Are you supposed to check for blood return when giving IMZ?

[pharmacy7424]

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Nothing in APhA mentions checking for blood return to see if you hit a small vessel before/after pressing the plunger.

Are you supposed to do this?

 

[BidingMyTime]

Good question. You would probably know if it happened, without pulling back the plunger. In giving myself SQ shots, the one time I hit a blood vessel, the plunger immediately shot up and filled with blood.

 

[Jibby321]

I think it's up to the Rph if they want to check or not.

 

[zelman]

No.

 

[npage148]

No. There is no veins large enough in the admin areas to cause concern

 

[group_theory]

Nothing in APhA mentions checking for blood return to see if you hit a small vessel before/after pressing the plunger.

Are you supposed to do this?

I do it, and the nurses/MAs who give immunizations should routinely do it. Good way to ensure you're not in a vessel. Now would there be any harm if you inject directly into a vessel ... probably not. Since the design of the vaccine was meant to be injected IM for the body to mount a proper immune response, not sure if a IV (or arterial) injection would affect its efficacy, or if there are more side effects (instead of local site reaction, perhaps systemic reactions?)

I guess if you're not careful - you can introduce air (or bits of tissue) into the venous system and run the risk of air/fat embolism. I guess if you didn't do a thorough job of cleaning/disinfecting the skin prior to injection, and you inject directly into system circulation, you can introduce bacteria into the bloodstream. The chances or likelihood of any of this happening are extremely low

Not much research or EBM on this subject - most of the papers are from the first half of the 20th century (ie effects of intravenous typhoid vaccine) and most are case reports

I wouldn't make a big deal or lose much sleep over this issue.

Now making sure you're in the muscular layer instead of subcutaneous layer - now that's more important (especially with obese patients). Not only are subcutaneous injections less effective (unless the vaccine was design that way), but I've treated patients who had some nasty abscess from improper injection techniques (seen a few subcutaneous granulomas as well)

Good question. You would probably know if it happened, without pulling back the plunger. In giving myself SQ shots, the one time I hit a blood vessel, the plunger immediately shot up and filled with blood.

You hit an artery

 

[BidingMyTime]

BidingMyTime said: ↑
Good question. You would probably know if it happened, without pulling back the plunger. In giving myself SQ shots, the one time I hit a blood vessel, the plunger immediately shot up and filled with blood.
You hit an artery

Leave it to me to figure out a way to do that, I was injecting in my thigh. It was startling, but no harm done.