Intramuscular injections- drawing back

[minnimouse]

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:

[NurseWannabe1129]

I just learned IM injections this week too.. We were taught to draw back.

[RNKel, ASN, RN]

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.

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Whew... I was wondering, too. I'm curious to see the reply.

Although I did give a SQ injection last week that did say to aspirate... I believe it was Neupogen. But I've never heard of aspirating with insulin.

[LPNdelgado]

the only injection that you HAD to drawn back on that is not required any longer is the Sub Q. The ONE injection you must aspirate is the IM. I never heard this and I just started injections 2 weeks ago. I am a newbie lol.. and a huge hello to everyone as well!

[minnimouse]

HI all and thank you very much for your responces,

Freedom42, thank you very much for coment and reference, Im not sure that this quotation is refering to drawing back to check you are not in a vessel? this sounds like it is referring to drawing air into the syringe prior to administration? I have never heard of this one mind you! I will obtain article to clarify.

Sub-cut - very interesting comments, I have never been taught (or practiced) drawing back when administering subcut injections. In view of your experience mommy perhaps its not such a bad idea.

Please keep them coming along with any evidence you find

[Freedom42]

Freedom42, thank you very much for coment and reference, Im not sure that this quotation is refering to drawing back to check you are not in a vessel? this sounds like it is referring to drawing air into the syringe prior to administration? I have never heard of this one mind you! I will obtain article to clarify.

Good point. Is it possible that we're not all on the same page re: drawing back versus aspiration? I didn't recognize the difference until I read the aforementioned article in Applied Nursing Research.

That article says you should still draw back to check for blood return, making sure that you are not in the vessel; however, it also says that the old method of aspirating an air bubble is not support by evidence. So yes, according to this article, you draw back for blood. But you don't aspirate a bubble.

Perhaps some veterans can shed some more light on this.

[DaveCRNA]

Thanks freedom,

I for one was using the terms interchangeably. So from my newly corrected perspective, here is my practice:

I never use the air bubble, I use Z-track if I'm worried about medication leaking through needle track and irritating subcutaneous tissue. I believe the old air bubble was supposed to accomplish the same task, but I'm not positive. NS seems so long ago now and I really don't give more than one or two IM injections a year in my current job.

I have always attempted to draw back on the syringe once in the muscle to ensure that I will not inadvertently administer the medication into a blood vessel instead of muscle.

Last, I have never used air or tried to draw back on a subcutaneous injection. I had never even heard of it prior to reading a previous post in this thread.

[Freedom42]

Thanks freedom,

I for one was using the terms interchangeably. So from my newly corrected perspective, here is my practice:

I never use the air bubble, I use Z-track if I'm worried about medication leaking through needle track and irritating subcutaneous tissue. I believe the old air bubble was supposed to accomplish the same task, but I'm not positive. NS seems so long ago now and I really don't give more than one or two IM injections a year in my current job.

I have always attempted to draw back on the syringe once in the muscle to ensure that I will not inadvertently administer the medication into a blood vessel instead of muscle.

Last, I have never used air or tried to draw back on a subcutaneous injection. I had never even heard of it prior to reading a previous post in this thread.

Interesting topic! I went to Applied Nursing Research to find out more:

"As noted by Beyea and Nicoll (1995), the use of an air bubble in the syringe is a topic that engenders heated debate among clinicians, especially nurses. Despite their conclusion that "drawing up an air bubble is an outdated recommendation and should be eliminated from

the IM injection procedure" (Beyea & Nicoll, 1995), it still appears to be a prevalent practice (Engstrom et al., 2000). However, the scientific

basis for this technique is weak to nonexistent.

"Two views among clinicians surrounding the need for an air bubble in the syringe are prevalent. View one suggests that an air bubble is necessary to ensure that a correct dose of medication is in the syringe; view two suggests that the air bubble seals the medication in the muscle after injection. Although view one does have a basis in historical fact, neither view is scientifically supported or appropriate for the procedure in current practice."

The article goes on to explore the two views in detail. It also says this about the blood vessel issue:

"Once the needle has been inserted through the skin and into the muscle, aspirate by pulling back on the plunger for 5-10 seconds. This time is necessary to ensure that the needle is not in a low flow blood vessel (Keen, 1981; Stokes et al., 1944). There are reports in the literature of complications that occurred as a result of intra-arterial or intravenous injection of medication (Ozel et al., 1995; Talbert et al., 1967). If blood is aspirated in the syringe, the needle should be withdrawn, the syringe discarded and a new injection prepared using new equipment, which should be given in a different location (Workman, 1999)."

I'm really glad I read this article; though my preceptor has instructed me to pull back to check for blood, I certainly didn't do it for five to 10 seconds. There are also a number of points made by the authors about technique that make this an interesting read.

[RNKPCE]

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!

It was SQ. I was taught in nursing school to aspirate on insulin injections

[Jules A, MSN]

It was SQ. I was taught in nursing school to aspirate on insulin injections

How long ago was this?

[mscsrjhm]

Never heard of drawing back on any subq injections.

If it is recommended for Neupogen-I admit negligence.

I did draw back blood only once in a deep maxglut IM.

The only bubble technique I have used is with Lovenox. It is already in the syringe- I always give the hypo a good shake to confirm the location of the bubble.

Anyone have anymore info re Neupogen? (I'm just too lazy today to look it up.)

[RNKPCE]

How long ago was this?

More than 20 years ago

[tirednurse1000]

I was also recently told that aspiration with IM injections was passe (don't know how to put the accent on the 'e'!).

Anyway, I just looked in my country's (Canada) immunization guidelines of 2006 (most recent edition). It says that "there are no studies that have assessed the need for aspiration prior to IM injection of vaccines in relation to vaccine safety."

I was taught to aspirate, and like others have stated here, it only takes a second to make sure you are safe!! I'm going to do it!!