Patient was administered an injection using a sterile 3-cc syringe with needle.

The safest practice is for a syringe and needle to be used only once to administer a medication to a single patient, after which the syringe and needle should be discarded. This practice prevents inadvertent reuse of the syringe and protects healthcare personnel from harms such as needlestick injuries.

However, when this is not feasible (e.g., when administration of incremental doses to a single patient from the same syringe is an integral part of the procedure), reuse of the same syringe and needle for the same patient should occur as part of a single procedure with strict adherence to aseptic technique. In such situations it is essential that the syringe never be left unattended and that it be discarded immediately at the end of the procedure.

There have been situations of disease transmission and recent patient notification events in the setting of unintentional syringe reuse after a syringe was not immediately discarded following use on a patient [2,15].

1. Kamlesh RL, Lala MK: Intramuscular Injection: review and guidelines. Indian Pediatr. 2003;40(9):835–845. [PubMed] [Google Scholar]

2. Ipp M, Sam J, Patricia PC: Needle aspiration and intramuscular vaccination. Arch Pediatr Adolesc Med. 2006;160(4):451. 10.1001/archpedi.160.4.451-a [PubMed] [CrossRef] [Google Scholar]

3. Mallet J, Christopher B: The Royal Marsden NHS Trust Manual of Clinical Nursing Procedure. 4th ed. London: Blackwell Science.1996. Reference Source [Google Scholar]

4. Workman B: Safe injection techniques. Nurs Stand. 1999;13(39):47–53. 10.7748/ns1999.06.13.39.47.c2623 [PubMed] [CrossRef] [Google Scholar]

5. Crawford CL, Johnson JA: To aspirate or not: an integrative review of the evidence. Nursing. 2012;42(3):20–5. 10.1097/01.NURSE.0000411417.91161.87 [PubMed] [CrossRef] [Google Scholar]

6. Canada, PHAo, Canadian Immunization Guide. 7th ed. Ottawa. Publishing and Depository Services Public Works and Government Services Canada: Ontario.2006. Reference Source [Google Scholar]

7. J CC: Aspiration before injection, in SIGN.2003;1–2. [Google Scholar]

8. Aceves-Avila FJ, Delgadillo-Ruano M, Ramos-Remus C, et al.: The first descriptions of therapeutic arthrocentesis: a historical note. Rheumatology (Oxford). 2003;42(1):180–3. 10.1093/rheumatology/keg001 [PubMed] [CrossRef] [Google Scholar]

9. Guggi V, Calame L, Gerster JC: Contribution of digit joint aspiration to the diagnosis of rheumatic diseases. Joint Bone Spine. 2002;69(1):58–61. 10.1016/S1297-319X(01)00342-6 [PubMed] [CrossRef] [Google Scholar]

10. Lane JG, Falahee M, Wojtys EM, et al.: Pyarthrosis of the knee. Treatment considerations. Clin Orthop Rel Res. 1990;45(252):198–204. [PubMed] [Google Scholar]

11. Johnson MW: Acute knee effusions: a systematic approach to diagnosis. Am Fam Physician. 2000;61(8):2391–400. [PubMed] [Google Scholar]

12. Manadan AM, Block JA: Daily needle aspiration versus surgical lavage for the treatment of bacterial septic arthritis in adults. Am J Ther. 2004;11(5):412–5. 10.1097/01.mph.0000087296.80768.1e [PubMed] [CrossRef] [Google Scholar]

13. Dooley P, Martin R: Corticosteroid injections and arthrocentesis. Can Fam Physician. 2002;48:285–92. [PMC free article] [PubMed] [Google Scholar]

14. Brown PW: Arthrocentesis for diagnosis and therapy. Surg Clin North Am. 1969;49(6):1269–78. [PubMed] [Google Scholar]

15. Lee AH, Chin AE, Ramanujam T, et al.: Gonococcal septic arthritis of the hip. J Rheumatol. 1991;18(12):1932–3. [PubMed] [Google Scholar]

16. Kesteris U, Wingstrand H, Forsberg L, et al.: The effect of arthrocentesis in transient synovitis of the hip in the child: a longitudinal sonographic study. J Pediatr Orthop. 1996;16(1):24–9. 10.1097/00004694-199601000-00006 [PubMed] [CrossRef] [Google Scholar]

17. Weidner S, Keller W, Kellner H: Interventional radiology and the musculoskeletal system. Best Pract Res Clin Rheumatol. 2004;18(6):945–56. 10.1016/j.berh.2004.05.011 [PubMed] [CrossRef] [Google Scholar]

18. Bureau NJ, Ali S, Chhem RK, et al.: Ultrasound of musculoskeletal infections. Semin Musculoskelet Radiol. 1998;2(3):299–306. 10.1055/s-2008-1080109 [PubMed] [CrossRef] [Google Scholar]

19. Grassi W, Farina A, Filippucci E, et al.: Sonographically guided procedures in rheumatology. Semin Arthritis Rheum. 2001;30(5):347–53. 10.1053/sarh.2001.19822 [PubMed] [CrossRef] [Google Scholar]

20. Feldmann H: [2000-year history of the ear syringe and its relationship to the enema. Images from the history of otorhinolaryngology, represented by instruments from the collection of the Ingolstadt Medical History Museum]. Laryngorhinootologie. 1999;78(8):462–7. 10.1055/s-2007-996909 [PubMed] [CrossRef] [Google Scholar]

21. Sibbitt W, Jr, Sibbitt RR, Michael AA, et al.: Physician control of needle and syringe during aspiration-injection procedures with the new reciprocating syringe. J Rheumatol. 2006;33(4):771–78. [PubMed] [Google Scholar]

22. Draeger HT, Twining JM, Jhonson CR, et al.: A randomised controlled trial of the reciprocating syringe in arthrocentesis. Ann Rheum Dis. 2006;65(8):1084–7. 10.1136/ard.2005.045781 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

23. Roberts WN, Hayes CW, Breitbach SA, et al.: Dry taps and what to do about them: a pictorial essay on failed arthrocentesis of the knee. Am J Med. 1996;100(4):461–4. 10.1016/S0002-9343(97)89524-1 [PubMed] [CrossRef] [Google Scholar]

24. Lobo A, Lightman S: Vitreous aspiration needle tap in the diagnosis of intraocular inflammation. Ophthalmology. 2003;110(3):595–9. 10.1016/S0161-6420(02)01895-X [PubMed] [CrossRef] [Google Scholar]

25. Qublan HS, Al-Jader K, Al-Kaisi NS: Fine needle aspiration cytology compared with open biopsy histology for the diagnosis of azoospermia. J Obstet Gynaecol. 2002;22(5):527–31. 10.1080/0144361021000003690 [PubMed] [CrossRef] [Google Scholar]

26. Jauniaux E, Holmas A, Hyett J, et al.: Rapid and radical amniodrainage in the treatment of severe twin-twin transfusion syndrome. Prenat Diagn. 2001;21(6):471–6. 10.1002/pd.96 [PubMed] [CrossRef] [Google Scholar]

27. Cederholm M, Haglund B, Axelsson O: Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping. BJOG. 2003;110(4):392–9. 10.1046/j.1471-0528.2003.02091.x [PubMed] [CrossRef] [Google Scholar]

28. Farran I, Sánchez M, Mediano C, et al.: Early amniocentesis with the filtration technique: neonatal outcome in 123 singleton pregnancies. Prenat Diagn. 2002;22(10):859–63. 10.1002/pd.424 [PubMed] [CrossRef] [Google Scholar]

29. Papp C, Papp Z: Chorionic villus sampling and amniocentesis: what are the risks in current practice? Curr Opin Obstet Gynecol. 2003;15(2):159–65. [PubMed] [Google Scholar]

30. Moore KP, Wong F, Gines P, et al.: The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club Hepatology. 2003;38(1):258–66. 10.1053/jhep.2003.50315 [PubMed] [CrossRef] [Google Scholar]

31. Murthy SV, Hussain ST, Gupta S, et al.: Pseudoaneurysm of inferior epigastric artery following abdominal paracentesis. Indian J Gastroenterol. 2002;21(5):197–8. [PubMed] [Google Scholar]

32. Webster ST, Brown KL, Lucey MR, et al.: Hemorrhagic complications of large volume abdominal paracentesis. Am J Gastroenterol. 1996;91(2):366–8. [PubMed] [Google Scholar]

33. Nettleman MD, Bock MJ, Nelson AP, et al.: Impact of procedure-related complications on patient outcome on a general medicine service. J Gen Intern Med. 1994;9(2):66–70. 10.1007/BF02600202 [PubMed] [CrossRef] [Google Scholar]

34. WHO, Global Facts & Figures. A safe injection does not harm the recipient, does not expose the health care worker to any risk and does not result in waste that is dangerous for the community, in SAFETY OF INJECTIONS .2006; 33:4. [Google Scholar]

35. Rodger MA, King L: Drawing up and administering intramuscular injections: a review of the literature. J Adv Nurs. 2000;31(3):574–582. 10.1046/j.1365-2648.2000.01312.x [PubMed] [CrossRef] [Google Scholar]

36. Furman MB, Giovanniello MT, O’Brien EM: Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976). 2003;28(1):21–25. [PubMed] [Google Scholar]

37. Higgins D: Subcutaneous Injections. Nursing times. 2004;100(50):32–3. [PubMed] [Google Scholar]

38. Rozani N: Aga Khan University School of Nursing enrichement program: Skills check list mannual, ed. AHN. Vol. 1. 2007, Karachi. 10. [Google Scholar]

39. Clinical Skills: Intramuscular Injections. Nursing times. 2003;99(26):27. [PubMed] [Google Scholar]

40. Nigeria C.h.p.r.b.o: Practical assesment record for cummunity health extension workers. Instructors Guide Book.2006. [Google Scholar]

41. Taddio A, et al.: Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin Ther. 2009;31(Suppl 2):S48–76. 10.1016/j.clinthera.2009.07.024 [PubMed] [CrossRef] [Google Scholar]

42. Hayes C: Injection technique subcutaneous. Nursing times. 1998;94(41):suppl 1–2. [PubMed] [Google Scholar]

43. WHO, I SIGN. Best Infection Control Practices for Skin-Piercing Intradermal, Subcutaneous, and Intramuscular Needle Injections.2001; [cited 2008 June 23]. Reference Source [Google Scholar]

44. WHO. A guide for supervising injections. Feb 2004 April 2008 [cited 2013 March 15]; Feb 12. 2004: [1–16]. Reference Source [Google Scholar]

45. Waibel KH: Aspiration before immunotherapy injection is not required. J Allergy Clin Immunol. 2006;118(2):525–6. 10.1016/j.jaci.2006.04.008 [PubMed] [CrossRef] [Google Scholar]

46. Miller JD, Bell JB, Lee RJ, et al.: Blood return on aspiration before immunotherapy injection. J Allergy Clin Immunol. 2006;119(2):512. 10.1016/j.jaci.2006.09.015 [PubMed] [CrossRef] [Google Scholar]

47. Guarneri F: Aspiration before subcutaneous immunotherapy injection: Unnecessary or advisable? J Allergy Clin Immunol. 2007;119(2):512–513. 10.1016/j.jaci.2006.10.010 [PubMed] [CrossRef] [Google Scholar]

48. Geller M: Aspiration before immunotherapy injection is required. J Allergy Clin Immunol. 2007;120(1):220–1. 10.1016/j.jaci.2007.02.039 [PubMed] [CrossRef] [Google Scholar]

49. H WK: Reply: Letter to the editor. J Allergy Clin Immunol. 2006;120(1). [Google Scholar]

50. Council NM: Guidelines for the administration of medicine.2002. [cited 2014 March 15]. Reference Source [Google Scholar]

51. Council NM: Standards for medicines management.2004. [cited 2014 March 15]. Reference Source [Google Scholar]

52. Corkery PF, Barrett BE: Aspiration using local anesthetic catridges with an elastic recoil diaphragm. J Dent. 1973;2(2):72–74. 10.1016/S0300-5712(73)80022-3 [PubMed] [CrossRef] [Google Scholar]

53. Meechana JG, Ramacciato JC, McCabea JF: A comparison of the aspirating abilities of re-usable and partly disposable dental cartridge syringes in vitro. J Dent. 2006;34(1):41–47. 10.1016/j.jdent.2005.03.003 [PubMed] [CrossRef] [Google Scholar]

54. Petersen JK: Efficacy of a self-aspirating syringe. Int J Oral Maxillofac Surg. 1987;16(2):241–4. 10.1016/S0901-5027(87)80140-6 [PubMed] [CrossRef] [Google Scholar]

55. Control, C.o.D. Sample Screening Form Dental Safety Syringes and Needles.2002. [cited 2014 March 15]. [Google Scholar]

56. Calin MA, Parasca SV, Savastru R, et al.: Optical techniques for the noninvasive diagnosis of skin cancer. J Cancer Res Clin Oncol. 2013;139(7):1083–104. 10.1007/s00432-013-1423-3 [PubMed] [CrossRef] [Google Scholar]

57. Pickering LK, EG V: Ill. Active and Passive Immunization: Report of the Committee on Infectious Diseases. 26th ed. Red book. 2003: American Academy of Pediatrics. Reference Source [Google Scholar]

58. Immunization, N.A.C.o., Canadian Immunization Guide. H. Canada, Editor. 2002, Public Health Agency of Canada, Infectious Disease and Emergency Preparedness Branch, Centre for Infectious Disease Prevention and Control: Ontario.38–40. Reference Source [Google Scholar]

59. CDC. Vaccine Administration. In: General recommendations on Immunisation. Eds. William LA, L.P., Benjamin S, Bruce W, John lskander, John Watson, Atlanta, USA. MMWR.2002;51(RR02):1–36. Reference Source [Google Scholar]

60. Jablecki CK: Letter to the Editor. Nursing Res. 2000;49(5):244 Reference Source [PubMed] [Google Scholar]

61. Duclos P: WHO/V&B. SIGN January 2003 July 2008 [cited 2014 March 15].1–2. [Google Scholar]

62. Ipp M, Taddio A, Sam J, et al.: Vaccine-related pain: randomised controlled trial of two injection techniques. Arch Dis Child. 2007;92(12):1105–8. 10.1136/adc.2007.118695 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

63. Catlin M, Crook B: Giving safe injections: introducing auto-disable syringes. PATH Seattle, WA U.S.A.2000. Reference Source [Google Scholar]

64. Program NI: Epidemiology and Prevention of Vaccine-Preventable Diseases.2007; [cited 2014 March 15]. Reference Source [Google Scholar]

65. APPENDIX D. Vaccine Administration.2007; [cited 2008 July 1]. Reference Source [Google Scholar]

66. Nicoll LH: IM injection: updated information. SIGNpost September.2002;1–2. [cited 2014 March 15]. [Google Scholar]

67. Nicoll LH, Hesby A: Intramuscular injection: an integrative research review and guideline for evidence-based practice. Appl Nurs Res. 2002;15(3):149–162. 10.1053/apnr.2002.34142 [PubMed] [CrossRef] [Google Scholar]

68. Sibbitt RR, Sibbitt WL, Jr, Nunez SE, et al.: Control and performance characteristics of eight different suction biopsy devices. J Vasc Interv Radiol. 2006;17(10):1657–1669. 10.1097/01.RVI.0000236837.47302.8E [PubMed] [CrossRef] [Google Scholar]

69. Robinson JN, Loeffler HH, Norwitz ER: A syringe adapter to facilitate aspiration at amniocentesis. Obstet Gynecol. 2000;96(1):138–140. [PubMed] [Google Scholar]

70. Furman MB, O'Brien EM, Zgleszewski TM: Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections. Spine (Phila Pa 1976). 2000;25(20):2628–2632. 10.1097/00007632-200010150-00014 [PubMed] [CrossRef] [Google Scholar]

71. Yankelevitz DF, Hayt D, Henschke CI: Transthorasic needle biopsy. What size syrine? Clin Imaging. 1995;19(3):208–209. 10.1016/0899-7071(94)00070-S [PubMed] [CrossRef] [Google Scholar]

72. Castellote J, Xiol X, Cortés-Beut R, et al.: Complications of thoracentesis in cirrhotic patients with pleural effusion. Rev Esp Enferm Dig. 2001;93(9):566–75. [PubMed] [Google Scholar]

73. Doyle JJ, Hnatiuk OW, Torrington KG, et al.: Necessity of routine chest roentgenography after thoracentesis. Ann Intern Med. 1996;124(9):816–20. 10.7326/0003-4819-124-9-199605010-00005 [PubMed] [CrossRef] [Google Scholar]

74. Sassoon CS, Light RW, O'Hara VS, et al.: Iatrogenic pneumothorax: etiology and morbidity. Results of a Department of Veterans Affairs Cooperative Study. Respiration. 1992;59(4):215–20. 10.1159/000196061 [PubMed] [CrossRef] [Google Scholar]

75. Callahan JA, Seward J: Pericardiocentesis Guided by Two-Dimensional Echocardiography. Echocardiography. 1997;14(5):497–504. 10.1111/j.1540-8175.1997.tb00757.x [PubMed] [CrossRef] [Google Scholar]

76. Bastian A, Meissner A, Lins M, et al.: Pericardiocentesis: differential aspects of a common procedure. Intensive Care Med. 2000;26(5):572–6. 10.1007/s001340051206 [PubMed] [CrossRef] [Google Scholar]

77. Salem K, Mulji A, Lonn E: Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade. Can J Cardiol. 1999;15(11):1251–5. [PubMed] [Google Scholar]

78. Tsang TS, Barnes ME, Gersh BJ, et al.: Outcomes of clinically significant idiopathic pericardial effusion requiring intervention. Am J Cardiol. 2003;91(6):704–7. 10.1016/S0002-9149(02)03408-2 [PubMed] [CrossRef] [Google Scholar]

79. Tsang TS, El-Najdawi EK, Seward JB, et al.: Percutaneous echocardiographically guided pericardiocentesis in pediatric patients: evaluation of safety and efficacy. J Am Soc Echocardiogr. 1998;11(11):1072–7. [PubMed] [Google Scholar]

80. Duvernoy OBJ, Borowiec J, Helmius G, et al.: Complications of percutaneous pericardiocentesis under fluoroscopic guidance. Acta Radiol. 1992;33(4):309–13. 10.1080/02841859209173184 [PubMed] [CrossRef] [Google Scholar]

81. Atkinson W, Hamborsky J, McIntyre L, et al.: The Pink Book. 10th ed. 2nd printing ed. Epidemiology and Prevention of Vaccine-Preventable Diseases. Washington DC: Public Health Foundation: Centers for Disease Control and Prevention.2008. Reference Source [Google Scholar]

82. Kaic B: Aspiration before injection. SIGNpost January 2003 July 2008. Reference Source [Google Scholar]

83. WHO. Fact sheet N°231 Injection safety.2002. [cited 2008 March 21]. Reference Source [Google Scholar]

84. NHS. Administration of medicines through intramuscular injections - Guidelines.2006. [cited 2014 March 15]. Reference Source [Google Scholar]

85. Center, T.U.M. Adverse reactions newsletter.1996. Reference Source [Google Scholar]

86. Nigeria, C.h.p.r.b.o., Curriculum for higher diploma in cummunity health. Instructors Guide Book.2006. [Google Scholar]

87. Curriculum, P.N.C.B.N.1990;50–51. [Google Scholar]

88. IndiaCLEN. Model Injection Centres (MICs): A Program to Improve Injection Practices in the Country (2005–2006). Reference Source [Google Scholar]

89. Nguyen QD, Tatlipinar S, Shah SM, et al.: Vascular endothelial growth factor is a critical stimulus for diabetic macular edema. Am J Ophthalmol. 2006;142(6):961–9. 10.1016/j.ajo.2006.06.068 [PubMed] [CrossRef] [Google Scholar]

90. British National Formulary.2007; [cited 2014 March 15]. Reference Source [Google Scholar]

91. Pakistan Pharma Guide. [cited 2014 March 15]. Reference Source [Google Scholar]

92. Battersby A: “To aspirate or not to aspirate” that is the question. SIGN January 2003 July 2008 [cited 2014 March 15]; July 2008: [1–2]. Reference Source [Google Scholar]

93. Safety, C.o.I. Supplementary Material. 2009 [cited 2014 March 15]. Reference Source [Google Scholar]

Page 2

Description of peer items reviewed with numbers reviewed.