The importance of aspiration when injecting covid vaccines.

There are references on the internet as far back as March and April 2021 suggesting that aspiration as an injection technique was not necessary for Covid vaccines. However, there are also references suggesting that it could cut this risks of inadvertently injecting the vaccine directly into the bloodstream.

Short, easily printed summary of key points - click here.

Given the political imperative to vaccinate as many people as quickly, it seems likely that pragmatic decisions were taken not to adopt the (arguably) safer aspiration technique, despite recent research (cited below) suggesting it could be advised. This would speed the process of 'training' or retraining as many vaccination staff as possible. Thus whilst more people might be vaccinated, a few more might suffer adverse reactions. The risk of death is extremely low - the AZ vaccine has already been administered probably 2 billion times - and in some countries without aspirating the injection.

For maximum vaccine effectiveness and minimum risk of side effects - ask for your vaccine doses to be injected by someone competent to use aspiration. Older doctors and nurses should have been trained in this technique - even if they have recently been told not to bother using it.

Aspiration for intramuscular injections is a technique that used to be standard practice. It was phased out maybe 20 years ago in the USA and UK yet is still apparently practiced in some countries. It could be very much the preferred approach for Covid injections. This is because these novel types of vaccines may be less effective if injected wholly or partly directly into the blood stream. Also, more severe side effects may be experienced.

Arguments against aspiration include that vaccines may be wasted if injections have to be repeated. This argument is absurd - the western world is awash with an excess stock of vaccines. Millions of doses might even be destroyed because they have reached their 'use by' dates - see below.

The main Covid subsection of my website contains a collation of some of the more compelling scientific references I read during the early months of the pandemic.

This more recent page, from late 2021, contains references to a possible explanation for the very small number of early deaths linked to blood clots after receiving the AZ vaccine especially. It seems also to be suggested that injecting the vaccines without aspiration might in some cases lead to a degraded effectiveness. Speculatively therefore, maybe with good injection technique, the vaccines might be even more effective in preventing or ameliorating Covid infections.

Amongst the early references to aspiration are these:

I first became interested in the topic having seen a report on the BBC website:

The BBC report contained the following image:

I sent the link to a number of folk dance and other contacts, some of whom are retired or serving doctors, nurses or other medical professionals. I found some of their responses alarming. Needless to say, there was some divergence of opinion.

In summary, it appears that a change in how intramuscular injections are given could be a root cause of the very small number of deaths from blood clots following a Covid vaccination.

There is no suggestion that any Covid vaccines themselves are defective. The problem may be the method of injecting them into muscle tissue following the modern practice in some countries of not aspirating. If an injection is aspirated, the needle is inserted than the plunger of the syringe is withdrawn to ensure that the vaccine is not injected directly into a small vein, and thus directly in the blood stream. This is supported by recent discussion in the British Medical Journal (links and extract below).

The BBC wording of "leaks into the bloodstream" drew this comment from a medical professional:

Leaks?  More likely due to direct injection into the blood stream.  A majority of injection administrators have poor technique.  After sticking the needle in, they should first draw back on the plunger to make sure there's no blood (and the needle isn't in a vein), and then push in the plunger.  But if they see blood, they're supposed to abort and start over. For your next jab, ask the administrator to draw back on the plunger (called aspiration) before pushing the plunger.

From a retired GP.

"I was always taught to aspirate to avoid direct injection into a vein.

However, “Recent research has found that there is no evidence to support the practice of aspiration, but despite policy changes, the procedure of aspiration continues to be taught and practised” (Canadian Agency for Drugs and Technologies in Health, 2014; Greenway, 2014; Sepah, Samad, & Altaf, 2014; Sisson, 2015).

Also: Vaccinations and immunizations given by IM injections are never aspirated (Centers for Disease Control, 2015)."

From a retired senior nurse.

"An intra-muscular injection (as opposed to a subcutaneous one) is delivered deeply enough to run the risk, albeit a small one, of hitting a vein.  Withdrawing the plunger a little, to check for the presence of blood, avoids delivering the contents of the syringe into the bloodstream."

From a serving GP, c. 35 year old. (She later thanked me for suggesting she looked only 35!)

"I've never been advised to aspirate. If an appropriate location is chosen then hitting a large vein (or worse artery) won't be an issue."

But maybe that is the whole point - some vaccine injections worldwide may be given by hurriedly trained volunteers as well as by younger medical staff who may never themselves have been taught about aspiration.

It seems that older medical staff were trained in what some experts still regard as the correct technique.

Also, the risk of death from a Covid vaccine being injected directly into the bloodstream may be much larger than for 'leakage' of other substances that are supposed to be injected direct into muscle tissue, and (maybe) especially for the AZ vaccine that seems to interact strongly with platelets in blood.

The first YouTube video on this subject by Dr John Campbell - who has attracted a large internet following for his lucid explanations of many aspects of the Covid story. He is basically a nurse educator with an extensive CV. Some of his earlier contributions are referenced here.    worth watching for the videos of how to inject (and, so he argues, how not to inject) vaccines.

His comments include:

Basically, we need to change the vaccine administration guidelines to include precautionary aspiration, prior to pushing in the vaccine. This will prevent cases of inadvertent intravascular administration of vaccine. ...........inadvertent intravascular vaccine administration is a variable in the aetiology of complications after adenoviral vector vaccine administration and after mRNA vaccines. These adverse events, although rare have reduced public confidence in covid vaccination, especially amongst the young, where vaccine rates are lowest. It has long been known that intravenous injection of adenovirus leads to TTS in mice.

In a later YouTube video, John Campbell again states that the small risk from blood clots and complications with all types of vaccines might be much reduced by aspirating the injection to ensure that it is never given directly into a small vein. Aspiration is (so he says) standard in South Africa but not in USA and UK.

Therefore, you might ask for your next vaccine injection being aspirated - even if it does annoy your doctor, nurse or pharmacist!

Link to Daily Mail article - very clear but it does not get as far as mentioning the possible importance of aspiration.

Link to scientific paper - highly scientific!!

And don't refuse the vaccine - the risks from Covid can be substantial even in fit young people.

The risk of a blood clot leading to death is vastly greater from a Covid infection than from a vaccine injection.

Comments on YouTube included these: - there are dozens more in support of aspiration.

My son asked the nurse that injected him. She said my son was lucky, because she was an instructor and could answer his question. Reason given was that aspiration would waste a vaccine dose in case it was found the injection was not done in muscle. This was in The Netherlands.

I was shocked to learn that saving a little money had higher priority than avoiding damaging side effects.

My best friend is my dentist, and he states that aspirating the needle is always done in his practice to ensure that the anesthetic does not enter the blood stream, being that close to the brain. He insisted on aspirating when receiving the covid vaccine. Thanks Dr. Campbell!

This US Registered Nurse learned to aspirate while giving intramuscular injections in nursing school back in 1976. I returned to nursing back in 2002 and aspiration was not standard procedure.

I just retired from nursing and can say that I have aspirated EVERY IM injection I have ever given. Period.

Hi, Dr. John, because of your videos on this subject, I asked the pharmacist to aspirate before she did the booster. She knew what “aspirate” was—said it wasn’t necessary—but promised to do it.

My request caused two other technicians to ask the pharmacist what aspirate was and so when it came time for my shot, the pharmacist asked whether it would be okay if the other two could look on so she could demonstrate!

As you can imagine, I was happy to be a part of spreading important knowledge! None of this would have happened without you!!

Thank you for all you do!! Tallahassee, Florida USA.

So happy my grey haired pharmacist said “I always aspirate, it’s is dangerous not to”. Thanks Dr John.

I had two AZ vaccines at my local surgery with no side effects. Later I had a Moderna booster at an NHS centre. This left me with a slightly sore arm for a few hours and a feeling of tiredness, also for a few hours, but later in the evening. Next day, all the side effects had dissipated.

But I now feel lucky to have survived having all my injections given without aspiration - or at least that is how I recall they were administered.

But there are contrary views, including from a UK based pharmacist I know who has been a trained vaccinator for a decade.

If indeed there are problems and unnecessary deaths, then evidence for and against aspiration needs to be investigated and national (and international) guidance updated.

John Campbell's videos are encouraging patients to ask for their injections to be aspirated. If this is refused (and it may well be, almost always) then it could reduce public confidence in vaccination - just at the time when the UK is embarking on a ramped up booster programme. So it seems irresponsible.

The few (70?) deaths from the AZ vaccine are a tiny number compared with the lives saved. We are too far along the established path to change procedures now. In any case, most boosters in the UK will not be AZ because those will now be going overseas, simply because they are easier to transport and store.

Currently accredited vaccinators have been trained in a specific technique not including aspiration. Any deviation from that precise procedure could invalidate their indemnity insurance.

As a government research scientist many years ago, I was involved on the periphery of several areas of medicine - sick building syndrome, radon and legionnaires' disease. My work with radon involved using hypodermic needles for gas sampling - the idea being that when a sample is taken in this way, any daughters present should plate out on the sides of the thin metal tube so the gas sample should be 'virgin' and not contaminated by daughters that have already been formed. But I digress! However, when it comes to bureaucrats and politicians seeking to cover up their failings, or seeking to prevent the publication of embarrassing data, nothing would surprise me. I have no formal medical training.

The following discussion is from the Postgraduate Letters section of the BMJ
COVID-19 vaccines (such as AstraZeneca, Pfizer, Moderna, Janssen/J&J) are designed for administration by intramuscular injection and should not be injected intravascularly, subcutaneously or intradermally.

It was, therefore, cautioned that intramuscular injection of vaccine should be done with aspiration technique to avoid inadvertent vaccine administration into deltoid muscle vasculature that may lead to vaccine distribution to distance tissues which increases the risk of developing severe adverse reactions to COVID-19 vaccines. Poor injection technique may also cause a direct injury to the axillary nerves adjacent to the injection site in deltoid muscle that may lead to peripheral neuropathy. The consequent vaccine transfection and translation in the nerves may spur an immune response against nerve cells potentially causing an autoimmune nerve damage, for instance Guillain-Barré syndrome. All COVID vaccinators should be made aware of potential complications of poor injection technique; competency-based assessments may be considered for all vaccinators to improve COVID vaccine safety.

An earlier contribution in the BMJ, also by Dr Hamid Merchant, is here. In essence, it is suggested that Covid vaccines could in some patients, and/or if delivered improperly, trigger an auto-immune response leading to possible blood clots. Dr Merchant summarised it for me as follows:

"Interestingly, we did propose a mechanism for vaccine-platelets interaction back in March 2021 in an attempt to understand why those clots were formed and possibly to identify those who would be at high risk, so timely interventions might be offered to prevent fatal outcomes. The mechanism that we proposed back in March is now confirmed by other scientists."

Scale of vaccine manufacture.

The scale of Covid vaccine manufacture is incredible - and billions of doses have piled up unused in western stockpiles (a point made often by Gordon Brown, UK Prime Minister from 2007 to 2010). One of the world's largest vaccine manufacturers was reported in December 2021 to be scaling back production because of a lack of future orders.

India's Serum Institute were said to be already sitting on a stockpile of over half a billion doses of Covishield, the local version of the AZ vaccine, one of those most suitable for use in Africa (for example) because it is more readily transported. Various scientists, including Prof Sarah Gilbert (see panel below) and Sir Jeremy Farrar have warned that failure speedily to immunise all parts of the world may lead to new variants arising. However, Jeremy Farrar's claim that world leaders should see Covid as "the most urgent threat facing our world" could be disputed. Covid is (by historical standards) a very minor pandemic. The lethality rate is well under 0.5% - it could easily have been 5%. Global warming is a more serious and urgent threat because time is running out to prevent the onset of positive feedback loops.

Curiously, India seems to have been omitted from the dataset. The top two 'wealthy' countries with surplus vaccine stocks were said to be the USA and the UK, with 1271 and 421 million doses respectively.

Extending the permitted shelf lives to those more in line for other vaccines might largely enable the stocks to be utilised. Covid vaccines were originally given only a short shelf life because they were rushed into production so quickly - so it might be alarmist to suggest that there may indeed be actual waste on this scale. Prof Costello of UCL has even argued that wealthy countries that hoard vaccine stocks should be tried in the International Criminal Court!

Graphic of the possible waste of vaccine doses owing to wealthy countries having over-ordered and stockpiled. From British Medical Journal, 13 November 2021.

A stunning and inspirational lecture given by Prof. Dame Sarah Gilbert,
first broadcast by the BBC on 6 December 2021.

An anti-vaccine picture from the early days of the Covid pandemic.
Source unknown, probably from the USA!

Contents for the earlier Covid subsection of this website (for the most part, last updated mid 2020).

0. Index page.

1. Wet markets, abuses of wildlife, organised crime and the origins of the virus.

2. Folk dancing and the importance of other 'super-spreader' events - experience overseas.

3. Scientists, government scientists, and criticisms of government policy in the UK.

4. How many people will die - no-one can tell until the final reckoning.

5. Policing of lockdown in the UK - the need for police reform (starting at the top?).

6. Religious nutcases and despotic governments (often the same people!)

7. Economics vs. Health - the lockdown cure being worse than the disease?

8. Ventilators and cures.

9. Shaggy dog stories - and wash your hands.

10. Reserved.

Home page of website

Please notify any errors or broken links to the author, Dr Stephen J Wozniak,     email =  stevewozniak42 (AT)