Injections- still pull back?

jeepgirl, LPN, NP · May 16, 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.

i wouldn't worry. i certainly wouldn't have double dosed her! i would have told her exactly what you told her... however i might have wanted to get one more correct return demonstration out of her before DC!

You're fine!!

sherylchaynes · May 16, 2005

There has been one occasion when I stock a patient, pulled back and there was blood in the syringe. All I did was, pull out the syringe, appologised to the patient , changed the needle and struck him again.

Afterwards I explained to him my reason for stucking him two times. He was quite pleasant about the whole things, seeing I told him it was done to prevent him from harm. I believe patients will prefer being stuck twice than having a risk of respiratory arrest. :rolleyes:

scooterRN52 · May 16, 2005

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. :)

That is exactly what I learned in 1988 when I went to school. I only aspirate on IM's, It is good to hear that they are sill teaching it that way, I was starting to get a little worried about it. :)

menetopali · Jun 2, 2005

In 3 years of hospital nursing I have given 2 IMs. Where are you folks working that you do these frequently? Seems like everything is IV these days.
I don't aspirate for insulin and heparin/enoxaparin, which are the SQs I give daily. I was taught it wasn't necessary.

i work in college health and give vaccines routinely to students. mostly IM, a couple SQ, and i also do TB screens for them. before this job i worked in an outpatient department / GI lab and gave a number of non-IV injectables.

menetopali · Jun 2, 2005

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.

if you can't remember the the administration parameters of a medication...look them up before giving the med or ask the prescriber. 'i forgot that i had to aspirate that one' is not an excuse; neither is 'i forgot that i shouldn't have aspirated with this one'.

the OP asked for background information about aspirating and wanted to know if such information existed. it does, i presented it with links to the source...the CDC. i am inclined to accept their advisory position as well-reasoned and as i noted in the post and is noted in the text of the CDC advisory opinion the question of aspiration that they addressed applies to IM vaccine administration...not the host of other drugs out there. for those drugs following the prescriber's instruction and the manufacturer's administration guidelines is more appropriate than an absolute rule of 'always aspirate'.

GrnHonu99, RN · Jun 3, 2005

we just went over subq and IM/ID injection sites last week, my instructor told us that we did not have to asperate in SubQ...she did say however that she was taught to when she learned so if we wanted to do it, it wouldnt hurt the pt. Our text book says not to asperate on subq, but with everything else I have to remeber Id rather just know to do it on all except insulin and heprin..much easier for me, and as long as it doesnt hurt the pt....

we dont get to practice on eachother....i am kinda glad but also kinda not glad..i would really like to practice on a real person before I have to give an injection to a patient...

scooterRN52 · Jun 8, 2005

we just went over subq and IM/ID injection sites last week, my instructor told us that we did not have to asperate in SubQ...she did say however that she was taught to when she learned so if we wanted to do it, it wouldnt hurt the pt. Our text book says not to asperate on subq, but with everything else I have to remeber Id rather just know to do it on all except insulin and heprin..much easier for me, and as long as it doesnt hurt the pt....
we dont get to practice on eachother....i am kinda glad but also kinda not glad..i would really like to practice on a real person before I have to give an injection to a patient...

I aspirate on everything except insulin and heparin, that is what I was taught 17 years ago, it does make it easier. We used to practice on oranges. We had to give each other one saline inection w/ an insulin syringe, that gave us a better idea of how it felt to give an injection. Congradulations to you and good luck!!!! :balloons:

nicenurse911121 · Jun 8, 2005

I have not read anything supporting this. With an IM injection you are aspirating to ensure you are not injecting an IM drug intravenously, so why would this EVER change? I would clarify with other staff and supervisor.

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?