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Should you aspirate when giving intramuscular injections? - Research - Nurses Arena Forum

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Should you aspirate when giving intramuscular injections? by Idowu Olabode : September 01, 2016, 06:57:12 PM
Question: What is the current practice for giving an IM injection across the lifespan? Should the nurse aspirate the syringe?


Answer:
Upon investigation of your clinical question, members of the committee have provided their expertise in regards to the appropriate technique in administering IM injections. Many of the members' organizations queried do not use have a specific policy in regards to the aspiration of an IM injection, although many do state that they follow the manufacturer’s guidelines per medication that is being administered.

There were no explicit guidelines to follow other than basing the technique of injection on each individual patient, making sure that the injection site, needle size, and needle gauge are all appropriate, as these are the most common mistakes made when performing an IM injection.

According to the CDC, aspiration is not indicated for IM injections of vaccines and immunizations, nor is it required for subcutaneous injections of immunizations, heparin, and insulin. However, it may be indicated for IM injections of medications such as PCN.


The CDC recommends following facility policy in regards to this practice. Perry & Potter describes aspirating when using Z track method of injections; yet for routine injections in the deltoid or vastus lateralis muscles, aspiration is not necessary as the sites do not contain large blood vessels.

Most nurses are concerned about the practice of aspiration as they often ask about the appropriate technique and are quite fearful. Because there are no large blood vessels in the recommended sites, aspiration before injection of vaccines (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary. Also, some safety-engineered syringes do not allow for aspiration.

The CDC recommends this technique when administering IM vaccinations:

*Follow standard medication administration guidelines for site assessment/selection and site preparation.

*To avoid injection into subcutaneous tissue, spread the skin of the selected vaccine administration site taut between the thumb and forefinger, isolating the muscle.

*Another technique, acceptable mostly for pediatric and geriatric patients, is to grasp the tissue and "bunch up" the muscle.

*Insert the needle fully into the muscle at a 90° angle and inject the vaccine into the tissue.

*Withdraw the needle and apply light pressure to the injection site for several seconds with a dry cotton ball or gauze.

The following references have been used during the research process of your clinical question.

References

CDC. (2016). http://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html

Crawford, C.L., Johnson, J.A. (2012).  To aspirate or not: An integrative review of the evidence, Nursing, 42 (3), p20-25

Perry, A.G., Potter, P.A., Ostendorf, W.R. (2014). Clinical nursing skills & techniques (8th ed.). St. Louis: Mosby and Mosby Skills

Source : Academy of Medical Surgical Nurses https://www.amsn.org/practice-resources/care-term-reference/medications/question-what-current-practice-for-giving-im

Aspirating during the intramuscular injection procedure: a systematic Literature Review from Pubmed


Abstract

AIMS AND OBJECTIVES:


To review the available evidence on aspirating when administering intramuscular injections and suggest recommendations for practice.

BACKGROUND:


The process of aspiration has been ingrained in the intramuscular injection procedure, and whilst many policies no longer recommend this practice, it often continues to be taught and practiced. The result is a variation in this procedure not always consistent with an evidence-based approach.

DESIGN:


A systematic literature review.

METHODS:


A systematic approach to searching the literature was undertaken using identified academic databases from inception to May 2014. Citation searching identified additional data sources. Six studies met the search criteria.

RESULTS:


The majority of health professionals do not aspirate for the recommended 5-10 seconds. Administering an injection faster without aspiration is less painful than injecting slowly and aspirating. The main influences on the decision of whether or not to aspirate are based on what health professionals are taught and fear of injecting into a blood vessel.

CONCLUSIONS:


In the paediatric vaccination setting, the practice of aspirating during the administration of an intramuscular injection is unnecessary and there is no clinical reason to suggest that these principles may not be applied when using the deltoid, ventrogluteal and vastus lateralis sites in other settings. Owing to its proximity to the gluteal artery, aspiration when using the dorsogluteal site is recommended. Nurses must be supported in all settings, by clear guidance which rejects traditional practice and facilitates evidence-based practice.

RELEVANCE TO CLINICAL PRACTICE:


Educators need to ensure that their knowledge is up to date so that what they teach is based on evidence. This may be facilitated via regular educational updates. Further research and subsequent guidance are needed to support evidence-based practice in intramuscular injection techniques in all nursing settings.

Source : http://www.ncbi.nlm.nih.gov/pubmed/25871949

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