# Hard to Aspirate..?



## bulldogz (Mar 27, 2011)

After injecting (injected delts) it seems the plunger on the syringe is hard to pull back to aspirate..

Feels like it has pressure and does not want to pull back...wtf??


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## VictorZ06 (Mar 27, 2011)

Don't aspirate.  Search these threads and you will learn why.  No need to.



/V


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## GH Consigliere (Mar 27, 2011)

thats new dont aspirate why


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## keith1569 (Mar 27, 2011)

I find it hard to aspirate delts due to being inflexible. I'm working on getting my wife to do delts for me ha


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## GH Consigliere (Mar 27, 2011)

i do it with one hand


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## TGB1987 (Mar 27, 2011)

I always aspirate.  Victor and I had a little dispute on this a little while back.  He is right though.  There are sources that say that aspirating is not needed for IM injections as long as they are done in proper sites.  It is not needed and can cause trauma to the muscle because you may be moving the needle around inside the muscle when doing it.  I still do it because it only takes a second and I would rather know that I didn't pass through a vein.  So if it is too hard to do it.  Then go without it you should be fine.  It is your choice.  I choose to do it because it is easy and I think that I would rather know for sure that I did not hit a vein.  Aspirating used to be required for a reason IMO.  Many never do it and don't have a problem.  Vic is one of those that doesn't do it and maybe when I have been doing this for more time I might not do it anymore either.  Who knows.  It's your choice.


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## VictorZ06 (Mar 27, 2011)

Chino0823 said:


> thats new dont aspirate why



Aspirating, that's old school.  They don't even teach RNs to aspirate any more.

The EBP and ACIP also do not recommend aspiration.  Some argue not to aspirate vaccines, but to aspirate other drugs.  Jet injections are not aspirated though.  I know many who have been using AAS ED for many many years who have yet to aspirate.  Read on...

*According to the CDC they state-*

"Aspiration - Aspiration is the process of pulling back on the plunger of the syringe prior to injection to ensure that the medication is not injected into a blood vessel. Although this practice is advocated by some experts, the procedure is not required because no large blood vessels exist at the recommended injection sites."

"Aspiration is not indicated for SC injections of vaccines, immunizations and insulin."

"Aspiration is not indicated for IM injections of vaccines and immunizations."

*STTI International Nursing Research Congress Vancouver, July 2009*

*
Organizations which state aspiration is not necessary:*


Centers for Disease Control (CDC)
Advisory Committee on Immunization Practices (ACIP)
Department of Health Services (DHS)
American Academy of Family Physicians (AAFP)
U.K. Department of Health (DoH)
World Health Organization (WHO)


*References*:

1. Atkinson, W. L., Pickering, L. K., Schwartz, B., Weniger, B. G., Iskander, J. K., & Watson, J. C. (2002). General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). Morbidity and Mortality Weekly Report, 51, RR2. 1-33.

2. Chiodini, J. (2001). Best practice in vaccine administration. Nursing Standard, 16(7), 35-38. 

3. Diggle, L. (2007). Injection technique for immunization. Practice Nurse, 33(1), 34-37.

4. Gammel, J. A. (1927). Arterial embolism: an unusual complication following the intramuscular administration of bismuth. Journal of the American Medical Association, 88, 998-1000.

5. Ipp, M., Taddio, A., Sam, J., Goldbach, M., & Parkin, P. C. (2007). Vaccine related pain: randomized controlled trial of two injection technique Archives of Disease in Childhood,92,1105-1108.

6. Li, J.T., Lockey, R. F., Bernstein, I. L., Portnoy, J. M., & Nicklas, R. A. (2003). Allergen immunotherapy: A practice parameter. Annuals of Allergy, Asthma, & Immunology, 1-40.

7. Livermore, P. (2003). Teaching home administration of sub-cutaneous methotrexate. Paediatric Nursing, 15(3), 28-32.

8. Middleton, D. B., Zimmerman, R. K., & Mitchell, K. B. (2003). Vaccine schedules and procedures, 2003. The Journal of Family Practice, 52(1), S36-S46.

9. Nicoli, L. H., & Hesby, A. (2002). Intramuscular injection: An integrative research review and guidelines for evidence-based practice. Applied Nursing Research,16(2), 149-162.

10. Ozel, A., Yavuz, H., & Erkul, I. (1995). Gangrene after penicillin injection: A case report. The Turkish Journal of Pediatrics, 37(1), 567-71.

11. Peragallo-Dittko, V. (1995). Aspiration of the subcutaneous insulin injection: Clinical evaluation of needle size and amount of subcutaneous fat. The Diabetes Educator, 21(4), 291-296.

12. Roger, M. A., & King, L. (2000). Drawing up and administering intramuscular injections: A review of the literature. Journal of Advanced Nursing, 31(3), 574-582. 

13. Talbert, J. L., Haslam, R. H. & Haller, J. A. (1967). Gangrene of the foot following intramuscular injection in the lateral thigh: A case report with recommendations for prevention. The Journal of Pediatrics, 70(1), 110-114. 

14. Workman, B. (1999). Safe injection techniques. Nursing Standard, 13 (39), 47-53. 

15. World Health Organization (2004). Immunization in Practice, Module 6: Holding an immunization session. Immunization in Practice: A practical resource guide for health workers ???2004 update,1-29. 

16. Center for Nursing History at Misericordia University: http://www.misericordia.edu17. Levels of Evidence, Canadian Medical Association & Centre for Evidence-Based Medicine (2001). Available at:http://www.cebm.net/index18. Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia: Lippincott, Williams & Wilkins.



/V


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## VictorZ06 (Mar 27, 2011)

Ya beat me to the punch TGB! lol



/V


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## keith1569 (Mar 27, 2011)

I def aspirate when I do quad shots 
I have pulled back blood a few times


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## WantsWidth (Mar 27, 2011)

I never aspirated ever


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## WantsWidth (Mar 27, 2011)

only once did I nick a vein....in my ass....


got light-headed and short of breath but the worst part by far was not knowing what was happening

if it ever happened again I wouldn't be panicky cuz I know wats up

P


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## blazeftp (Mar 27, 2011)

Put it this way guys.
You will KNOW when you are in a vein it feels funny and the syringe will start to fill with blood without pulling back on the plunger,Sometimes it won't but its a strange feeling you know somethings up.


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## GH Consigliere (Mar 27, 2011)

this is why i love this place great info never ends of knowledge


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## BigBird (Mar 27, 2011)

VictorZ06 said:


> Don't aspirate. Search these threads and you will learn why. No need to.
> 
> 
> 
> /V


 
x2.  Never aspirated - never will.  Never any issues out of a gazillion injects either.  Nor have any of my associates ever aspirated.


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## TGB1987 (Mar 27, 2011)

VictorZ06 said:


> Ya beat me to the punch TGB! lol
> 
> 
> 
> /V


 
I thought I would save you some hassle but you covered it better anyway  .


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## keith1569 (Mar 27, 2011)

blazeftp said:


> Put it this way guys.
> You will KNOW when you are in a vein it feels funny and the syringe will start to fill with blood without pulling back on the plunger,Sometimes it won't but its a strange feeling you know somethings up.



Ya that is true. But also sometimes I get that feeling and I must have gone through it, not always in it. But ya quads is mainly where I always aspirate. I never had it fill with blood without pulling back, but like I said it has only happened a few times


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## bombboogie (Mar 27, 2011)

aspiration may or may not be needed, but it ensures you are not shooting it within a vein.

but that is just my take, to comfort my mind.


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## MDR (Mar 27, 2011)

No aspirating for me, and no problems in 23 years of use.


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## oden (Mar 27, 2011)

aspiration is not required it causes muscle micro trama and sorness


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## malfeasance (Mar 27, 2011)

The other issue is this - that stupid needle is never in the same place at the end of the injection as it was when the injection started.  Just pushing on the plunger moves it more than the thickness of a vein.  I have been aspirating, but I have been starting to think, "what is the use of this?"  If I aspirate and am not in a vein, there still might be one waiting an eighth of an inch deeper that I get into once I start depressing the plunger.  

Just my two centavos.


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## AwesomeSmiley (Mar 27, 2011)

This will be my first time pinning with testE. This thread has been brilliant for information. Thanks guys. No aspirating it is then


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## SFW (Mar 27, 2011)

wow. interesting how many of you dont asp. guess ill have less to worry about from now on.


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## mjh12795 (Mar 27, 2011)

If i die tomorrow i will know 1 thing. Never say never!!! That being said i always inject in glute and never aspirate and never had a problem.


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## evanps (Mar 27, 2011)

Experience is paramount man. These guys have plenty of it and I pretty much agree. I've given myself very few injections but I give tons of em at work. IM, sub-q, IV, intradermal, I've done em in joint cavities and yea I used to ALWAYS aspirate with most IM injections. But I never do any more. Its traumatic to the pt, or to yourself and with all the thousands I've ever given I've never once aspirated blood and had to waste a shot.... If you're getting deep in a tissue ur good, and if you're having a hard time aspirating then you're good. You don't need to jerk on the plunger till it moves. If you're in a vein its gonna back up before you even aspirate. Resistance is a good thing so don't tug on it..... Do a google search for IM injection spots and poke away. Just be clean and use common sense. 

here's something that might help:


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## bulldogz (Mar 27, 2011)

I hear the argument and I did the search on why to and why not to...but....

I was more wondering why the plunger of the syringe is so hard to pull back..like it has a suction to it and make it difficult to aspirate especial on my delts...needle to small?? (using 25g - 1in)


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## evanps (Mar 27, 2011)

bulldogz said:


> I hear the argument and I did the search on why to and why not to...but....
> 
> I was more wondering why the plunger of the syringe is so hard to pull back..like it has a suction to it and make it difficult to aspirate especial on my delts...needle to small?? (using 25g - 1in)



25g is good, I never use anything larger, even for real thick shit.... like ativan, shits like maple syrup......anyway the resistance is prob suction and if you're creating suction you're in tissue, period. Like I said its a good thing. The slightest tug at the plunger is going to draw blood if you're in a vein/open space even with a 25g. what ur gettin is a normal/good thing.


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## keith1569 (Mar 27, 2011)

evanps said:


> 25g is good, I never use anything larger, even for real thick shit.... like ativan, shits like maple syrup......anyway the resistance is prob suction and if you're creating suction you're in tissue, period. Like I said its a good thing. The slightest tug at the plunger is going to draw blood if you're in a vein/open space even with a 25g. what ur gettin is a normal/good thing.




good point..although my new fav gauge is 23


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## nyf1nest (Mar 27, 2011)

I never aspirate anymore, never have a problem


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## bulldogz (Mar 27, 2011)

Ok..so suction is good which means that I'm in tissue and not in a vein or open space...thanks evan!

I'm really startin to double think aspirating since this shit can cause tissue damage if needle is moved around too much...


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## evanps (Mar 27, 2011)

bulldogz said:


> Ok..so suction is good which means that I'm in tissue and not in a vein or open space...thanks evan!
> 
> I'm really startin to double think aspirating since this shit can cause tissue damage if needle is moved around too much...



tissue damage isn't really too much of an issue, buuuut if ur pinning often the less damage the better. Could develop fibrous areas (callouses/scars) in ur muscle and decrease absorption of ur gears....... rotate, rotate, rotate and be clean. feel free to pm.


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## carli (Mar 28, 2011)

i aspirate the hole time since i started because the very first injection blood went into the syringe as soon as it went in , can never be too careful either


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## bulldogz (Mar 28, 2011)

evanps said:


> tissue damage isn't really too much of an issue, buuuut *if ur pinning often the less damage the better*. Could develop fibrous areas (callouses/scars) in ur muscle and decrease absorption of ur gears....... *rotate, rotate, rotate and be clean*. feel free to pm.


 
^^this...


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