To aspirate or not to aspirate?!

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by RNStephNicole RNStephNicole (New) New

Specializes in Pediatrics, NICU, Telemetry.

You are reading page 3 of To aspirate or not to aspirate?!. If you want to start from the beginning Go to First Page.

We were taught to aspirate. I do it as a rule. Better to take that extra fraction of a second than to mainline a drug thats supposed to be IM.

dymnback

dymnback

Specializes in Med/Surg. 3 Posts

I am also a student who has had the point driven home! Thank you! CountyRat mentions an alternate technique for aspirating injections...does anyone have any good links or videos that demonstrate this. I always feel like I have four thumbs when trying to aspirate! Thanks!

tink33

tink33

2 Posts

Wow your responses are overwhelming in favor of aspiration. I do not aspirate for vaccine administration. I have found research that has shown faster is better and aspiration is not nessessary. The places chosen for vaccine administration-vastis lateralis and deltoid are considered safer as they are not near any major vessels. However, research also states that if one chooses to aspirate and blood is drawn, to discard med/vaccine and do it again.

So.very.blessed

So.very.blessed

15 Posts

I'm an "old" RN, but attended the local health department immunization conference in 2006 where we were instructed we "didn't have to aspirate anymore." (And wasn't I up to date on the current procedures?! -- felt even older...) I questioned this, but wasn't actually administering at the time so I just filed away.

I am so glad to read the above posts!! I actually hit "red" one time on myself when I was administering a med SubQ in my abdomen.... Pretty scary! The blood return was rather dramatic and I just pulled the needle out and discarded it. I will be giving flu shots this fall, and I'm going to aspirate! It's what I was taught, and I'd rather be safe than sorry! Thanks!

Wishinonastar

Wishinonastar, BSN

Has 37 years experience. 3 Articles; 1,000 Posts

Are you sure they are not aspirating with their thumbs? I can do this with some injections depending on the syringe type and unless you watch carefully I do it pretty quick. A blood flash happens fast and it does not take much of a pull back. Keep aspirating.

BTW I have also seen nurses give flu shots subq instead of IM because they did not bother to pull the sleeve up high enough. It is very upsetting to see a nurse do something wrong, but they can always learn from YOU.

So.very.blessed

So.very.blessed

15 Posts

EXACTLY!! Attention any new nurses who are going to be giving Flu shots.... as cxq174 says, I also saw MANY flu shots administered SubQ, partly because we were given too short of needles (5/8") which is inappropriate for obese patients. But the other reason was poor technique not uncovering the deltoid muscle.

A SubQ injection of flu vaccine is painful. I have seen site inflammation the next day, and I knew immediately what happened. It really hurts! If a patient can't expose their deltoid muscle in public, be sure you have a spot that is private. If not, don't give the vaccine.

msslim

msslim

Specializes in Home Health. 43 Posts

Dconing,

I thought u wasn't supposed to aspirate with sub-Q injections or is that just for heparin, lovenox, and insulin?

lcprnc

lcprnc

67 Posts

Being in charge of the community flu shot program, I have done research on this topic and developed our policy. I have seen the recommendations a few years ago and stopped aspirating prior to injecting influenza vaccinations. Here it is. Hope it helps:

ASPIRATION BEFORE INJECTION

Previous versions of the General Recommendations have recommended aspiration (i.e., gently pulling back on the plunger to check for blood before injection) prior to injection, particularly before intramuscular injection. No data exist to document the necessity of this procedure. The 2002 General Recommendations on Immunization does not recommend aspiration before injection.

Source: http://www.immunize.org/genr.d/issue297.htm

LCPRNC

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 46 years experience. 7,039 Posts

Wow your responses are overwhelming in favor of aspiration. I do not aspirate for vaccine administration. I have found research that has shown faster is better and aspiration is not nessessary. The places chosen for vaccine administration-vastis lateralis and deltoid are considered safer as they are not near any major vessels. However, research also states that if one chooses to aspirate and blood is drawn, to discard med/vaccine and do it again.

Just wondering what you mean by "faster is better"? I'd be interested to see where you did your research on this. Thanks!

Mas Catoer

Mas Catoer

Specializes in General. Has 30 years experience. 77 Posts

aspirating or applying negative pressure in im injection is mechanically my habit for decades although got the blood only once in years. all i concern is just if the drug may have totally different effect given by im or iv.

but i've been thinking about the insulin injection. might have different consideration as insulin is injected with a much shorter needle (i.e. 5/16 to ½ -inch) into the subcutaneous tissue, which does not contain major blood vessels. to avoid hitting a vein, gently pinch up a two-inch or three-inch area of skin. as reasoned by: judy kohn, rn, bsn, cde

source http://www.myfreestyle.com/fs/d/en_us/50.90:90/injecting-insulin---aspirate[/url]

for the vaccines i agree not to aspirate.

the current recommendation is not to aspirate during administration of im

or sc vaccines based on the following rationale.

1) recommended sites for immunizations do not have major blood vessels;

hence the risk of accidentally injecting the vaccine into a blood vessel

is thought to be minimal [20].

2) ad syringes have been given [used] in mass campaigns for im injections

without any reported adverse effects [18, 10] or injury from failure to

aspirate [18, 21, 22]. all complications reported in literature of intra-

arterial injection involved penicillin and other medications and not

vaccines [6]. "it is safe to assume that immunization as a class of im

injection poses less risk to the patient" than other medications

particularly antibiotics [6, 18, 23, 24]. hence according to clements

[18], "the practice of aspiration during vaccinations is not evidence-

based".

3) aspiration can result in wastage of vaccine [21].

4) aspiration prolongs the time that the needle is inside the patient

hence increasing the pain experienced by the recipient [14].

5) less control is exercised during two handed aspiration using a

conventional syringe, which may lead to local injury. during a one handed

vaccination without aspiration, the vaccinator can use the other hand to

control the child [18].

6) at present, at the public health level, the use of auto-disable

syringes represents best practice to protect the health of the public

despite the fact ad syringes do not allow aspiration for the recommended

5-10 seconds. the increased risk presented by eliminating aspiration from

routine vaccine administration technique can be mitigated to an extent by

a thorough understanding of the anatomy and landmarks of recommended

injection sites [23].

the who appreciates that there is not enough evidence to support the

exclusion of aspiration [6,18] at present. as a result, who is neither

able to support nor offer alternative actions in relation to aspiration

undertaken during the administration of vaccines. until such time as clear

evidence becomes available to indicate which method is preferable,

vaccinators should make locally appropriate choices 18]. in addition, it

is suggested that in individual clinical practice using non-ad syringes,

aspiration should continue to be a part of the standard technique for im

injection administration [23].

source: http://uqconnect.net/signfiles/archives/posts00462-464-aspiration.txt

miracleluke

miracleluke

12 Posts

Ultimately, who is responsible for that person you are giving the injection to? You are! So my advice is to remember what you learned and why you learned to do it that way and continue the procedure of giving an injection the way it was taught to you in school! That is the safest and surest practice! The other nurses you are observing not doing this are only responsible for themselves and if something should happen to that little patient they gave an injection to, they would be the ones responsible, right? Protect yourself and instead of following the leader, do what you think is appropriate based on your knowledge and nursing practice that was taught to you and what you know is correct procedure.:wink2: Good Luck!

dhinson45

dhinson45

Specializes in criminal. Has 37 years experience. 42 Posts

I work at a Peds office and I am constantly administering immunizations (lucky me)! I am a recent new grad, and remember being taught to aspirate, however I have noticed very few nurses who actually do this. I am continuing to aspirate because I figure it's what I was taught in school, however, when my kindergardeners are screaming, kicking, and fighting the 4 shots I need to give them I begin to question, do I really NEED to be doing this?! Im curious to hear what everyone thinks...

I say yes, always chance of that vein, no matter how small. That's what I was taught since 1973.

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