Hello, Welcome to my channel Medicine with Dr. Moran. If this is your first time visiting my
name's Dr. Keith Moran. My channel is all about presenting the best available medical evidence
that has been critically appraised on a number of topics, medical topics that is. I have a number of
general medical videos including procedures that I do as well as a number of videos on Covid-19.
Today's topic is important because it shows how a small change that costs nothing could potentially
impact an individual's life quite greatly. Could receiving the Covid shot without aspiration lead
to some of the side effects that we've been seeing over the last number of months? The Covid-19
pandemic has seen 6.5 billion vaccinations given thus far as of October 11, 2021. People
are getting vaccinated around the world with injections into their upper arm into this muscle
the deltoid muscle. We've all seen numerous videos of people being immunized. The needle
of course goes into the muscle and the plunger of the syringe is then pushed in to quickly deliver
the vaccine as quickly as possible. Now the World Health Organization as well as the Center for
Disease Control in the United States no longer recommend aspiration of the syringe plunger
during an intramuscular injection. Essentially they've recommended against this so as to minimize
pain. They feel that the veins and arteries within the reach of a syringe needle in the deltoid
are too small to allow rapid intravenous injection of a vaccine without rupturing a blood vessel,
but this lacks supportive scientific evidence. Is this the correct way of injecting vaccines?
This is certainly not how I was taught in medical school. In my 30-year career as a physician I've
used needles in numerous different parts of the human body and this is not how I believe
it should be done. Let me explain. When you're using a needle you need to know where the end
of the needle is. In this case are you in the muscle or are you in a blood vessel?
At the end of a needle is a bevel. The bevel is the opening at the end of the needle
where the solution that you're going to inject will come out.
Remember this is a blind procedure but you still must know where the bevel is.
For example in the instance of an intramuscular injection how do you know if the bevel is in
the muscle or could you be in a very small blood vessel. I believe it matters. I have done hundreds
or in some cases into the thousands of specific procedures and using needles in my career.
This slide lists a number of those procedures that I have performed. Procedures such as putting
in an intravenous catheter into a jugular vein in the neck so that I can then place a
temporary pacemaker through this or a pressure catheter into the right side of the heart.
We used to do this using landmarks looking at the skin the muscle and bone to guide us where
to stick the needle in. We would typically use a small needle to find the vessel while gently
pulling back the plunger which we call aspirating. This would be to see where the needle is.
When the bevel of the needle would strike the vein that you want, the internal jugular vein
you would see a flashback of venous blood which is a very dark red color because the oxygen has been
extracted from it. Inserting the needle into the carotid artery which is right beside the jugular
vein would give you a very bright red flashback because you're in an artery which is well
oxygenated. Now for some time we have miniaturized ultrasound machines that I now use in combination
with the procedure so that we can look at the vein beforehand so that when we place the needle under
the skin we can actually see where the needle and vein is located and their relationship. We
can also see when the needle enters the vein and it helps us avoid puncturing the carotid artery
and to safely insert a catheter into that jugular vein. Many of the procedures that we do of course
require injection of local anesthetic into the skin, the subcutaneous tissues, and into other
structures such as the lining of the bone which we call periosteum for example when I'm doing a
bone marrow aspirate and bone marrow biopsy. So through the procedure we're aspirating before
injecting local anesthetic because we don't want to inject local anesthetic into a vein.
We want the anesthetic to freeze local tissues not go into the vein. Now the opposite situation can
actually occur if I'm doing a procedure where a patient needs sedation and thus has an intravenous
which has been placed by the nursing staff but for some reason the intravenous
catheter unknowingly migrates out of that small vein and goes into the subcutaneous tissue.
Unfortunately this does occur from time to time and if it does when sedation is given through one
of the IV ports the medication will cause swelling at the IV site because it didn't go into the vein
it leaked into the subcutaneous tissues. Thus the patient won't receive the sedative medication
through the intravenous and a new IV needs to be started in order to give that medication. Now of
course over the next number of hours the sedative medication which is located now in subcutaneous
tissues will be reabsorbed into the body and will slowly exert a mild sedative effect over
the next number of hours. As another example if a patient has a collection of fluid around
their lung which we call a pleural effusion or a collection in the abdomen which we call ascites
we want to sample that both for diagnostic reasons but also to drain it for therapeutic reasons and
so after freezing is placed in those procedures from the skin down into the subcutaneous tissues
as the needle is advanced we're always aspirating or pulling back on the plunger so we know when
we enter that particular cavity. When you do there'll be a flashback of the fluid.
The point I'm making is that it's important for us all to know where that bevel of the needle is.
Often if there's a very localized collection of fluid somewhere particularly around the
lung the area can be ultrasounded and it can be marked so we know exactly the depth of where the
needle needs to be in order to get to the fluid. So why is this not important as it pertains to
vaccinations? The vaccine after all is supposed to go into the muscle not into the vein. We
do want to know where it's going of course. Now the reason is when we inject medication
we want to know where it's going. You want the vaccine to go into the muscle and not into the
vein as that's how all the clinical studies were done. I cannot give you specific numbers of the
likelihood of a deltoid injection going into a blood vessel because it's not been well studied,
but I would guess that this is likely going to be 1% or less when it comes to a deltoid injection.
Now there's an interesting study in 2016 of 164 registered nurses who were surveyed
and they noted that 74% of the nurses continue to aspirate at least 90% of the
time when they give these injections. Only 3% aspirated for the recommended 5 to 10 seconds.
40% of nurses have seen blood aspiration at least once and 4% reported blood aspiration at least 13
times or more during intramuscular injections. Blood aspiration occurred most frequently in
the buttock area in 15% and the deltoid in 12% of nurses who did the study. Now the deltoid
muscle of course is where we're going to give the vaccine to protect people against the Coronavirus
and this finding suggests that inadvertent intravenous injection is definitely possible
and given the number of vaccines that we're giving currently 6.5 billion so far as I said.
Is almost a certainty that many people out of those billions will have had an intravenous
injection if aspiration did not occur first. As I mentioned physicians and nurses over the
years have been taught to aspirate, pull the plunger back before injecting for many of the
reasons I've stated above. Having said that this has not been the case with many of the
current vaccinations that are being given. It only takes several seconds to pull the
plunger back to make sure you're not in a blood vessel before delivering the vaccine.
Now what happens when these vaccines are given intravenously? I want to share a paper from July
in regards to the AstraZeneca vaccine. We know that with this vaccine as well as the Johnson
and Johnson one there have been problems with vaccine-induced blood clots with low platelets
which I've reported on in earlier videos. This paper was written by a group from Munich
as well as Milan and provides a potential mechanism of how blood clots and low platelets
could occur if there were to be intravenous administration of the AstraZeneca vaccine.
As always there's a link to the study below in the description. Now this study is a preprint and
it's not been peer reviewed. In the paper as you can see in their summary paragraph on this slide
they showed that intravenous but not intramuscular injection of the AstraZeneca vaccine
triggers platelet activation and formation of a platelet to adenovirus aggregate followed
by an immune response with antibodies to platelets which then triggers the blood clots.
In a more recent second paper researchers from Hong Kong looked at the possibility that
intravenous injection of the Pfizer vaccine could be the reason for Myocarditis or Pericarditis.
Myocarditis and Pericarditis is a rare side effect from both the Pfizer and Moderna vaccines which
I've reported recently on in another video. There's a link in the description. Myocarditis
refers to inflammation of the heart muscle, and pericarditis refers to inflammation of the sac
that surrounds the heart. The risks of Myocarditis and Pericarditis are much higher in younger men
especially after the second dose and are also much higher with the Moderna vaccination than
the Pfizer. Now the reason for the difference between the two vaccines may be because the dose
of MRNA in the Moderna vaccine is 100 micrograms as opposed to only 30 micrograms with Pfizer.
The data from the province of Ontario and Canada which I've reported on in the study
I just mentioned is very similar to experiences in other countries. Now due to that data Moderna
is not being used in Ontario in this group of people and I believe this was the first place
to make that decision. I also note that there are a number of European countries that have
also followed suit since then in the last couple of weeks. Now here's the Hong Kong
study. This study has been peer reviewed and has been published in Clinical Infectious Diseases.
They use a mouse model. They took mice and allocated them to three groups. One group
received intramuscular injection of the Pfizer vaccine, another group intravenous injection of
the Pfizer vaccine and a third group received normal saline which was the control group.
All of the mice were monitored for up to 14 days. A group of mice did receive a second boosting dose
14 days after the first priming dose and they use both male and female mice what they found was that
only the intravenous group developed changes of Myocarditis under the microscope and they
were seen in both male and female mice. They also saw evidence of Pericarditis which actually was
visible to the researchers unaided eye when looking at the hearts of the mice that had
intravenous injections. They also saw degeneration of liver cells in the intravenous group.
The changes of Myocarditis after the first dose persisted for two weeks and they were
markedly aggravated by a second iv booster dose or even if the second dose was given correctly
into the muscle. So in this mouse model there is evidence that inadvertent intravenous injection
of the Pfizer vaccine can induce Myocarditis and Pericarditis. They indicated that a brief
withdrawal of the syringe plunger to exclude blood aspiration may be one possible way to reduce
such risk. In summary I think it's important to withdraw the plunger to aspirate just prior to
injecting the vaccine it doesn't cost anything and in my personal experience it did not lead to
any additional discomfort other than the fact that the needle was in my body several seconds longer
during both my vaccinations. Remember that it may prevent complications from these vaccines. We
don't know for sure. I have encouraged my patients who are getting vaccinated to politely ask the
nurse pharmacist or is vaccinating to aspirate before injecting. You can watch them of course
aspirate if you're so inclined. Thanks for joining me today on medicine with Dr. Moran. I'm Dr. Keith
Moran. I hope you found this to be helpful, and remember get healthy and stay healthy.