The purpose of this study was to investigate the technique RNs use during IM injections and incidence of blood aspiration.

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2 BLOOD ASPIRATION WHO and CDC recommendations to eliminate blood aspiration during IM injections Decrease pain Lack of reported adverse reactions The rationale for aspiration was to prevent a serious reaction if a drug intended for IM injection was injected into a vein or artery While there is no recent documented research evidence How does the lack of evidence, become evidence?

3 PURPOSE The purpose of this study was to investigate the technique RNs use during IM injections and incidence of blood aspiration. IRB for this purpose was sought and approved by West Chester University of Pennsylvania and The Chester County Hospital

4 METHODS Descriptive Design Survey How often is aspiration used during IM injection by RNs? What amount of time do nurses spend in aspiration during IM injection? What is the incidence of RN blood aspiration while performing IM injections? What is the incidence of injury that occurs from IM injection by the RN?

5 SUBJECT SAMPLE Power analysis yielded a total subject sample of 122 subject participants (power.80, alpha.05) A total of 165 subjects were recruited The total N for this study was 164 participants

6 RESULTS Variable Mean (SD) n (%) Sample Demographics Age (years) 44.5 (11.5) Years of RN practice 17.7 (12.1) RN specialty Adult acute, M/S, ICU, ER Maternal Child Other Pediatric acute Psychiatric 85 (52%) 15 (9%) 52 (32%) 7 (4%) 2 (1%) Highest level of education Diploma ADN BSN Masters Doctoral Other 28 (17%) 25 (15%) 76 (46%) 24 (15%) 8 (5%) 2 (1.2%)

7 RESULTS Frequency of Performing Aspiration Variable n (%) Frequency of performing aspiration during IM injection Never Rarely Occasionally about 30% Sometimes about 50% Frequently about 70% Usually about 90% Every time (n=156) 3 (2%) 13 (8%) 8 (5%) 10 (6%) 5 (3%) 42 (27%) 75 (48%)

8 RESULTS Blood Aspiration Incidence Incidence of blood aspiration n (%) 0 99 (60%) 1 32 (20%) 2 11 (7%) 3 7 (4%) 4 4 (3%) 5 3 (2%) > 13 6 (4%)

9 ANALYSIS Blood aspiration does occur in the acute care settings and other patient populations Current recommendations to eliminate the practice of aspiration during IM injection for all IM injections may not be safe Nurses should identify whether a medication, dose, administration rate, patient condition, or emergent situation if mistakenly given IV would be harmful for patients When these instances occur and could pose a threat to patient safety if accidently given IV vs. IM, then the practice of aspiration during the IM injection procedure should be implemented

10 IMPLICATIONS FOR PRACTICE 1) No aspiration needed : length of time used would post a danger when the medications would not pose a patient safety concern 2) Aspiration needed : medication would be a safety concern - based on rate of administration, dose, viscosity, or other reasons. high doses of narcotics Viscous medications such as Ativan (lorazepam) that require a 1:1 dilution if administered IV.

11 FUTURE RESEARCH Research investigating where the medication is disbursed and to what degree is needed. There is a need for further evidence to inform the practice of IM injection technique that blends practice, theory and research. The researchers recommend a systematic decision making process that includes patient condition, medication properties, and the situation at hand be used by nurses during to IM injections to decide if aspiration is warranted.

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13 REFERENCES London. Rodger M.A. & King L. (2000). Drawing up and administering intramuscular injections: A review of the literature. Journal of Advanced Nursing, 31(3), Lynn, P. (2008). Lippincott s photo atlas of medication administration. (3rd ed.). Philadelphia: Lippincott Williams & Wilkins Lynn, P. (2011). Lippincott s photo atlas of medication administration. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Mallet J. & Bailey C. (1996). The Royal Marsden NHS Trust Manual of Clinical Nursing Procedures. (4th ed.) London: Blackwell Science. Nicoli, L.H., & Hesby, A. (2002). Intramuscular injection: An integrative research review and guidelines for evidence-based practice. Applied Nursing Research, 16(2), Ozel, A., Yavuz, H., & Erkul, I. (1995). Gangrene after penicillin injection: A case report. Turkish Journal of Pediatrics. 37(1), Taddio, A., Appleton, M., Bortolussi, R., Chambers, C., Dubey, V., Halperin, S., Shah, V. (2010). Reducing the pain of childhood vaccination: An evidence-based clinical practice guideline. Canadian Medical Association Journal, 182(18), E843-E855. Talbert, J.L., Haslam, R.H., & Haller, J.A. (1967). Gangrene of the foot following intramuscular injection in the lateral thigh. Journal of Pediatrics, 70, Workman, B. (1999). Safe injection techniques. Nursing Standard,13(39), World Health Organization (2004). Immunization in Practice, Module 6: Holding an immunization session. Immunization in Practice: A practical resource guide for health workers 2004 update, 1-29.

14 Thank you for your time and attention Any questions