Aspirate Before Intramuscular Injection

Aspiration during any kind of injection is meant to ensure that the needle tip is at the desired location during this blind procedure. While aspiration appears to be a simple procedure, it has generated a lot of controversy concerning the perceived benefits and indications. Keeping in view the huge number of injections given worldwide, it is important that we draw attention to key questions regarding aspiration that, up till now, remain unanswered. Wrongly administering COVID-19 vaccines into blood vessels instead of the muscles could be behind the serious side effects.

A report published by the Journal of Korean Medical Sciences is one of the first in the world to suggest that technique known as aspiration -- which is pulling back on the syringe plunger before injecting the vaccine to ensure no blood vessel is accidentally punctured -- may provide better chances of avoiding side effects.

The report looked at Korea’s first fatal case of a rare blood clotting condition called thrombosis with thrombocytopenia syndrome, or TTS, in a 33-year-old man who received AstraZeneca’s vaccine. He died 19 days following his first vaccination in June, after developing blood clots in the brain called cerebral venous sinus thrombosis. As of Sept. 30, the latest date for which the data is available, there were 56 confirmed cases of myocarditis, pericarditis, or both, after Pfizer’s vaccine in Korea, and seven after Moderna’s. Thirty-two out of the total 63 cases were in people under 30. One in his early 20s died.

Over the same period, three people in Korea were confirmed with TTS after their first AstraZeneca dose. Two were men in their early 30s, one of whom died, and the other a woman in her 70s.

Another study, published in the journal Clinical Infectious Diseases, made similar observations with mRNA-type vaccines. The study concluded that “inadvertent intravenous injection of COVID-19 mRNA vaccines may induce myocarditis or pericarditis.” Myocarditis is inflammation of the heart muscle, and pericarditis, an inflammation of the tissue surrounding the heart.

You might think it should occur equally in men and women, and also in older men and women. But heart inflammation after mRNA vaccines is reported to be more common in young men, while blood clots after adenovirus vector vaccines are more common in young women.

Hence, intramuscular injection, with aspiration prior to injection, could be a potential preventive measure when administering adenovirus-based vaccines. Currently, the guidelines do not require health care providers to aspirate before giving a COVID-19 vaccination. 

It astonishes me that anyone in the medical field would NOT aspirate before intramuscular injection. It is shocking that this could happen worldwide. So much harm has been done and no mention that it could have been inflicted upon innocent and possibly vulnerable patients. No wonder some people don't trust the vaccination. Please, aspirate before every single IM injection. It’s so simple. This should be standard protocol in every medical institution across the world and the fact it isn’t already is shocking to me. Zeljko Serdar, CCRES