Methods: Three databases were used to investigate the research question: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE and PsycINFO. Variations of the keywords IM injection, aspiration, and patient experience were input into each database with patient experience being defined as pain or discomfort. An extensive 20-year time frame was searched to account for the limited research on this topic. Studies conducted on or with humans of all ages were included. A total of 340 studies were found after the initial filters were applied to all databases. The resulting studies were further reviewed for relevancy based on title or abstract. Articles were deemed relevant if the title or abstract contained all three research question key points: IM injection, aspiration, and patient experience (pain). Relevant literature was combined and all duplicates were removed. Only 16 relevant articles were identified. A review of the references of those articles was also undertaken. Reference lists were reviewed, and articles were assessed for relevancy based on title or abstract as previously described above. Only primary literature was considered as part of the inclusion criteria. Duplicates were removed. A quality assessment tool was used to critically appraise the articles.
All articles were combined and reviewed in context of the inclusion and exclusion criteria. The remaining articles were read in their entirety to determine relevancy. A total of seven studies were used for this literature review. Two studies were deemed relevant due to their investigation of IM injection techniques related to pain, although aspiration was not a specific focus. An additional study did not identify patient experience but explored the use of aspiration by nurses during IM injection.
Results: Three studies specific to aspiration and pain were identified. Results from a study conducted in adults by Petousis-Harris et al. (2013) suggested aspiration does not significantly contribute to pain during IM injection. Two research studies conducted in infants contradict these findings and suggested the practice does cause increased pain (Ipp, Taddio, Sam, Goldbach, & Parkin, 2007; Girish & Ravi, 2014). Despite two studies suggesting aspiration causes increased pain, only 32.4% of nurses surveyed prior to attending an educational seminar (Moores & Allan, 2012), believed the intervention to be more painful than withholding it. This suggests that awareness of the impact of aspiration on patient pain is not widespread.
Conclusion: Aspiration as a component of IM injections is widely discussed in the nursing profession; however, research on the topic is limited. Available literature does suggest the practice during immunizations causes increased pain. Scant literature is available on the effects of pain during other types of IM injections such as psychotropic medications. The evidence, in addition to major organizations no longer recommending this practice during immunizations, supports our position that aspiration should not be performed during IM immunizations. Thomas et al. (2016), asserts that aspiration may remain a safety precaution for some types of medications to avoid accidental intravenous administration, but there is little available current research to support this concern. IM injections are still widely incorporated into nursing practice. Standardization in education and practice is essential to optimal patient care. We question the utility of aspiration as a safety precaution during IM injections, based on recommended injection site vasculature, limited current research on the topic, and the move by major organizations such as AHS and the WHO to either to not mention or recommend against aspiration as part of the immunization process. Further research into this topic and the subsequent application into nursing education and practice is recommended.