How should you manage a suspected intravascular injection after a negative aspiration?

• A. Immediately withdraw and stop
• B. Inject again while monitoring patient
• C. Pause, reassess needle position, possibly reposition and re-aspirate; continue with caution
• D. Continue with the injection without reassessment

Answer: (C)

When aspiration isn’t a perfect safeguard, the best move is to pause and verify your needle position before continuing. Negative aspiration can still miss a vessel, especially with small or collapsed vessels or needle proximity to a vessel wall. So if you suspect intravascular placement, stop injecting, reassess where the needle tip is, and reposition if needed. Then re-aspirate to confirm you’re not in a vessel, and proceed with the injection only with extra caution—using slow administration, smaller amounts, and careful monitoring of the patient. This approach reduces the risk of delivering the anesthetic or vasoconstrictor into the bloodstream while still allowing you to complete the procedure safely. Injecting again without rechecking position or continuing without reassessment are not prudent, and simply stopping without reassessment can leave you unprepared if the situation changes.