I know this is an old thread, but here's something I found that some here may find interesting. It basically says that there's no conclusive evidence that aspirating while injecting IM is actually necessary. One has the option of doing so however, for large molecule medications (I would assume that oils fall into this category).
On the other hand, I definitely don't want to experience the "thinking you're gonna die" feeling that some people here have had. Anyway, here's the study:
Source: stti.iupui.edu/pp07/vancouver09/41810.Crawford,%20Cecelia%20L.-F%2010.pdf
Excerpts:
Aspiration may not be a reliable indicator of correct needle placement(11)
Aspiration during subcutaneous injection is not necessary(2,7,8,11,14)
There is no reported evidence that aspiration with or without blood return (8,11)
- confirms needle placement
- eliminates the possibility of an intramuscular injection into a non-subcutaneous blood vessel
Fears of adverse reactions following non-aspiration of intramuscular injections mainly center on intra-arterial injection of penicillin and other large molecule medications(4,6,9,10,13)
Most nurses do not follow slow aspiration guidelines and perform the procedure too quickly for it to be effective(5)
Ten Second Rule:
- Slow aspiration (5-10 seconds)
- Slow injection (5-10 seconds)
- Slow withdrawal, no rubbing (How many nurses do this?)
Use of jet injection for delivery of vaccines and immunizations does not involve the aspiration technique(1)
Aspiration is not indicated for SC injections of vaccines, immunizations and insulin(2,8)
Aspiration is not indicated for IM injections of vaccines and immunizations(2,5)
Aspiration maybe indicated for IM injections of large molecule medications, such as penicillin(4,10,13)
Until a standard can be determined, injection techniques must be individualized to the patient, the equipment, and the medication being administered in order to decrease the risk of incorrect needle placement(3,11,13,14,15)
CareAlthough the practice of aspiration is advocated by some experts, the procedure is not required because no large blood vessels exist at the recommended injection sites(3,8,15)
Organizations which state aspiration is not necessary for immunizations & vaccines are(1,3,15):
- 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 ***8211;2004 update,1-29. 16. Center for Nursing History at Misericordia University: misericordia.edu17. Levels of Evidence, Canadian Medical Association & Centre for Evidence-Based Medicine (2001). Available at: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