New way to give shots

[gonzo1]

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.

[mariebailey, MSN, RN]

Right, that's what I said: 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.

I know. After I posted that, I re-read you post and realized my blunder. I honestly do not think you will find a universal recommendation not to aspirate made by an authoritative source. However, you cannot find much research supporting the use of aspiration either. It's one of those situations where people think that the fact that we've always done it that way is enough to support its continued use.

[Ayvah, RN]

Its definitely a topic of debate, and I agree that the data is lacking, and that there isn't much need to aspirate low risk medications. But its the high risk ones that I'm concerned about, which is why I respond to posts on this topic.

[klone, MSN, RN]

Our facility's policy is do not aspirate unless you're giving the injection in the dorsogluteal. Any other IM site does not have vessels large enough that medication could inadvertantly be given vascularly. Also, in order for aspiration to even be effective, it needs to be done over 10 seconds, and research has found that the vast majority of nurses who aspirate, do not do so correctly.

I sought out research several months ago because one nurse was telling a new nurse to aspirate, and I was telling her that it's not necessary, so I looked up the research, and presented that to our nurse educator, and that is how the "official" policy came to be. If I have time later, I will try to find it for you.

[Ayvah, RN]

"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

I just finished reading the article. Their conclusion is not that aspiration is unnecessary for all injections, but only unnecessary for vaccines, heparin, and insulin.

Here's 2 quotes from that article:

Aspiration may be indicated for I.M. injections of medications such as PCN.6,9,12,14

• Until a standard can be established, injection techniques must be individualized to the patient, the equipment, and the medication being administered to decrease the risk of incorrect needle placement.

Do we still need to teach aspiration for blood when giving an I.M. or subcutaneous injection?” Based on the reviewed evidence, expert opinion, and scientific judgment, the answer is clearly no” for the injection of vaccines, immunizations, heparin, and insulin.

[mariebailey, MSN, RN]

I just finished reading the article. Their conclusion is not that aspiration is unnecessary for all injections, but only unnecessary for vaccines, heparin, and insulin.

Here's 2 quotes from that article:

There are organizations of importance that do not support aspiration through:

Currently, the American Academy ofPediatrics, The American Academyof Family Physicians (AAFP), theAdvisory Committee on ImmunizationsPractices (ACIP), the UnitedKingdom's Department of Health,and the World Health Organization(WHO) have stated that aspirationisn't necessary and serves only to prolongthe injection procedure.10,17,19,20Even so, the aspiration technique hasbeen widely practiced over severaldecades.

[Ayvah, RN]

There are organizations of importance that do not support aspiration through:

Just prior to your quote they article is talking about immunizations. They then reference 10,17,19,20, which all are in reference to immunizations, not to any injection.

10. Diggle L. Injection technique for immunization.

Practice Nurse. 2007;33(1):34-37

17. Atkinson WL, Pickering LK, Schwartz B, Weniger

BG, Iskander JK, Watson JC. General recommendations

on immunization: recommendations of

the Advisory Committee on Immunization Practices

(ACIP) and the American Academy of Family

Physicians (AAFP). MMWR Recomm Rep. 2002;

51(RR-2):1-35.

19. Kroger AT, Atkinson WL, Marcuse EK, Pickering

LK. General recommendations on immunization:

recommendations of the Advisory Committee on

Immunization Practices (ACIP). MMWR Recomm

Rep. 2006;55(RR-15):1-48.

20. World Health Organization. Immunization in

Practice, Module 6: Holding an Immunization Session.

2004. Object not found!.

php?q=content/module-6-immunization-practiceholding-immunization-session.

[_firefly, BSN, RN, EMT-B]

If you are following the landmarks for IM or using the proper needle size and angle for SQ it is virtually impossible to hit a vein or artery. Aspirating only causes unnecessary tissue stress and accomplishes nothing (in the case of IM and SQ injections). Needle makers advise aspirating, but I think it is just to cover themselves.

For ampules you need to use a filter needle and a second injection needle. For vials, it is also useful to change needles due to the dulling of the aspiration needle as it pierces the rubber seal. I use the blunt or dull filter needles to aspirate the medication, so there is little chance of a needle stick and I avoid any stray paticles.

[Ayvah, RN]

If you are following the landmarks for IM or using the proper needle size and angle for SQ it is virtually impossible to hit a vein or artery. Aspirating only causes unnecessary tissue stress and accomplishes nothing (in the case of IM and SQ injections). Needle makers advise aspirating, but I think it is just to cover themselves.

For ampules you need to use a filter needle and a second injection needle. For vials, it is also useful to change needles due to the dulling of the aspiration needle as it pierces the rubber seal. I use the blunt or dull filter needles to aspirate the medication, so there is little chance of a needle stick and I avoid any stray paticles.

How many injections are given every day, every year? Unlikely to hit a vein does not mean impossible. Would you knowingly ignoring Humira's manufacturer instructions to aspirate? Would you feel comfortable not aspirating on a high risk med like an allergy shot? Don't forget, not everyone's anatomy is textbook. I think if it were clearly unnecessary then one of the major organizations would have put out guidelines to not aspirate for even high risk meds. Unfortunately there needs to be more data for full clarity on this subject, but you can not state it as an absolute when the guidelines don't support that.

[gonzo1, ASN, RN]

Thanks for all the info guys.

[LadyFree28, BSN, LPN, RN]

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.

THIS...although the ventrogluteal is slowly becoming my favorite...

If anything, it's just updated recommendations; instead of giving an option for a risk, just the less risky areas. :)

[klone, MSN, RN]

Here is a pretty exhaustive review of the literature:

Aspiration in injections: should we continue or abandon the practice? - F1000Research

Upshot (ha, no pun intended) is that the recommendations are totally mixed, depending on who you ask. Vaccines, we all know you don't have to aspirate. Medications, opinion is mixed - if the medication has fatal consequences if administered vascularly, then every precaution should be taken. Most medications would not have fatal consequences.

[nursel56]

Thanks for all the info guys.

I worked in two teaching hospitals, the last in mid-eighties before I took time off to be a SAHM. The ventro-gluteal preference gained favor at that time. Another was the using a filter needle when drawing from a glass ampule. I'm not even gonna talk about the glove issue 'cause I know lots of people will take the gloves off haha!