Pediatric Immun. question

MadRedneckRN · Aug 28, 2005

I was always taught that you aspirate any IM or SQ injection. The only injections I don't aspirate are insulin. Better safe than sorry I figure

Lori

Ok I would like the scoop and here from other nurses on this topic because I have gotten different answers.
When I worked as a medical assistant in a pediatric office for 7 yrs I was trained by the doctor to give the immunizations. I would draw them up and give them. Well I worked with 4 different doctors and one NP. I just finished LPN school and had this disscusion with my instructor and both of them had different answers for this question. Here it is............Do you have to aspirate on an IM immunization for a pediatric patient? The 4 different doctors I trained with never did and did not train me to. They were in and they were out! I am assuming because of the kid screaming and squirming thing. I had one instructor tell me on Immunizations you DO NOT have to because she looked it up and read it, and one instructor yell at me after that for giving a flu shot with out aspirating. LOL I did at least 20-30 kids a day over a 7 yr period. Please everyone give me your thoughts or run ins on this, I would be interested in hearing everyone's! Thank you!

Scottish-Fee · Sep 3, 2005

I was also always taught to aspirate a im or sc.. just incase but im in the uk so maybe it's different in the states!

caringchic · Sep 5, 2005

That is a good question. I never aspirate on Ped pts. I have never gotten yelled at for it....but.... what it is the golden rule on that? Any research anywhere for a final ruling ?

Zolitahh1 · Sep 10, 2005

Ok I would like the scoop and here from other nurses on this topic because I have gotten different answers.
When I worked as a medical assistant in a pediatric office for 7 yrs I was trained by the doctor to give the immunizations. I would draw them up and give them. Well I worked with 4 different doctors and one NP. I just finished LPN school and had this disscusion with my instructor and both of them had different answers for this question. Here it is............Do you have to aspirate on an IM immunization for a pediatric patient? The 4 different doctors I trained with never did and did not train me to. They were in and they were out! I am assuming because of the kid screaming and squirming thing. I had one instructor tell me on Immunizations you DO NOT have to because she looked it up and read it, and one instructor yell at me after that for giving a flu shot with out aspirating. LOL I did at least 20-30 kids a day over a 7 yr period. Please everyone give me your thoughts or run ins on this, I would be interested in hearing everyone's! Thank you!

About aspirating when doing pediatric IM immunizations: the danger is giving the immunization intravenously, which greatly increases the risk of an allergic reaction. It is unlikely that you will hit a vein, but in the hundreds I have given, it has happened to me at least twice....and once to my daughter when she received her kindergarten immunization from another nurse. Yes, aspirate before you immunize these children.

yogastudentRN · Sep 10, 2005

Yes always aspirate for IM. Just because a person has a high level of education (MD) does not equate to good common sense and/or teaching skills.

"its too hard because they're squirming" will not save you from disclipliary action if something should go wrong.

caringchic · Sep 11, 2005

My aspiration... or could that be, appreciation to you on the advice! Now that makes good common sense about the rationale for unintentional IV administration! Thanks so much.

MissJoRN, RN · Sep 11, 2005

wish I could remember where...maybe Advance for Nurses? I very recently read an evidence based study to aspirate or not to aspirate...and the conclusion was that aspiration is best practice!

As for the pediatric spin...any thing that could go wrong in an accidental IV access would be so much more dramatic in a pedi patient! I've given many IM injections to kids... including thorazine to a violent child and have always "been able" to aspirate first.

NYNewGrad · Sep 11, 2005

I worked in a peds office too and the MD NEVER apirated. I asked her about it and I forgot what she answered. Sorry.

I just noticed on this CDC Skills Checklist for Pediatric Immunization it says "if office policy, apirate." Hmmmm....

http://www.cdc.gov/nip/publications/pink/appendices/G/skills_cklist.pdf

newflgrad · Sep 11, 2005

I was begining to wonder why we had SO MANY incompetent doctors! haha Because It wasn't just one office I worked in, it was a couple. And none of the doctors aspirated.

truern · Sep 11, 2005

We were taught aspirate everything except insulin and heparin.

Jolie, BSN · Sep 12, 2005

I was begining to wonder why we had SO MANY incompetent doctors! haha Because It wasn't just one office I worked in, it was a couple. And none of the doctors aspirated.

I'm not sure incompetent is the word to use here, so much as untrained. Physicians are not taught to give injections in medical school. If they learn IM technique at all, it is on the job, taught by a senior resident who doesn't know what he/she is doing either.

I once asked my sister, an internist, to give me an injection of fertility drugs. She quizzed me on how to find the landmarks, how deep to inject, whether to aspirate, etc. I jokingly said, "Don't you know what you are doing?" Her answer was, "No, we were never taught this." What an eye-opener for me! She attended a prestigious med school, graduated at the top of her class, did a residency in a well-known medical center, and had been in practice for a number of years at that time.