New way to give shots

Nurses General Nursing

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My lovely and talented daughter in law is in nursing school and she is teaching me all kinds of new things.

Today she says that there is a new place to give "butt" shots. Supposedly we are supposed to go ventrogluteal now. Something about not accidentally hitting the sciatic nerve.

Does anyone else know of this? She knows I'm going on allnurses to see who else is learning this. She even showed me the handout from a rapid med type place that she recently went to.

Where can I find out more info about this. Fortunately I'm in ICU now and we don't ever really give shots. But if I float to ER I'm gonna need to know about this.

Specializes in hospice.

Here's a link that is not supportive of changing needles, and also addresses one of my concerns, which was that changing the needles increases the chance of needle injuries to nurses.

Best Practices in Newborn Injections Nursing Center - CE Article

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Specializes in hospice.

And here's one that claims it reduces injection pain:

Effect on pain of changing the needle prior to administering medici... - PubMed - NCBI

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Here's a link that is not supportive of changing needles, and also addresses one of my concerns, which was that changing the needles increases the chance of needle injuries to nurses.

Nursing Center - CE Article

In my personal experience, changing the needle DECREASES risk of needle stick. When I use the same needle, I have to recap it after drawing up the meds. When I change it, I draw up the med and immediately slide the cover thing over the needle, then unscrew and discard.

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Specializes in Geriatrics, Dialysis.
In my personal experience, changing the needle DECREASES risk of needle stick. When I use the same needle, I have to recap it after drawing up the meds. When I change it, I draw up the med and immediately slide the cover thing over the needle, then unscrew and discard.

Interesting. The needle/syringe we use wouldn't support this. It's a single unit [non-removable needle] that automatically pulls the needle up into the syringe after injection. So no way to change the needle even if I wanted to. Another negative is this means the only way to prevent recapping the needle for transport is to draw up the med at bedside. We have these syringes for all injections, including the multiple sq insulins I give every day.

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Specializes in Med Surg, Specialty.
Haven't aspirated on an injection for YEARS.

Can you provide a link from a solid, definitive source like CDC/WHO/major nursing text specifically stating aspiration should be stopped with all medications? Again, the only guidelines I've seen which specifically mention not aspirating is for vaccines (CDC) and heparin/insulin (per Lippincott text). Many major institutions/bodies don't talk for or against aspiration.

Here's a few examples of strong sources which state you should aspirate.

Here is a 2009 Lippincott text which states SQ injections should be aspirated with the exception of heparin or insulin (p 306)

Lippincott's Nursing Procedures - Google Books

I've got an older Lippincott text at home which also states to aspirate for IM/SQ injections.

ATI also states (though I'm not sure what date this is) "Always aspirate with the plunger of the syringe to check for blood return in the syringe before injecting the medication."

Medication Administration 3

As of 2012, BD also recommends aspirating. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDAQFjAC&url=http%3A%2F%2Fwww.bd.com%2Fhypodermic%2Fpdf%2FIntramuscular_Injection_Guidelines.pdf&ei=ZGXaVKysNoWfyAS2zoLgBQ&usg=AFQjCNGei5G-Timx1nBGD3TF37WtBm_szw&sig2=hX_YZ3GRPYoWeQyikKAECg&bvm=bv.85464276,d.aWw&cad=rja

12/2014 Manufacturer patient instructions for use for injecting Humira syringes state you should aspirate. https://www.humira.com/

I especially think manufacturer's instructions regarding their medication are important to follow. If your next patient needed a Humira injection, would you ignore this step?

So that's why I keep asking for links to good, definitive sources when people state that you should never aspirate, because what I've seen contradicts that. I've aspirated blood on an allergy shot before, which is scary when you think of the possibilities.

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Specializes in Med Surg, Specialty.
no aspiration line up with what I'm learning now.

Does your text specifically state to not aspirate with any injection(not just immunizations/heparin/insulin)? Or does it just not mention aspiration at all? See my post above, the manufacturer of Humira states you should aspirate. Are you saying you would not aspirate when administering Humira?

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Specializes in Med nurse in med-surg., float, HH, and PDN.

Thank you for all those links; sorry I have none to enter here for you. I don't work any critical care and haven't worked a facility for some time now, as I do PDN mostly with Alzheimer's patients. Unfortunately all I can tell you is that when giving pain shots, antibiotics and vaccinations, several docs I worked under at the time told me I didn't have to aspirate. Pretty lame sounding as I type it out, but that's the truth of it.

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I'm not gonna tell you how long ago I learned this in school, but nobody's gotten close yet. :) We used the same landmarks as the diagram posted above.

I had a classmate, though, who darted that needle right into her webspace between the 2nd and 3rd fingers. Ooops. :wideyed:

Edited to include: I missed sallyrnrrt. Pretty close. :)

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Can you provide a link from a solid, definitive source like CDC/WHO/major nursing text specifically stating aspiration should be stopped with all medications? Again, the only guidelines I've seen which specifically mention not aspirating is for vaccines (CDC) and heparin/insulin (per Lippincott text). Many major institutions/bodies don't talk for or against aspiration.

Here's a few examples of strong sources which state you should aspirate.

Here is a 2009 Lippincott text which states SQ injections should be aspirated with the exception of heparin or insulin (p 306)

Lippincott's Nursing Procedures - Google Books

I've got an older Lippincott text at home which also states to aspirate for IM/SQ injections.

ATI also states (though I'm not sure what date this is) "Always aspirate with the plunger of the syringe to check for blood return in the syringe before injecting the medication."

Medication Administration 3

As of 2012, BD also recommends aspirating. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDAQFjAC&url=http%3A%2F%2Fwww.bd.com%2Fhypodermic%2Fpdf%2FIntramuscular_Injection_Guidelines.pdf&ei=ZGXaVKysNoWfyAS2zoLgBQ&usg=AFQjCNGei5G-Timx1nBGD3TF37WtBm_szw&sig2=hX_YZ3GRPYoWeQyikKAECg&bvm=bv.85464276,d.aWw&cad=rja

12/2014 Manufacturer patient instructions for use for injecting Humira syringes state you should aspirate. https://www.humira.com/

I especially think manufacturer's instructions regarding their medication are important to follow. If your next patient needed a Humira injection, would you ignore this step?

So that's why I keep asking for links to good, definitive sources when people state that you should never aspirate, because what I've seen contradicts that. I've aspirated blood on an allergy shot before, which is scary when you think of the possibilities.

The CDC does not recommend aspirating during vaccine administration.

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[TD]Do you need to aspirate before giving a vaccination?[/TD]

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[TD]No. ACIP does not recommend aspiration when administering vaccines because no data exist to justify the need for this practice. There are data that show that aspiration is more painful for the vaccine recipient. IM injections are not given in areas where large vessels are present. Given the size of the needle and the angle at which you inject the vaccine, it is difficult to cannulate a vessel without rupturing it and even more difficult to actually deliver the vaccine intravenously. We are aware of no reports of a vaccine being administered intravenously and causing harm in the absence of aspiration.[/TD]

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Ask the Experts: Administering Vaccines
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"To aspirate or not: An integrative review of the evidence" is an article on aspirating that ends by concluding it is not necessary. Interesting article.

2012: To aspirate or not: An integrative review of the evidence

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Specializes in Psych ICU, addictions.

Hardly new :) It's a better muscle than dorsogluteals because there's no sciatic nerve to dodge.

Though personally, when it comes to giving shots, I am a vastus lateralis fan.

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Specializes in Med Surg, Specialty.
The CDC does not recommend aspirating during vaccine administration.

Ask the Experts: Administering Vaccines

Right, that's what I said:

Again, the only guidelines I've seen which specifically mention not aspirating is for vaccines (CDC) and heparin/insulin (per Lippincott text).
Multiple people have been saying here that you should not aspirate any injection. What I'm asking for is any major definitive source which confirms guidelines to be that you should not aspirate for anything (besides the already established vaccines/heparin/insulin), especially since this contradicts things like Humira's current manufacturer's guidelines to aspirate their drug.
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