Ask the Experts: Aspiration before injection of vaccines or toxoids

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Revised ACIP General Recommendations on Immunization provide advice on aspiration and a range of other topics.

Question: I was told that I need to aspirate before injecting, but I remember being told during our APhA training not to do this. Where do I find documentation of this?

Answer: This can be found in the General Recommendations on Immunization.1revised version (click here for PDF version) of the recommendations was published in Morbidity and Mortality Weekly Report (MMWR) on January 28, 2011, updating the December 2006 version.

Specific to your issue, the general recommendations state: “Aspiration before injection of vaccines or toxoids (i.e., pulling back on the plunger after needle insertion but before injection) is not necessary because no large blood vessels are present at the recommended injection sites, and a process that includes aspiration might be more painful for infants.” In addition, if you aspirate and get blood to return, which is still possible even if you are not in a large blood vessel, the vaccine will need to be discarded. This can lead to wastage of vaccine and possibly a large expense to your program.

The new general recommendations are a reference that every practice site that administers vaccines should keep. The document contains sections on timing and spacing of immunobiologics, contraindications and precautions, adverse reactions, administration technique, storage and handling, altered immmunocompetence, record keeping, and much more. I would recommend that every practicing immunizer read these new guidelines in great detail. It answers many of the questions that we receive.

Stephan L. Foster, PharmD, FAPhA
Professor and Vice Chair
University of Tennessee College of Pharmacy
APhA Liaison Representative to the Advisory Committee on Immunization Practices (ACIP)


  1. CDC. General recommendations on immunization practices: recommendations of the Advisory Committee on immunization practices (ACIP). MMWR Recomm Rep. 2011;60(RR-02):1–60.
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