To Aspirate or Not to Aspirate, that is the Question: An Integrative Review of the Evidence

2.50
Hdl Handle:
http://hdl.handle.net/10755/154158
Type:
Presentation
Title:
To Aspirate or Not to Aspirate, that is the Question: An Integrative Review of the Evidence
Abstract:
To Aspirate or Not to Aspirate, that is the Question: An Integrative Review of the Evidence
Conference Sponsor:Sigma Theta Tau International
Conference Year:2009
Author:Crawford, Cecelia L., RN, MSN
P.I. Institution Name:Kaiser Permanente, Southern California
Title:Project Manager, Evidence-Based Nursing Practice
Co-Authors:Joyce A. Johnson, PhD, RN-BC
[Evidence-based Practice Session Presentation] Purpose: The precautionary practice of blood aspiration during injections is a nursing tradition added and eliminated based on anecdote, assumption, and arbitrary choice. However, past literature and integrative reviews have indicated that blood aspiration prior to injection is not based on scientific evidence. This integrative review examined the aspiration technique for subcutaneous and intramuscular injections, primarily involving vaccine and immunization administration, in the ambulatory care setting. Methods: A 2000-2008 review of the research evidence via electronic databases used the search terms of "aspiration", "subcutaneous", "intramuscular", and "injections".  A total of 306 hits yielded 14 articles.  Reference links and a web-based search resulted in 7 additional articles. 21 total articles were reviewed and 15 selected as relevant. Results: The strength of the research evidence ranged from insufficient to fair, with a final grade of insufficient. In addition, an internationally known immunization nurse specialist assessed the integrative review. The evidence summary reveals that aspiration may not be a reliable indicator of correct needle placement. Aspiration during SC injection is not necessary. There is no evidence that aspiration with or without blood return confirms needle placement or eliminates the possibility of an IM injection into a non-SC blood vessel. Fears of adverse reactions following non-aspiration of IM injections mainly center on intra-arterial injection of penicillin and other large molecule medications. Nurses often do not follow aspiration guidelines and perform the procedure too quickly. Conclusion: Conflicting best practice guidelines reflect the need for more research in this deceptively routine procedure. Due to patient safety issues and the large sample size required to detect this rare adverse event, a randomized control trial may not answer this question. Until a standard is determined, injection techniques must be individualized to the patient, the equipment, and the medication in order to decrease the risk of incorrect needle placement.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleTo Aspirate or Not to Aspirate, that is the Question: An Integrative Review of the Evidenceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/154158-
dc.description.abstract<table><tr><td colspan="2" class="item-title">To Aspirate or Not to Aspirate, that is the Question: An Integrative Review of the Evidence</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Crawford, Cecelia L., RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Kaiser Permanente, Southern California</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Project Manager, Evidence-Based Nursing Practice</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Cecelia.L.Crawford@kp.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Joyce A. Johnson, PhD, RN-BC</td></tr><tr><td colspan="2" class="item-abstract">[Evidence-based Practice Session Presentation] Purpose: The precautionary practice of blood aspiration during injections is a nursing tradition added and eliminated based on anecdote, assumption, and arbitrary choice. However, past literature and integrative reviews have indicated that blood aspiration prior to injection is not based on scientific evidence. This integrative review examined the aspiration technique for&nbsp;subcutaneous and&nbsp;intramuscular injections, primarily involving vaccine and immunization administration, in the ambulatory care setting. Methods: A 2000-2008 review of the research evidence via electronic databases used the search terms of &quot;aspiration&quot;, &quot;subcutaneous&quot;, &quot;intramuscular&quot;, and &quot;injections&quot;.&nbsp; A total of 306 hits yielded 14 articles.&nbsp; Reference links and a web-based search resulted in 7 additional articles. 21 total articles were reviewed and 15 selected as relevant. Results: The strength of the research evidence ranged from insufficient to fair, with a final grade of insufficient. In addition, an internationally known immunization nurse specialist assessed the integrative review. The evidence summary reveals that aspiration may not be a reliable indicator of correct needle placement. Aspiration during SC injection is not necessary. There is no evidence that aspiration with or without blood return confirms needle placement or eliminates the possibility of an IM injection into a non-SC blood vessel. Fears of adverse reactions following non-aspiration of IM injections mainly center on intra-arterial injection of penicillin and other large molecule medications. Nurses often do not follow aspiration guidelines and perform the procedure too quickly. Conclusion: Conflicting best practice guidelines reflect the need for more research in this deceptively routine procedure. Due to patient safety issues and the large sample size required to detect this rare adverse event, a randomized control trial may not answer this question. Until a standard is determined, injection techniques must be individualized to the patient, the equipment, and the medication in order to decrease the risk of incorrect needle placement.</td></tr></table>en_GB
dc.date.available2011-10-26T12:47:14Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T12:47:14Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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