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

Flare, ASN, BSN · Dec 10, 2009

I have worked my fair share of surge capacity H1N1 clinics. While I am a firm believer in aspirating, there are times - such as when having to give an injection to a struggling child and not having the proper manpower to fully restrain the child when it's a quick clean, stick and push scenario.

Lacie, BSN, RN · Dec 10, 2009

There was a previous thread on this very issue and I would have to hunt it down but according to the CDC guidelines Aspiration is NOT required during Flu immunizations. It's unlikely to hit any major vessels/nerves in the deltoid area if you are doing your landmarks properly. Also the thought is you end up disposing of a vaccine unnecessarily and also putting the pt through a second injection. It's up to the individual injecting if you aspirate or not. This is only for immunizations. I have worked Immunization clinics for years and I dont aspirate either although I do with all other meds. As an RN from old school days lol, it was hard to change my mindset on this issue also until I did some research on the subject and have to agree with the CDC opinion.

I found the other thread which is lengthly but lots of very good links and information regarding this controversy.

https://allnurses.com/general-nursing-discussion/aspirate-not-aspirate-412639.html

DalmatiaRN · Dec 10, 2009

There was a previous thread on this very issue and I would have to hunt it down but according to the CDC guidelines Aspiration is NOT required during Flu immunizations. It's unlikely to hit any major vessels/nerves in the deltoid area if you are doing your landmarks properly. Also the thought is you end up disposing of a vaccine unnecessarily and also putting the pt through a second injection. It's up to the individual injecting if you aspirate or not. This is only for immunizations. I have worked Immunization clinics for years and I dont aspirate either although I do with all other meds. As an RN from old school days lol, it was hard to change my mindset on this issue also until I did some research on the subject and have to agree with the CDC opinion.
I found the other thread which is lengthly but lots of very good links and information regarding this controversy.
https://allnurses.com/general-nursing-discussion/aspirate-not-aspirate-412639.html

Our class was taught last semester that the CDC no longer requires aspiration for the flu vaccines in the deltoid.

Zookeeper3 · Dec 10, 2009

A drop of blood is not arterial or even venous for that matter, pick a wiser battle. An IM should aspirate, but this is so inconsequential that I lack a reply to it. No worries, just breathe. The vaccine, placed in venous form, if you refer to your anatomy and physiology will simply result in the same effect. (Go back to cellular level with antigens). Quit borrowing trouble, none here.

Aymese · 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??

Uhhh ~ worst case scenario is that it is injected directly into an ARTERY or vein.

~Mi Vida Loca~RN, ASN, RN · Dec 11, 2009

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.

We just got done doing injections and school and we were taught to aspirate IM and not SubQ. That said, we were also taught that apparently there isn't a requirement to aspirate for Vaccines and the instructors didn't know the rationale for it. They said they just go off the most current information and that is what it was.

sweetiepeas · Dec 11, 2009

We were taught to aspirate but in actual clinical and flu clinics that I did we did not aspirate. If you are locating your IM marks correctly you will not hit an artery or a vein.

I have never had a shot given to me that the nurse aspirated. If it is located right the worst that you could do is hit a blood capillary within the muscle.

Medic443 · Dec 11, 2009

I always aspirate when i give an IM. Its what we were taught so I do it till they change it.

Otessa, BSN, RN · Dec 11, 2009

CDC and ACIP state that it is unnecessary to aspirate for any vaccines.

otessa

Otessa, BSN, RN · Dec 11, 2009

cdc and acip state that it is unnecessary to aspirate for any vaccines.
otessa

here is the article : the information is on page 16-intramuscular injections...

http://www.cdc.gov/mmwr/pdf/rr/rr5515.pdf

it states:[color=#231f20][color=#231f20][color=#231f20]

"aspiration before injection of vaccines

or toxoids (i.e., pulling back on the syringe plunger after needle

insertion, before injection) is not required because no large

blood vessels exists at the recommended injection sites."

general recommendations on immunizations december 1, 2006

otessa