To aspirate or not to aspirate

[Inquisitive one]

Do you aspirate for blood when you give an insulin sub q injection? What are the pros and cons? My facility bases it's policy on our pharmacy's policy, which is TO aspirate. None of the nursing schools in the area teach this and some of our new nurses are having difficulty remembering to do this. What have you been taught? Thanks.

[Beary-nice]

I was taught not to aspirate with an insulin sub-Q injection.

[fultzymom]

I have never heard of having to aspirate with a sub-Q injection. I have never heard anything from our pharmacy about it either. We were always taught it is for IM only.

[meownsmile, BSN, RN]

No aspiration. I dont see the rational behind it. Even though the subq tissue does have some vacularity if proper technique is used there is little chance you would hit a vein big enough to get any aspirate anyway.

[PamUK]

I have never heard of aspirating for subq injections either & I have worked in quite a few hospitals in the UK and the USA. However, if it is your hospital's policy, then I guess you have to follow it for two main reasons:

a) you wont place yourself in the position of being disciplined if someone was petty enough to do so (and I think that is a higher chance - nursing seems to have a lot of petty managers!)

b) the hospital will take vicarious liability for your actions if you have followed their policy and there has been harm as a direct result of aspirating

However, I cant see what harm aspirating could do. Just unnecessary. It would be interesting to ask pharmacy the rationale behind their thinking though. Let us know if you find out.

[RN and Mommy]

[color=deepskyblue]we use the insulin pens, so no we can't aspirate. i think i remember being taught in school that aspiration for insulin was optional. either way is correct.

[busy-bee]

We don't aspirate either.........I would ask the pharmacy the rational behind aspiration with a subq inj, and view the policy in writing.

[tvccrn, ASN, RN]

As a diabetic nurse on insulin I can pretty much say you DON'T aspirate.

[Spidey's mom, ADN, BSN, RN]

I graduated 9 years ago and we were specifically taught NOT to aspirate. Others have articulated why and I agree.

Ask your pharmacy specifically why and I'd contact a diabetic association and ask also.

steph

[V. Nightingale]

I aspirate, and what's more, I have gotten blood return! On one patient the needle apparently hit a little vein beneath the surface of the skin; I was glad I checked, because my SQ injection almost became IV.

[bigsyis]

ALWAYS aspirate. Some folks can have some pretty superficial veins that may not be visible to the naked eye. You do not want to give an IV insulin bolus!

[Dolce, RN]

I've never aspirated for insulin or for any other SC medication. I just did some research and found this study (its old...1989)

http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&sid=3698

Their research showed that aspiration is "not a reliable indicator of correct needle placement." Not sure if their are other studies out there or not but my (old) clinical skills book from nursing school recommends to NOT aspirate with SC insulin or heparin citing a study done in 1995 by Ross and Soltes and 1997 by the ADA.

This article from the ADA states that aspiration is not necessary.

http://care.diabetesjournals.org/cgi/content/full/26/suppl_1/s121

Injection procedures

Injections are made into the subcutaneous tissue. Most individuals are able to lightly grasp a fold of skin, release the pinch, then inject at a 90° angle. Thin individuals or children can use short needles or may need to pinch the skin and inject at a 45° angle to avoid intramuscular injection, especially in the thigh area. Routine aspiration (drawing back on the injected syringe to check for blood) is not necessary. Particularly with the use of insulin pens, the needle should be embedded within the skin for 5 s after complete depression of the plunger to ensure complete delivery of the insulin dose.