirate blood and have to start over?

Melody1968 · May 16, 2005

I am currently in my last 2 months of nursing school. We were taught to aspirate on IM's, but not SQ's (we were taught to pinch the skin on SQ's). We also gave each other shots in class, including IM's (ouch)!
What do you say to patient's when you aspirate blood and have to start over?

The truth.

jeepgirl, LPN, NP · May 16, 2005

I am currently in my last 2 months of nursing school. We were taught to aspirate on IM's, but not SQ's (we were taught to pinch the skin on SQ's). We also gave each other shots in class, including IM's (ouch)!
What do you say to patient's when you aspirate blood and have to start over?

you just say - sir, when i pulled back on the syringe, i got a large return of blood. this means that i hit a vein in the muscle. this happens rarely... but we pull back to make sure we're not accidentally giving you this medicine in your blood stream. this medicine has to go in the muscle, and if it goes in your blood stream it can be very dangerous. i'm going to throw this medicine away and i'm going to go draw up some more and we'll do this again. be right back.

just an example.

jeepgirl, LPN, NP · May 16, 2005

Ok, this is probably going to be a very scary post to all of you nurses out there because I am a new nurse...acctually pinning is on wednesday and I graduate saturday :balloons: :balloons: but I have never pulled back on any syringe. Maybe it is because I usually give everything IV, but I have given insulin, and heparin and lovenox, and such but I have never have pulled back. Am I practicing wrong? or am I just not understanding something.
I know my school told me to aspirate IM injections but recently I was told we don't give IM injections unless it is necessary because it kills the muscles. Insulin is not an IM its SQ So I am confused....:chuckle wow..and I thought I had it all figured out! lol :chuckle

it is taught both ways for insulin. you do not aspirate (or at least i thought) on heparin... or massage after injection. i haven't given it since my first year in nursing school, so maybe i am not remembering correctly. however, i do remember we were taught to always aspirate with im injections.

i've never heard that it kills tissue. i do wonder if it could leave some tissue damage however... like how diabetic pts who dont rotate sites properly have after years of injections.