What Happens If the Nurse Didn't Aspirate For H1N1?

Virgo_RN, BSN, RN · Dec 10, 2009

I watched a nurse give someone an h1n1 vaccine last week and she didn't aspirate, a small drop of blood came out after she withdrew the needle.
Isn't that dangerous?

The blood was most likely from the capillary bed. Are you certain she didn't aspirate? When I give IMs, I use the thumb on the same hand that's holding the syringe to pull back on the plunger, which could be easily missed because it's such a quick movement.

jamesy7 · Dec 10, 2009

I'm not an expert, but I would think that the vaccine would still be absorbed IM or subQ - which is the difference from aspirating and not aspirating. Are you sure she didn't aspirate? Some nurses do it so quickly you can hardly notice. As for the drop of blood, that can happen regardless of the injection type (well, IM and subQ - I can't recall ever seeing it with intradermal).

Worst case scenario - not fully absorbed/medication possibly draining from site of injection??

HappyMeNow · Dec 10, 2009

My mom watched it happen and she didn't see any aspiration either. The whole procedure was just clean, poke, inject, pull, wipe blood, done.

HappyMeNow · Dec 10, 2009

I'm not an expert, but I would think that the vaccine would still be absorbed IM or subQ - which is the difference from aspirating and not aspirating. Are you sure she didn't aspirate? Some nurses do it so quickly you can hardly notice. As for the drop of blood, that can happen regardless of the injection type (well, IM and subQ - I can't recall ever seeing it with intradermal).
Worst case scenario - not fully absorbed/medication possibly draining from site of injection??

So not like it could cause death or something because it might be in a vein or artery? We're giving injections next semester and I'm paranoid about messing up and hurting a patient.

Colo9740 · Dec 10, 2009

I am working with 2 differnet flu clinics and BOTH said we are not required to aspirate....that said I still do

ChapterTwo · Dec 10, 2009

I heard that new research says aspirating is not necessary. But, I never got a chance to check it out myself... maybe I will.

shiccy · Dec 10, 2009

I aspirate as instructed by my educational facility when I went through college (

I asked what would have happened if it had been giving anyways, and her answer was that it would just not be held in the muscle as long. While vaccines are a bit innocuous and it doesn't really matter as much, giving medications like Demerol IM vs IV, I know OUR floor Demerol IM (I believe) is 25mg, but IV is less. There's a few other meds that are the same. The reason we still give IM is to elongate the effects over time. This is why you can give a mega dose IM, so a puny dose IV. Also, if you inject 50mg of Demerol, 5mg of Ativan, etc. via IM route and it ends up in the venous system, you may be in a world of hurt (and may be in desperate need for Narcan and/or Romazicon)

sharona97, BSN, RN · Dec 10, 2009

With all the news coverage on TV showing flu clinics and patients receiving the vaccine, I have yet to see the nurse, or person injecting aspirate. Just like previouslly said, clean, poke, push, and withdrawal.

I would aspirate for the simple reason, you just don't know if you have entered a vein. Precaution saves future problems I guess.

The nurse did not aspirate when I received my H1N1.

Is the nasal type a live virus, like the seasonal nasal? I've been curious about that.

Sharona

danamobile · Dec 10, 2009

I'm not an expert, but I would think that the vaccine would still be absorbed IM or subQ - which is the difference from aspirating and not aspirating. Are you sure she didn't aspirate? Some nurses do it so quickly you can hardly notice. As for the drop of blood, that can happen regardless of the injection type (well, IM and subQ - I can't recall ever seeing it with intradermal).
Worst case scenario - not fully absorbed/medication possibly draining from site of injection??

The difference is not IM to subQ, its IM to IV---and if you do not aspirate you cannot possibly know where you are injecting, it it hit a blood vessel or not.

But you know that its best practice to aspirate before injecting and that's the most important thing. If you see someone doing anything you don't feel comfortable with, ask a charge nurse or supervisor that you're working with and maybe they can give you some insight on the matter, or deal with it appropriately.

Stacy in North Texas · Dec 10, 2009

I got the seasonal flu vaccine at a Walgreens. Even the pharmacist that administered it to me knew to aspirate. I was taught to aspirate and that is what I do. I think it should be done. It only takes a second.

melsman1904 · Dec 10, 2009

While vaccines are a bit innocuous and it doesn't really matter as much, giving medications like Demerol IM vs IV, I know OUR floor Demerol IM (I believe) is 25mg, but IV is less. There's a few other meds that are the same. The reason we still give IM is to elongate the effects over time. This is why you can give a mega dose IM, so a puny dose IV. Also, if you inject 50mg of Demerol, 5mg of Ativan, etc. via IM route and it ends up in the venous system, you may be in a world of hurt (and may be in desperate need for Narcan and/or Romazicon)

50 mg of Demerol IV isn't that uncommon on my ortho floor. I've actually seen 75 mg IV q 4 hours with the pt routinely requesting the prn up to 60 minutes early.