Effectiveness of the aspiration technique during the needle injection One of the most essential nursing skills is administration of a safe injection skill. A nurse should always be up-to-date and knowledgeable about the best practices and the injection techniques. Nurses must constantly review the evidence base practices, recommendations, and literature to identify the best practice and be aware of the safest injection method. In fact, Needle injection is a painful medical procedure that needs several interventions to be performed to maintain of injection safely and less painfully. An injection can be defined as a method of parenteral administering of medication through the patient`s skin with a syringe and the needle (Balthasar, Geert-Jan, Marjolein, Lucassen, Roggeveen, Bruaset, & Bruhn, 2017). Aspiration is the procedure of pulling back the plunger of the syringe for 5- 10 seconds prior to the medicine injection to make sure that the tip of the needle is in a correct location and is not in the blood vessels or in a wrong place (Hensel, Morson, & Preuss 2013). The controversial question that is the topic of this research paper asks if aspiration or the process of checking the needle placement has any advantage or effectiveness? And for what reason experts and professionals no longer recommend this procedure? Due to frequent disagreements among the medical workers, schools, nurses, and other healthcare professionals, further research needed to clarify the requirement or not requirement of aspiration technique prior to the needle injection. Advocates of aspiration mention that aspiration is an easy step to follow to provide a safe injection practice and it can be performed rapidly in a short amount of the time (Hensel, et al., 2013). Patients usually tolerate well this procedure and there is no need for increasing the costs of an injection (Hensel et al., 2013). In contrast, opponents believe that there is not enough data or evidence to prove the benefits or accuracy of aspiration technique. Investigating the literature and the evidence base practices show that still there is a debate on the necessities of aspiration and its effectiveness (Balthasar et al., 2017). This doubt is increased, especially after the recent widespread of using the new form of syringes that are auto-disable and are not generally designed to aspirate (Balthasar et al., 2017). Summaries of the several peer review researches about the aspiration procedure during the needle injection include, systemic review of total 31 studies show that an acute infant distress can be decreased in injection without aspiration (Taddio, Shah, McMurtry, MacDonald, Ipp, Riddell, Noel, & Chambers, 2015). In one of the quantitative research studies with participating 114 children and adults, there is no evidence that vaccination without aspiration is benefited versus vaccination with aspiration (Taddio et al., 2015). In another research study including 313 infant’s participants prove that the level of acute distress can decreases in infants who receive a fast injection without pulling back the plunger and checking the blood return compare with those infants who receive injection with aspiration in longer time (Taddio et al., 2015). However, these researches studies fail to provide enough evidences to prove either the beneﬁt of aspiration or the harmful effect of aspiration. In the other word, the result of the studies does not support major difference between aspirating or not aspirating (Balthasar et al., 2017). One of the significant reasons of the limitation of these research studies include, having insufficient variables. (Taddio et al., 2015). The analysis of the results only prove that the speed of the injection has a direct effect on the comfort and acute distress of the injection. Faster injection leads to less feeling of the pain and fear during the injection (Taddio et al., 2015). Another peer review article indicates that vascular areas such as a dorsogluteal site need to be checked carefully and must to make sure first for the needle placement by aspiration before the medication administration (Ogston-Tuck, 2014). Opponents argue that this site is no more recommended, therefore, overall aspiration is not required in the routine injections no longer (Ogston-Tuck, 2014). The article explains that because the use of the dorsogluteal site is removed from the routine practices, therefore, aspiration also should be removed from injection practices as well (Ogston-Tuck, 2014). In addition, the new auto-disable syringes that are automatic retraction devices have the technology that does not match with aspiration and the device can be triggered by aspiration during the injection and can cause harm to the patient. For that reason, the aspiration technique should not be used no longer in the needle injection practices (Ogston-Tuck, 2014). Some other researches show that aspiration of the syringe or pulling back the plunger after insertion of the needle into the muscle mass, can cause a formation of hematoma, and abscess in site of the injection (Pereira Gomes, Oroski, & Traverso, 2019). Therefore, factors such as change in needle bevel, irritation of muscle tissue, and the risk of contamination of the needle during aspiration can lead to patient`s discomforts and experiencing more pain during the injection (Pereira Gomes et al., 2019). Furthermore, there is no enough reported data and evidences that can justify aspiration method. In the other word, evidences do not prove that the aspiration or blood return can confirm the correct placement of the needle and not hurting the blood vessels (Rishovd, 2014). In fact, elimination of the aspiration Reduces the injection duration time and therefore it potentially effects on decreasing the pain during the injection (Rishovd, 2014). Aspiration during subcutaneous and intramuscular injection, except in the dorsal gluteal site, is not necessary because there is no major blood vessel in those sites (Ogston-Tuck, 2014). The dorsal gluteal site is no longer recommended for IM injection and other sites such as ventrogluteal, vastus lateralis, and deltoid are the preferred sites for IM injections because these sites do not have major blood vessels and nerves (Ogston-Tuck, 2014). Center for Disease Control (CDC) also recommends the elimination of aspiration before injection and indicates that injection with aspiration might cause more pain and discomfort for the infants (Hensel et al., 2013). In the past, experts thought the slow injection minimizes the pain of injection and sudden distention of the body tissue, but according to the recent researches and studies, fast injection of vaccines, at a rate of 0.5 mL for 1 second, is less painful or has discomfort (Ogston-Tuck, 2014). Therefore, as result of all researches studies, rapid injection with not using the aspiration technique leads to rapid process of medication administration and less pain and discomfort in the patient. (Hensel et al, 2013). In other word, needle remains in the muscle tissue in shorter amount of the time that leads to minimizing the pain and discomfort of the injection significantly (Balthasar et al., 2017). Another important point about vaccination with aspiration is that during using two hands for aspiration, it might cause less control on the injection, especially when a provider uses a conventional syringe and injury can happen at the site of the injection (Hensel et al., 2013).