Aspiration, more information

However, if you have done this and a flash of blood appears in the needle hub, withdraw the needle and select a new site for injection.

Egro

I checked The Australian Immunization Handbook and incredibly, this is item 5. under 'Intramuscular Injections'

It is not necessary to draw back on the syringe plunger before injecting a vaccine.14 However, if you have done this and a flash of blood appears in the needle hub, withdraw the needle and select a new site for injection.

So the technique I was taught decades ago and which you have taught since has been quietly retired. I'll check the science behind this curious decision. Keep up the good work.

Good question

Mom

This doesn’t explain why it’s mostly only happening to adolescent and young males. Matter of fact, that narrow demographic almost excludes your reasoning here unless you’re saying only males are getting accidental IV vaccines.

US military

23 male patients, (20 after 2nd dose)

2.8 million doses of mRNA COVID-19 vaccines administered.

One in 121,739

US series

20 had vaccine-related myocarditis

37 had pericarditis

= 57

2,000,277 individuals receiving at least one dose

One in 35,092

Aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion but before injection)

is not necessary because no large blood vessels are present at the recommended injection sites,

and a process that includes aspiration might be more painful for infants

Vaccines should not be given intravenously.

It is not necessary to aspirate the syringe after the needle is introduced into the muscle (WHO, 2004; Plotkin and Orenstein, 2004).

WHO, Section 5.4, immunization in Prctice

Clinicians who got blood

Deborah, (RN)

A few years ago, I aspirated and got blood return. I was shocked as it had never happened to me before but it confirmed the importance of aspiration.

JH

hospital corpsman in the Navy, I gave thousands of shots over the 4+ years of duty,

we were taught to always use aspiration when giving IM shots, every person I see on TV or Internet never aspirated before injection

there were many times I hit a vein and had to retract the needle and try again

where do they fine these people who are giving these injections McDonalds or is there just no training for this job?

Avinash (peadatrician)

Nurses in UK don't aspirate inspite of requests which is scary..

Young adults have more chance of myocardits ,they have turgid blood vessels

Abnormal radial artery is known. Pulse is felt on lateral side and not at usual site.

So even inside body abnormaly positioned blood vessels or extra vessels are possible.

I came across frank blood while giving vaccines.

I had to remove needle and discard injection.

Once it was MMR and other was typhoid vaccines.

Although rare it can be fatal as well.

When my son got Pfizer vaccines twice in England Statford nurse did not aspirate inspite of requests from him.

It is scary for me to imagine injection without aspirating as I have seen frank blood twice in 32 years

A commenter

I inject myself with anabolic steroids and have done for the past 20 years,

my preferred injection site is the deltoids,

its a deep intramuscular injection,

I aspirate and on many occasions I have drawn blood,

I would say around 1 out of 30.

Good suggestion

Can I ask for aspiration?

Gillian

Hi John, when I get my booster, can I ask who ever is administering it to aspirate, before they give it???

Jerome (cancer and reconstructive surgeon)

I have never understood why present day training seems to advise against aspiration prior to intramuscular injection in both medical and nursing courses.

[skyout]

I had similar experiences here in Germany when I went for my jabs. I had translated and printed out the recommendations from Denmark (around 18th April 2021) and showed them to the medical personell : in the first case the soldiers at the vaccination centre said no problem, but at the second jab, in the company where I work, the doctor argumented that he had studied Anatomy for 6 years and there was no danger of the needle entering a blood vessel, but I was adamant and said: it is my arm. He then referred me to the person who was giving the jab, and with a little convincing she aspirated. Moral of the story: IT IS YOUR ARM AND YOUR BODY.

[hunterellis]

I asked my mother about it, she was an army nurse (Vietnam era), and they were taught to aspirate.

[ukitamoreno]

Thanks to your comments I went to have my booster yesterday in Croydon and asked for aspiration. I was lucky that a very experienced nurse called Sally agreed with me and said she also follows your videos. She took us to one side and gave me and my husband the vaccine with aspiration. She said she was trained to do this 40 years ago when training to be a nurse. Many thanks to you and wonderful Sally. You gave me peace of mind

[WillCowlin]

Went for my first vaccine and requested the needle was aspirated. I had conversations with several people at the centre who all refused so I went home. As a 21 year old male I'd like to reduce my risk of myocarditis but I'm not sure how to be vaccinated by someone willing to aspirate.

[lilyrose]

As a registered nurse we were trained to aspirate when giving IM injection the rationale behind is to ensure that the needle hits the muscle not a blood vessel no matter how small.The only way of knowing this is through aspiration....so i do not understand why they refuse to aspirate.

[bwj]

I found a local pharmacy which was happy to aspirate and not only got my booster there, but move all my prescriptions there. To me it reflects on the entire pharmacies ability, when they refuse to take care of my well being on such a request. My new pharmacy has more limited hours, but I doubt I will ever look back.

[katesullivan]

Thank you for your so helpful videos! When both my daughter (an RN) and I recently got our booster shots, we both requested the administer aspirate first. Neither had heard of this and asked why. After referring to your explanation, both separate administers acknowledged that this made great sense and complied. My pharmacist said he would be doing so in the future.

[schumanhuman]

If someone started an online petition, I would certainly sign it.

[remnantmombaker]

I'm a retired Director of Nursing, I worked as an LPN and then RN for near 30 years. We were always taught to aspirate first on ALL injections. No matter what you are administering, the effects on your patient are very different when a substance is given intravenously or intramuscular. The amount of standards of practice that have been thrown out the window in this ridiculous worldwide scenario speaks volumes about what the real goals are here.

[AnDrW]

Andreas from Norway here.
I had the same uncomfortable experience with my 2nd dose of moderna. First when checking in I asked about aspiration, if that's something they've started doing or not. She said "no, we don't and that's not the practice either." She seemed upset about the question and when i explained that there was evidence pointing to this being safer, she just responded with "I know this is a controversial topic I've heard been discussed, but we're not changing our practice". I said I'd ask the nurse giving the injection, and I'll take it from there.
The nurse that gave the shot showed me the same resilience, but she was willing to give it to me the way i requested at least.

[k.h.]

I started my medical career in 79 & we were always taught to asperate, retired now & must have been lucky as never drawn blood in all the countless injections that have been given but it would have been unthinkable not to aspirate a IM...
Perhaps John a open letter to the medical journal also, voicing your concerns to other clinicians, good luck in getting the message out there as this is not best practice .
Thank you for the great podcasts, always interesting & very informative.keep up the good work

[johnswimcat]

It seems that professional vanity is often more important than ensuring safety. It would seem reasonable at the very least to aspirate if the patient asks for that, preferably to adopt aspiration as normal practice

[susibul]

I agree, aspirating makes complete sense. My vaccine nurse did it for me when I asked, at first she said it was not necessary but made a point of explaining how she was pulling back as she injected, she did it skilfully and quickly, and I thanked her, also thank you dr John for persisting with this important detail on giving a safe vaccine.

[TheMhannah]

My elderly mother went to Walgreens here in the US for her booster. I explained Aspiration and advised her to ask. The person administering the vaccine said it wasn't in their guidelines, and refused. For something so simple that takes no time, I am dumbfounded.

[demef]

I am certainly no doctor, but I am learning a great deal about medicine through your channel, Dr. Campbell. And because of the knowledge you have imparted to me, I suspect SOME of my healthcare providers are going to regretting seeing me in the future ....

[maureena]

Went for flu jab yesterday and brought up the 'controversy' over drawing back on the syringe plunger. The injection giver said she had never heard of the procedure and with pre-filled syringes not possible. Checked RCN/PHE guidelines and aspiration deemed to be unnecessary. When I was nursing I always aspirated and very early on in my career was shocked to see blood in the syringe. Keep it up, John, this practice needs reintroducing asap.

[MinMin-uypl]

I got my booster yesterday as two of my coworkers. I asked her to aspirate and the person giving it to me was obsolutely agreeable to do so. I was very thankful to her, as well as to you for letting us know this information. I also informed my pediatrician and she has requested your video and the link to the study. Thank you again.

[ebthedoc]

Thank you, Dr. John. We have discussed this in my heavily medical family, all of athletic body type.
I’ve mentioned before that I (a retired urologist) had to insist insist very firmly upon aspiration, for my Pfizer shots, this May / June. The first time, the young pharmacist called her manager, who also tried to cite the present CDC guidelines at me. I told her the guidelines don’t prohibit aspiration; that this old doc was insisting upon it, or she would have to discard the dose she was holding. That worked. The chief pharmacist was older: she’d learned the technique, and did the injection as I’d requested. I believe she later instructed her subordinates. For my second shot, 3 1/2 weeks later, a brief reminder was sufficient, for correct injection technique.
Now, all three of us retired medics (one Sis an anæsthesiologist in South Africa and the US, and the other an RN / teacher in Anæsthesia, Recovery, ICU, in New England) had trained in the ‘70s. The change seems to have come in the mid-90s (apparently NOT in SA!), possibly from time constraints in over-stressed healthcare. But gawddammit, if that half-second prevents intravasal injection, it’s worth it!
The preponderance of cardial complications in young males I think is constitutional - look at the well-vascularized deltoids on them young soldiers!
And I still think the gluteus or vastus lateralis the better injection sites! My Sis in SA agrees.
<smile>

[StreakyP]

what gets me is that the extra time taken to aspirate an injection if asked is still way less than the time taken to summon a manager and debate the situation.

[MamguSian]

I wrote to my MP who just quoted the standard response, and also said **** 'should a vaccinator aspirate and draw blood, they would be required to dispose of the needle and shot of vaccine they were using, which would be an unjustifiable waste of precious vaccine supplies.'****
I hardly think it's a waste to dispose of a vaccine which is going to be injected into the blood supply, potentially causing major harm to the patient. These would be the only doses they would need to dispose of. I think they are not aspirating in order to avoid pain, so that there is likely to be a greater uptake of the vaccination.
I wrote back to him pointing this out, and also that of course there is no evidence because the only way to get that is to aspirate. I haven't had a reply to my second email.