POST 00539E : ASPIRATION BEFORE INJECTION
Follow-up on Post 00537E
12 January 2003
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Mary Catlin (mailto:[log in to unmask]) from the USA makes some
comments on John Clements' reply to Bernard Kaic. This is followed by a
short comment by Silvia Bino (mailto:[log in to unmask]) from Albania.
Finally, some further comments from Veronica Isaacs
(mailto:[log in to unmask]) from South Africa.
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Just a comment on this part of the answer- "If the intended vaccination
site is visibly dirty, obvious dirt can be removed using clean water, water
for injection or saline and a clean tissue, cloth, cotton wool, gauze or
other such non-impregnated material. Wipes that are impregnated with
medicated chemical must not be used."
I would disagree that single-use alcohol wipes are harmful - most of the
clinical trials in the U.S. evaluating the efficacy of vaccines are done
wiping the injection site without evidence of inactivity. A more moderate
position would be to warn people that shared vials of many skin antiseptics
and pre-wettened cotton can become contaminated, and that routine skin
cleansing, in WHO's opinion, can be omitted. But you will conflict with the
ACIP guidelines you quoted (the current version at least !) if you actively
ban use of alcohol cleaning at the site.
While the SIGN committee recently decided that there was no evidence
showing that skin antisepsis prior to injections was cost effective, we
must be careful not to generalize this to other settings and other
procedures. There is good evidence about the role of skin antiseptics used
before IV placement, obtaining blood cultures, central lines placement and
some suggestive evidence about the benefit of antisepsis for IV drug users.
RE aspiration: now that tens of millions of injections have been given with
vaccines into standard sites with AD syringes, we at least do have
substantial field experience that injection with EPI vaccines into standard
sites has not had reports of adverse events.
Happy New Year to Technetees.
Mary Catlin
Injury and Infection Prevention
Tucson, AZ USA
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I fully agree with Dr.Clements response. Aspiration prior to injection is
not a good practice and itself can cause harm by losing control and also
all AD syringes we use do not permit aspirations.
Dr.Silvia Bino
Albanian Institute of Public Health
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I think the query of Bernard Kaic is relevant. I am a nurse by profession
trained in the late sixties. Aspiration before injection is just regarded
by many well-trained nurses as part and parcel of safe injection practice.
This became a positive habit even with the administration of vaccines even
though the correct site for vaccination poses a lesser risk of getting into
blood vessels.
This of course is not possible with the AD syringe which does not allow for
aspiration. This I suppose will become acceptable practice since the use of
the AD syringe is approved , also for reasons of injection safety. Once
again, I suppose not so much for the recipient but moreover for the
administrator.
We, in South Africa are not using the AD syringe and therefore do not know
whether any AEFI as a result of this has been reported/investigated,
definitively not in our province.
Veronica Isaacs ,
EPI Manager, Department of Health ,
Provincial Administration Western Cape ,
Cape Town, South Africa.
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