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March 2012, Volume 42 Number 3 , p 20 - 25


  • Cecelia L. Crawford MSN, RN
  • Joyce A. Johnson PhD, RN-BC


IT ALL STARTED with this question from an ambulatory care nurse educator: "Do we still have to teach aspiration of blood when giving an I.M. or subcutaneous injection?" This question led to an informal query about the practice of aspirating for blood before injection to confirm that the needle hasn't inadvertently entered a blood vessel.We verbally polled about 40 nurses at departmental and one-on-one meetings, and found that about 50% of respondents supported the practice of aspirating for blood before injection. The final tally of responses found no correlation to their age, education, or other demographics. However, the responses did seem to illustrate that how nurses were taught to give injections during basic nursing education strongly influenced their views: those who'd been taught to aspirate supported the practice while those who weren't taught to do so continued to omit this step.This impromptu survey mirrored a brief literature search about this long-standing injection technique. We developed this targeted clinical question: "What's the evidence for aspirating for blood before administering I.M. or subcutaneous immunizations in the ambulatory care setting?" We decided to formally explore this clinical topic and selected the integrative review process as our method of investigation. This article describes how we conducted an integrative review to answer this deceptively simple clinical question and discusses the impact of the integrative review results on nursing practice. First, we'll explain the method we chose.Our examination of the evidence included literature, systematic, and integrative reviews.1 (See Sorting out types of evidence reviews.) Although a systematic review is the most rigorous method for minimizing bias, it's also likely to provide more information than necessary to answer a simple clinical question.2,3 An integrative review suited our area of clinical inquiry best because it lets the researcher draw conclusions about the current state of

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