Intramuscular injections- drawing back

GrumpyRN63, ADN, RN · Oct 23, 2008

There is a long thread out there on this subject. Apparently a lot of CI's in nsg school say it is no longer necessary. I disagree, I was taught to always aspirate back, I always will, only takes a second to do, and I feel its always better to err on the side of safety.

Annisme · Oct 23, 2008

Our CI's still say to draw back...I've never heard that it was okay not to:no:

DaveCRNA · Nov 4, 2008

minnie

Can you post a link to the WHO guideline?? Have you actually read this or is it just something you heard from someone who heard from someone who heard......

I still aspirate when giving IM injections. However clinical research needs to guide our practice, so if there is credible research that shows we don't need, or should not aspirate I will change my practice. I am a member of my unit's nurse practice committee and haven't heard of this change, however I don't actually give very many IM shots in my practice.

It would be interesting to see what if anything the WHO actually published.

minnimouse · Nov 4, 2008

Hi CVSICU RN

Yes it has come to me second hand to ask if I can investigate, originally started with a student nurse who said they were not being tought in school to draw back ( I am trying to contact school)

The district nurse who has asked me about it told me of the statement in the WHO document 'The green Book'

I am still searching the WHO site and havent accessed it yet!! I have ordered 'The Green Book' (2006) immunisation against infectious diseases. Immunization in practice:a guide for health care workers

pg 30 where it has been sited.

I understand the only relevent reference in the WHO document is to:

Plotkin SA and Orenstien WA (eds) 2004 Vaccines 4th Edition Philidelphia WB Saunders Company

but again this book is currently on loan from our library so waiting for it

will post any info I can find

CT Pixie, BSN, RN · Nov 4, 2008

I can't speak for all CI or instructors in nursing schools but in my school we were taught to aspirate. They did mention that many people don't think its necessary and don't teac it but they were teaching us to do it and it was expected of us to do it.

I have given more IM injections than I care to count in my very short LPN career (flu vaccines in all my clinical rotations because I happened to be there when the flu vaccines were given and I also do flu clinics, add in all my LTC pts who get IM Vit B injections and their other IMs) and I always, always, always aspirate. Hey! It took me forever to gain the skill of pulling back and holding the syringe at the same time :) I'm going to do it.

I have to add that although 99.9% of the time we aren't in a vessel, there is that wee chance that you are. It takes all of 0.3 seconds to aspirate, in my mind better safe than sorry. Also want to add, that only once did I go into a vessel, and I was thankful that i had aspirated because the injection was one of those that they always preach will hurt...bad..if not in the muscle but in the vessel.

Just my :twocents:

justme1972 · Nov 4, 2008

New to site so a big hello to all . My question relates to drawing back when giving intramuscular injections to check you are not in a vessel. I understand the WHO published guidelines that suggested this is no longer necessary and wondered if any one has or knows of research that supports this? Or the theory behind it? I would apprectiate your comments and views :bugeyes:

I have heard this also, however, I cannot imagine not aspirating when it literally takes a second, and you can save a ton of potential damage to the patient.

Can you imagine being the patient who had a nurse that did hit a vessel?

RNKPCE · Nov 4, 2008

I have been a nurse for over 15 years. I was giving insulin about a month ago and drew back as usual and got blood. I have never had that happen before. I was kind of shocked. Needless to say I pulled the syringe out and redrew up a new syringe of insulin. So I think it is important.

Jules A, MSN · Nov 4, 2008

I have heard this also, however, I cannot imagine not aspirating when it literally takes a second, and you can save a ton of potential damage to the patient.
Can you imagine being the patient who had a nurse that did hit a vessel?

It does only take a second and I'm not advocating skipping it but wanted to add that in psych when you are doing an emergency IM on a struggling patient and you need to get it in the patient and not yourself or the staff attempting to restrain them that extra "second" and then performing manuever itself on a moving target is not as easy as it looks on paper, imo.

Flare, ASN, BSN · Nov 4, 2008

I would also be surprised to see that it's no longer being taught. it is the ounce of prevention to save for a pound of cure. Though Jules does have a point - there have been times in dealing with psych patients that you are just lucky to get near the person withy a needle.

DaveCRNA · Nov 4, 2008

I have been a nurse for over 15 years. I was giving insulin about a month ago and drew back as usual and got blood. I have never had that happen before. I was kind of shocked. Needless to say I pulled the syringe out and redrew up a new syringe of insulin. So I think it is important.

I find this interesting. Were you giving it Subcutaneous? I was never taught to draw back on SQ shots. And I don't recall ever giving Insulin IM.

If indeed it was SQ I would be shocked as well!

Freedom42 · Nov 4, 2008

My school teaches us not to draw back on IM injections but to perform the Z-track method. Here's what my fundamentals book says (Taylor, Lillis, Lemone, Lynn):

"An outdated practice is the drawing up of an air bubble into the syringe after the medication has been prepared. This is not supported by research and should not be used (Nicoll & Hesby, 2002).

"Many of the drugs given intramuscularly can cause irritation to subcutaneous tissues when backflow into the tissues occurs along the injection track. The Z-track technique is recommended for all IM injections to ensure medication does not leack back along the needle track and into the subcutaneous tissue (Nicoll & Hesby, 2002)."

Here's the actual citation:

Nicoll, L. & Hesby, A. (2002). Intramuscular injection: An integrative research review and guideline for evidence-based practice. Applied Nursing Research, 16(2), 149-162.