No aspiration where indicated → intravascular injection risk
What it is
Failing to aspirate before depositing local anesthetic in injections where there is a meaningful chance the needle tip is in a vessel (classically nerve blocks like IANB, and also injections near highly vascular areas). This can lead to intravascular injection, causing systemic effects (especially with vasoconstrictor), inadequate anesthesia, and increased risk of toxicity.
Why it happens
• Rushing or assuming "it's fine" because aspiration is sometimes negative even when close to vessels (false negatives can occur) • Using non-aspirating syringes or poor technique so aspiration isn't reliable (AAPD notes ADA standards for aspirating syringes; needle selection should allow adequate aspiration) • Belief that aspiration "doesn't matter" because the chance is low — but for IANB it's not low: one clinical study reported ~15.3% aspiration-positive during inferior alveolar nerve block injections • Not knowing which injections are higher risk (e.g., IANB, PSA block), so aspiration is skipped inconsistently
The full clinical mistake entry includes
- How to avoid it — the prevention protocol
- The clinical tip experienced clinicians use
- The documented reference behind the mistake
More clinical mistakes
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