Topic: Bicillin Users: Do you HAVE to aspirate before injection?
bcb1200
Frequent Contributor (1K+ posts)
Member # 25745
posted
Hi folks:
I just had my first IM injection of Bicillin by a Nurse who is experienced giving them.
I had done my research before hand and had always read that one MUST aspirate prior to injection to see if the needle happened to enter a blood vessel. (It is VERY bad to inject Bicillin into a blood vessel.)
However, the nurse today said that, given the Bicillin was always going to be a DEEP IM injection in the Glut (i.e. Butt Cheek), then it is not necessary since there aren't any veins in that area.
She said it is only necessary to aspirate on a subcutaneous injection as that is where blood vessels / veins are. They are not deep within muscle. Thus..aspiration during Deep IM injections is unnecessary. (provided you know the landscape of the area you are injecting into and ensure you are in the right spot.)
So...on one hand it makes sense. On another, I'm bit concerned as my wife will now be giving them and we weren't instructed how to aspirate (I know one pulls back..but I don't know how long and what happens if air gets in there.)
Your thoughts?
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
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Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
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posted
Its not a big deal if you didn't it won't hurt you.
My Dr who used to give me IVs said you would need at least 4 syringes full of air injected into your vein before you'd even see any issues at all. (and thats directly into your vein)
So just do it next time :-)
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bcb1200
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posted
OK..and what is SUPPOSED to happen when you pull back?
nothing? Air? I know blood is bad. but if "all goes well" what is the result?
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
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posted
You want to make sure when aspirating that you are not pulling back blood. Because Bicillin is so thick, if given directly into a blood vessel can be very dangerous.
My Doctor's office gave me mine and they did not aspirate either.
Posts: 747 | From Utah | Registered: Apr 2010
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glm1111
Frequent Contributor (5K+ posts)
Member # 16556
posted
Absolutely you must pull back(aspirate) on the syringe even when giving an IM injection. Foolish not to do that. As kimmie mentioned it can be dangerous if you hit a blood vessel.
Go to you tube and type in
"How to Give an intramuscular injection"
for complete visual directions. You were very wise to question.
Gael
-------------------- PARASITES/WORMS ARE NOW RECOGNIZED AS THE NUMBER 1 CO-INFECTION IN LYME DISEASE BY ILADS* Posts: 6418 | From philadelphia pa | Registered: Jul 2008
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posted
Air in your blood vessel in not the concern, it's blood that will be dangerous.Big NO NO, Kimmie is absolutely right as to why, you must aspirate or your nurse could easily kill you some day! you were lucky. at 3 shots a week, you're playing with fire if you don't, so ALWAYS DO IT!!!! also if you inject slowly, over 3+ minutes, it will hurt a lot less. By the way, you CAN hit a blood vessel in your butt with an IM, and see blood in bicillin when you aspirate. I know this first hand.
-------------------- LSG Scott Posts: 513 | From Boston, Cape Cod, Mass | Registered: Aug 2009
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sammy
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Member # 13952
posted
OMG!!!
bcb, your nurse was seriously confused. Sometimes you don't have to aspirate with more superficial sub q injections (fat layer). Sometimes you still have to aspirate if the injection is deeper in the fat layer.
Yes you always want to aspirate before injecting ANY ANY intramuscular medications! IM is deeper, the muscle layer is where the veins and arteries and nerves run through. You always have to be careful!
Everyone's body is slightly unique. Our blood vessels especially do not always follow the picture map that is printed in the anatomy and physiology books. If your nurse thinks that this is true then sadly, she is mistaken.
I can tell you from experience, my sister had a tetanus shot given in the text book appropriate place but unfortunately it hit her sciatic nerve. She had extreme pain and developed a large fluid filled cyst at the site that drained didn't heal for months. Now my sister, as an young adult, has an indentation in her hip/butt area to remind her of that experience.
Please always aspirate before injecting Bicillin LA. If you use the appropriate sites (dorsogluteal and ventrogluteal), odds are you will not hit a vein. It is very important to make sure that you do not hit a vein because injecting Bicillin LA directly into the vascular system can cause "cardiorespiratory arrest and death".
Bicillin LA syringes come prefilled with a little pocket of air left near the tip. The package insert advises that you leave that air in the syringe, do not "prime the needle" (because the medication is so thick this will assist with visualization if you do aspirate any blood). Attach the needle as usual, leave it unprimed.
When you or your nurse aspirates, you probably will not feel or see anything. They insert the needle as usual, gently pull back the plunger to make sure that they did not hit a vein, as long as they do not see blood, they will go ahead and proceed with the injection. This is a quick process. Usually you will not notice if they aspirate or not. Most nurses aspirate even when they give you a vaccine in your arm. It's routine.
So to aspirate, just pull back on the plunger for a second or two. That's all it takes. If you get a flash of blood, take the syringe out. Start over with a new syringe and new site.
I just want you to understand how important this is since your nurse didn't explain it to you. I want you to be safe and well. If you have more questions or I didn't explain clearly, please ask and I'll clarify. I hope I didn't upset you.
Take care Posts: 5237 | From here | Registered: Nov 2007
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fflutterby
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Member # 28081
posted
I always aspirate, also make sure you warm it up in the palm of your hands. Mine hurt less when they are room temp. I put the needle in my pocket for a 1/2 hour before injecting.
Make sure she injects very slowly. This also makes it hurt less. I massage the area real good afterwards too, which helps prevent lumps. I have had nurses say they do not need to aspirate and have asked them to please aspirate when they are doing mine.
-------------------- Psalm 46 1 God is our refuge and strength Posts: 1367 | From North Jersey | Registered: Sep 2010
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Carol in PA
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posted
Here is a tip that will reduce the pain of darting the needle into the skin:
SCRUB the injection site hard, with the alcohol swab.
Alcohol does kill germs, but you'd have to let it soak for a minute. Just lightly wiping the area does very little.
Scrub, or rub very firmly, for 30 seconds, an area about the size of your palm. This does two things. The friction on the skin will mechanically remove any dirt/germs.
Rubbing will desensitize the little nerves, and you won't feel pain when the needle goes through the skin.
I gave injections over a period of ten years, and never hit a vein or nerve. Pulling back a little on the plunger would have resulted in a bit of blood showing up in the barrel, if the tip of the needle had been in a blood vessel.
What SHOULD happen when you pull back on the plunger is that you feel a vacuum and you're not able to pull it back at all. So, if the needle is in a safe spot, you WON'T be able to pull back on the plunger.
How long are the needles that you'll be using. I found that a 2.5 inch or longer needle worked well to get through the layer of skin and fat.
Learning to give injections is nerve wracking. My first injection was on a little boy who was diabetic.
His skin was tough and the needle bounced off! I wasn't "darting" the needle with enough force. Then I did get the needle through the skin, but it didn't go all the way in.
My instructor took her hand and slapped down on the barrel to push the needle in. Hah, that poor kid.
You can practice first using your fist, to get the hang of hitting the right spot with enough force. Make a fist and aim your thumb and forefinger at the spot you intend to hit. Strike straight down and firmly....you don't want to draw your hand back right after you strike the skin.
Sigh...there are so many steps to learning this. Just showing a person once is not really enough.
Posts: 6956 | From Lancaster, PA | Registered: Feb 2004
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bcb1200
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Member # 25745
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THanks all. Well now I've done it. My wife is upset because she was taught not to aspirate and now I want her to do it. But she doesn't want to since a "professional" hasn't taught her how.
In researching this topic, it does seem there is a fair bit of controversy / conflicting information on the subject. The older info seems to say you MUST aspirate, but the newer says you DO NOT necessarily need to.
Here are some links to documents saying it is NOT needed:
Excerpt: "Aspiration of the syringe plunger once the needle has been inserted into the muscle is an accepted part of IMI procedure but there is no evidence of the need to do this. Justification includes to ensure the drug does not enter the capillaries (Hunter, 2008) or to avoid inadvertent IV administration (Workman, 1999).
Aspiration may be relevant to detect possible penetration of gluteal artery when the dorsogluteal muscle is used � this would indicate incorrect initial land-marking. However, official guidance (DH, 2006; WHO, 2004) does not recommend routine use of the dorsogluteal muscle, and this should be sufficient to justify changing practice. If this site were removed from routine practice, aspiration could be removed from the procedure, simplifying it and reducing the risk of adverse events. Pharmaceutical developments including reduced volume and less caustic injectates, along with prescribing changes, now support its removal from selected injection sites." So this sounds like it isn't needed if the Dorsogluteal muscle isn't used.
Presentation �To Aspirate or Not To Aspirate� by Kaiser Permanente. Uses evidence / analysis to examine whether or not to aspirate before injection. (The general finding is �no� for most injections, except for Penicillin where it �may� be done. ( �Aspiration May be indicated for IM injections of large molecule medications such as penicillin.�) http://www.stti.iupui.edu/pp07/vancouver09/41810.Crawford,%20Cecelia%20L.-F%2010.pdf
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
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bcb1200
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Member # 25745
posted
It also seems to be very dependent on where you go in . Dorsal versual ventralgluteal, etc.
There is another thread on it and it seems 2/3 aspirate, 1/3 don't. For me..it is a precaution.
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
bcb, I am aware of newer guidelines and recommendations for aspiration with IM injections.
I've heard (and read) that they are now teaching that you should avoid giving shots in the dorsogluteal site and should use the ventrogluteal site instead. Sadly, many practitioners are not familiar with this injection site (from what I've observed and experienced...).
Also, they are teaching students that it is safe to not always aspirate for small volume IM shots like vaccines if given in the arm or upper thigh. They do still recommend aspirating for deep IM injections in the vastus lateralis ( upper outer thigh) or the ventrogluteal (hip/side area) or dorsogluteal (hip/butt area).
Because of the large volume of the drug, Bicillin LA can ONLY be given deep IM in the dorsogluteal and ventrogluteal injection sites. This info can be found in the package insert.
Ventrogluteal is safest, generally avoids major nerves and blood vessels (and I found it to be the most comfortable). If you are going to do these shots long term, you will need to rotate your sites and you will need to use the dorsogluteal sites also.
Aspirating only takes a second. It is a safety check. It is not difficult.
I'm sorry your wife is upset right now. She has been forced to learn something new and unfamiliar. It will get easier with time.
Bicillin LA can cause cardiorespiratory arrest and death if accidentally injected into a vein. I'm not exaggerating, this is the big boxed warning on the package insert. This is why it is so important for you to aspirate.
[ 02-06-2012, 10:50 PM: Message edited by: sammy ]
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glm1111
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posted
"Bicillin LA can cause cardiorespiratory arrest and death if accidentally injected into a vein"
bcb,
If it were me, there wouldn't even be a further debate. Just show your wife this insert and insist the injections be done with aspirations. This is YOUR life!!
Gael
-------------------- PARASITES/WORMS ARE NOW RECOGNIZED AS THE NUMBER 1 CO-INFECTION IN LYME DISEASE BY ILADS* Posts: 6418 | From philadelphia pa | Registered: Jul 2008
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posted
My husband is getting Bicillin injections weekly. A registered nurse (my sister) comes to our house to do them.
He is a definite believer in aspirating Bicillin injections. If you don't aspirate and you hit a vein, it's like injecting a clot directly in your vein. Why would you take that chance when aspirating is so easy to do?
-------------------- Peggy
~ ~ Hope is a powerful medicine. ~ ~ Posts: 2775 | From MN | Registered: Apr 2001
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merrygirl
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posted
whats the big deal about aspiriating? it takes 2 seconds. if you are in the muscle you do not draw up air so you dont need to worry about injecting air, thats silly.
I have done bicillin for almost 3 years combined. I say aspirate. its not hard
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bcb1200
Frequent Contributor (1K+ posts)
Member # 25745
posted
Thanks all.
I agree it is better to be safe than sorry. The issue in my house is: a) my wife is barely comfortable giving me injections as it is and b) this is in direct conflict with what our very experienced Nurse said.
From my wife's perspective, an experienced medical professional said it wasnt necessary and didn't show her how to do it. So the fact that I want to do it as a precaution makes her nervous because she hasn't done it before and wasn't shown how and is worried she will mess up.
She also isn't thrilled that it will take more time (my wife often watches Grey's Anatomy with he eyes closed because she hates blood, etc. )
Well get it. No biggie. Thanks.
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
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bcb1200
Frequent Contributor (1K+ posts)
Member # 25745
posted
So I heard from my LLMD.
He recommends aspirating as a precaution.
It is settled
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
| IP: Logged |
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