IM Injection Technique

[EpiEMS]

Is there any reason to aspirate before IM injection into the anterolateral thigh? Is there really a risk of hitting the vasculature?

I've seen some different guidance for this -- ACIP seems to say that it's not necessary for vaccines, period, and yet I see guidance that it is necessary for IM epinephrine injection in anaphylaxis. I understand why aspiration is in theory of benefit for a site where you might hit a vessel and have an inadvertent IV injection, but it's not like we aspirate before an autoinjector use (my service's previous epinephrine administration mechanism for BLS providers).

 

[DrParasite]

auto injectors don't have a mechanism in place to aspirate, and the general public wouldn't understand. I believe when I got my covid vaccine (in my arm) the nurse did aspirate before she pushed the drug. I believe it's more of an over abundance of caution (you want the medication to go into the muscle not the blood vessel), and if you have a shallow enough vein, you can cause issues.

Check out this video: its about IM testosterone, but the information about IM aspiration applies

 

[E tank]

Giving an IM drug "into" a vein isn't a disaster. Aspirating doesn't guarantee you're not in a vessel anyway. Likely to extravasate most of any drug you happened to hit a vein with anyway. Not like giving it through an IV at all. I never aspirate.

 

[akflightmedic]

We stopped teaching "aspiration" several years ago. Even nursing school no longer teaches aspiration. If you have been doing this recently while administering vaccines or any other IM medication, then someone has told you wrong.

 

[DesertMedic66]

I think I stopped aspirating for IM injections the day medic school ended.

 

[Peak]

We stopped teaching "aspiration" several years ago. Even nursing school no longer teaches aspiration. If you have been doing this recently while administering vaccines or any other IM medication, then someone has told you wrong.

There are some medications that should be aspirated before injection. Asparaginase for example already has a high rate of profound anaphylactic shock, and mortality increase with rapid IV administration.

 

[akflightmedic]

Well you got me there, but I am not a Chemo Nurse and will most likely never give this medication. As always, there will be statistical outliers, or exceptions to every rule. In context, we were discussing vaccines and routine/typical IM administrations, along with injecting into a thigh with risk of striking vasculature, right?

But I did go read up on the drug....

 

[NomadicMedic]

we do have a tendency to go off on obscure tangents not related to prehospital care here, don't we?

 

[E tank]

Well you got me there, but I am not a Chemo Nurse and will most likely never give this medication. As always, there will be statistical outliers, or exceptions to every rule. In context, we were discussing vaccines and routine/typical IM administrations, along with injecting into a thigh with risk of striking vasculature, right?

But I did go read up on the drug....

Attempting to aspirate for blood in any IM injection into a large muscle with an appropriately sized needle is basically theatre. We do a lot of things that make intuitive and theoretic sense that don't make any difference at all in practice. Just the mechanical action of attempting to aspirate blood moves the tip of the needle to where it isn't in the same place after the attempt as before, ie the attempt can move the needle tip into a vessel as easily as not. But if you work under guidelines to aspirate, then aspirate. Being lulled into a false sense of security, tho, is worse than not aspirating, IMHO.

 

[ffemt8978]

we do have a tendency to go off on obscure tangents not related to prehospital care here, don't we?

Yes, but I'm willing to tolerate it to a point as long as it remains educational and tangentially related

 

[EpiEMS]

Sounds like the consensus is that it is indeed not necessary for vaccinations and probably not of benefit for IM epinephrine into large musculature (vastus lateralis, for example). Thanks all!

 

[Peak]

Attempting to aspirate for blood in any IM injection into a large muscle with an appropriately sized needle is basically theatre. We do a lot of things that make intuitive and theoretic sense that don't make any difference at all in practice. Just the mechanical action of attempting to aspirate blood moves the tip of the needle to where it isn't in the same place after the attempt as before, ie the attempt can move the needle tip into a vessel as easily as not. But if you work under guidelines to aspirate, then aspirate. Being lulled into a false sense of security, tho, is worse than not aspirating, IMHO.

I think that depends on how you hold the syringe. It is possible to manipulate the plunger while holding the barrel, and therefore the needle, completely still. I hold the barrel under my 2nd and 3rd and then over the proximal phalanx on my 4th and then use my thumb to manipulate the plunger.

we do have a tendency to go off on obscure tangents not related to prehospital care here, don't we?

It isn’t uncommon for there to be a need for EMS transport from outpatient infusion centers to the ED with certain chemo infusions. Some patients become vastly more sensitive between infusions.

 

[akflightmedic]

Either the chemo would be discontinued or the chemo nurse would take a ride, right?

 

[Peak]

Either the chemo would be discontinued or the chemo nurse would take a ride, right?

The dose that is in them is still bioactive.

 

[Carlos Danger]

The dose that is in them is still bioactive.

But what does that have to do with IM technique?

 

[Peak]

But what does that have to do with IM technique?

It has to do with the comment that chemo infusions are irrelevant to EMS.

 

[akflightmedic]

I do not recall saying they were irrelevant. I do believe I said the chemo would be discontinued, or a chemo nurse would ride along. And the medication you mentioned would never be seen on a normal ambulance, nor would it ever be up for discussion in IM technique in a paramedic/EMS capacity.