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An Integrative Review of the Evidence on Injection Aspiration
Thirty years ago, when I was in my Bachelor's program for nursing, I was taught to aspirate for intramuscular (I.M.) injections to make sure I didn't puncture an artery or vein. I am confident that all of you reading this post were taught the same technique. The question we need to ask is, "Is the technique based on evidence or is it just the way it has always been done?"
 
In an integrative review published in the March issue of Nursing2012, To aspirate or not: An integrative review of the evidence, researchers examined the literature to determine if there was any evidence supporting the practice of aspiration for injections. The researchers used an integrative review methodology to review the literature. The integrative approach answers a targeted clinical question using a systematic search strategy and a rigorous appraisal method (Crawford & Johnson, 2012). 

The results were not surprising; there was no research evidence to support the use of aspiration in giving I.M. or subcutaneous injections. The researchers recommended the following for consideration:
  • Aspiration is not indicated for subcutaneous injections of immunizations, heparin, and insulin
  • Aspiration is not indicated for I.M. injections of vaccines and immunizations
  • Aspiration may be indicated for I.M. injections of medications such as penicillin
  • Until a standard can be established, injection techniques must be individualized to the patient to prevent incorrect needle placement (Crawford & Johnson, 2012). 
Unfortunately in nursing, we often practice a certain way because that is the way it has always been done. I applaud the work of the researchers who did this study; they are truly moving nursing practice forward based on evidence. Translating evidence into practice is a series of steps and the researchers have taken the first steps to appraise the evidence and recommend practice changes based on the evidence. It is up to each of us to take the evidence presented and integrate it into practice. 

References
Crawford, C., Johnson, J. (2012).
To aspirate or not: An integrative review of the evidence. Nursing2012 (42)3, 20-25. 

Submitted by:
Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC
Chief Nurse and Publisher
Wolters Kluwer Health / Lippincott Williams & Wilkins / Ovid Technologies

Posted by Anne Dabrow Woods on 3/7/2012 11:46:03 PM with 3 comments
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Comments
Constance Thomsn
Route I.M. is not the same as Route I.V. If one doesn't aspirate, the route intended may not be the one achieved. Common sense to me. I do know of one case of severe blood infection resulting from incorrect route. We all marvelled that the MD that did the injection didn't aspirate, and obviously didn't know what he was doing. It's a good practice.
3/22/2012 5:25:36 AM

Kavita
Thanks
3/20/2012 11:07:00 PM

linda.goen
The last time I administered flu vaccine, the accompanying literature said to aspirate and if blood is returned give injection with a NEW vaccine syringe. Does the manufacturer typically test value of aspiration before placing aspiration and disposal of blood return into the accompanying literature?
3/20/2012 12:58:45 PM

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