To aspirate or not to aspirate?!

Nurses General Nursing

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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...

Plus, it depends on the medication you are injecting and the recommended ways to deliver it based on how fast it acts that you need to be aware of as well as if you are in a vein or not? Again, why take the chance? I say Aspirate! and be safest!

Specializes in heart failure and prison.

I am a new grad also but, I have been a Medical Assistant for years and I was taught to aspirate in both schools. However, I don't aspirate because it hurts the person more. In my opinion, their is not reason to aspirate. My motto is to stick and move, I get in and get out and my patients feel less pain.

It was an article on adminstering vaccine to children.

Specializes in L&D.

i decided to check out a reference posted earlier...

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

here is what blew me away:

the centers for disease control and prevention (cdc) has issued an online summary of the seven major changes made by the advisory committee on immunization practices (acip) in the new "general recommendations on immunization,"

"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 cdc general recommendations on immunization does not recommend aspiration before injection."

interesting, huh?

after thirty years of aspirating all im injections, i read that the cdc has been stating it is not necessary as of >5 years ago!

guess it's time for this old nurse to do some more reading!

I'm right there with you! I was shocked when I first heard this, but I'm more concerned about the overwhelming responses I have read about "change".... WE ARE EDUCATED NURSES! We must always practice based upon evidenced based process/research.

When I (and probably you, HazeKomp) graduated (1979 for me), the "Nursing Process" was just being implemented. This was VERY difficult for the "old nurses" (and "old nursing assistants") to change their practice based on research instead of "we've always done it that way". Care Plans? Who needs them???

I'm an old OB nurse.... Do you want to know how many new moms I taught to lay their newborns prone??? Now (current research) has found that this increases the incidence of SIDS (instead of preventing aspiration as was my goal). I have worried so if I ever caused a baby to die from SIDS... Yes, it was "standard of care" at the time, and now "standard of care has changed based on new data, so we all must change our practice!

No, aspirating will not kill anyone. But, minds greater than I have made this recommendation, and we ALL must make this change and update our practice. Additionally, notice the date? 2002.... Anyone heard of any catastrophic occurences from this new practice the last 7 years? I haven't (but I haven't researched it either...) I will be administering my IM flu shots this fall without aspirating....

Speaking of "standard of care".... If anything ever were to happen and you were not following "standard of care" in your practice, the DEFENSE LAWYER of the injured patient would be singing all the way to the bank!! (I also was a certified legal nurse consultant.)

Change is OK when it's based upon research! :nurse:

Specializes in Peds/outpatient FP,derm,allergy/private duty.
I am a new grad also but, I have been a Medical Assistant for years and I was taught to aspirate in both schools. However, I don't aspirate because it hurts the person more. In my opinion, their is not reason to aspirate. My motto is to stick and move, I get in and get out and my patients feel less pain.

I don't think it's a very good idea to change a procedure you were taught in Nursing School and Medical Assisting School because YOU think it "hurts the person more" when you aspirate. Or because, for whatever reason, it is your opinion that this or that is not the correct way to do a procedure.

Anyway, pain from an injection isn't caused by aspirating. It just bothers me that you are changing things because of what your opinion is. It opens up a really dangerous can of worms.

When I am told in an inservice that we no longer aspirate I will stop. We have been told what drugs NOT to aspirate with, but we have not been told to NEVER aspirate. If it won't hurt and it protects my patient and I, then I will do it. The CDC may say it is not necessary, but they have not said to stop. Of course I am not in Peds and things may be different there. I have hit blood vessels before and I don't know what harm could come from IV injection of some meds, therefore I will continue to aspirate for now.

Specializes in General.

Well then. We should smartly combine the evidence based theory, experience, the circumstances, and ultimately the local policy. When things are supported by strong reasoning, it should be able to drive us to take a good view of it. Keep learning while working is a great thing to do. There is always a new cheese out there..

Love nursing... :-)

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

. . . yes!! God help us if our brains are so ossified we grump around about "the old way" There was that quotation on the masthead of a Nursing Journal "times change and we must change with them"---- after that change has been shown to improve over the old way by evidence-based practice.

Specializes in Family Nurse Practitioner.
Well then. We should smartly combine the evidence based theory, experience, the circumstances, and ultimately the local policy. When things are supported by strong reasoning, it should be able to drive us to take a good view of it. Keep learning while working is a great thing to do. There is always a new cheese out there..

Love nursing... :-)

Yup, I love new cheese! :D

Jules, Love the kitty... How did you get that on your page?

Again, What I have been reading holds true then, "That in Nursing we never stop learning and the day we do, should be the day we consider getting out of the profession! Always keep your ears and eyes open Nurses to everything that comes down the pike towards you to offer you a new way of doing it if it improves the situation, but question it if you are not sure and make sure you research it to back it up!" Good Luck Nurses!

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