In the event of a suspected intravascular injection with negative aspiration, what is a recommended step?

• A. Proceed with the injection to test the response
• B. Increase the volume to confirm intravascular infiltration
• C. Pause, reassess needle position, possibly reposition and re-aspirate; continue with caution
• D. Stop immediately and remove the needle

Answer: (C)

The important idea is that negative aspiration does not guarantee you’re not in a vessel. Aspiration tests aren’t foolproof because the needle tip might be at or near a vessel, the vessel can be small, or tissue compression and bevel orientation can mask blood return. If you suspect intravascular injection, pause the injection and reassess the needle position. Reposition if needed, and re-aspirate before continuing. Then proceed with caution, injecting slowly and in small increments while monitoring the patient for any signs of systemic uptake. This approach helps minimize the risk of delivering anesthetic into the bloodstream and protects the patient from potential toxic effects.