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Sblendorio E. Intramuscular vaccine administrations including the adoption of “Zeta-track technique” & “without aspiration slow injection technique” (ZTT & WASiT): a prospective review. FRONTIERS OF NURSING 2023. [DOI: 10.2478/fon-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Objective
To review the current literature on the practice of intramuscular injections (IMIs), focusing on immunizations.
Methods
The present study comprises 2 reviews, characterized by high-quality evidence, pertaining to the deployment of the slow injection technique without aspiration (referred to in this paper as the without-aspiration slow injection technique [WASiT]) and combined with the Zeta-track technique (ZTT). The literature review is oriented toward the analysis of 2 features associated with IMIs techniques: safety and pain, integrating new evidence on vaccinee positioning for each muscle site and general relaxation techniques in the multi-parametric analysis.
Results
The rigorous and in-depth reviews in the current study reveal the usefulness of including, among the international guidelines for via intramuscular immunizations, the adoption of WASiT only for compliant vaccinees, and in combination with all validated techniques for IMIs, and the use of ZTT limitedly if specific well-developed muscles are indicated. All the technique’s limitations are exposed.
Conclusions
Future research directions are presented by including the author’s study designs to provide indirect evidence for the validity of the rationale of the slow injection technique using scientific methods, and for the conduction of future randomized controlled trials (RCTs) focused on revisiting the adoption of ZTT in a dynamic and integrated immunizations protocol in anterolateral thigh (ALT), ventrogluteal (VG), and also in the deltoid muscle, in the specific cases analyzed.
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Affiliation(s)
- Elena Sblendorio
- a Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari , Bari , Italy
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
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Kalra S, Mithal A, Sahay R, John M, Unnikrishnan AG, Saboo B, Ghosh S, Sanyal D, Hirsch LJ, Gupta V, Strauss KW. Indian Injection Technique Study: Population Characteristics and Injection Practices. Diabetes Ther 2017; 8:637-657. [PMID: 28289893 PMCID: PMC5446372 DOI: 10.1007/s13300-017-0243-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION It was estimated that 3.2 million Indians with diabetes injected insulin in 2010, but little is known about the techniques used. METHODS In 2015 we conducted an injection technique questionnaire (ITQ) survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as rest of world (ROW). RESULTS Mean HbA1c was 8.6. BMI values in India were 1.5-3 units lower than in ROW depending on patient group, meaning the risk of intramuscular (IM) injections is high in India. The mean total daily dose (TDD) of insulin was lower in every category of Indian patient than in ROW, perhaps reflecting the lower BMI. Needle reuse, whether with pens or syringes, is much higher in India than ROW and so is the number of times the needle is used. The majority (56.8%) of Indian insulin users performed only 2 injections/day as opposed to ROW where 45% of patients performed at least 4 injections/day. Indian patients inject insulin in the thighs more often than patients in ROW, a site where IM injections are more risky. Many patients do not have proper access to sharps containers or have other risk factors that could lead to blood-borne pathogen spread. More than 60% of used sharps in India go into the rubbish, with nearly 12% not even having the minimum protection of a cap. DISCUSSION The shortest needles are very common in India; however, the level of needle reuse is high. Multiple daily injections therapy is not as common in India as ROW. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulins, skinfolds, and safe sharps disposal.
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Affiliation(s)
| | - Ambrish Mithal
- Medanta the Medicity, CH Baktawar Singh Road, Sector 38, Gurgaon, Haryana, India
| | - Rakesh Sahay
- Osmania Medical College, Turrebaz Khan Rd, Esamiya Bazaar, Koti, Hyderabad, Telangana, India
| | - Mathew John
- Providence Endocrine & Diabetes Specialty Centre, TC 1/2138, Near GG Hospital, Murinjapalam, Thiruvanthapuram, Kerala, India
| | - A G Unnikrishnan
- Chellaram Diabetes Institute, Pune-Bangalore, NH4, Bavdhan, Pune, Maharashtra, India
| | - Banshi Saboo
- Diacare-Diabetes Care & Hormone Clinic, 1 & 2 Gandhi Park Society, Nehrunagar Cross Roads, Ambavadi, Ahmedabad, Gujarat, India
| | - Sujoy Ghosh
- AMRI Medical Centre Kolkata, No. 97 A, Southern Avenue, Above Maruti Showroom, Opposite Lake Stadium, Kolkata, West Bengal, India
| | - Debmalya Sanyal
- KPC Medical College and Hospital, Raja Subodh Chandra Mullick Road, Jadavpur, Near Jadavpur Railway Station, Kolkata, West Bengal, India
| | - Laurence J Hirsch
- BD Diabetes Care, 1 Becton Dr. MC 378, Franklin Lakes, New Jersey, USA
| | - Vandita Gupta
- BD Diabetes Care, BD, 6th Floor Signature Tower-B, South City I, NH 8, Gurgaon, Haryana, India
| | - Kenneth W Strauss
- BD Diabetes Care, POB 13, Erembodegem-Dorp 86, 9320, Erembodegem, Belgium.
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Zabaleta-Del-Olmo E, Vlacho B, Jodar-Fernández L, Urpí-Fernández AM, Lumillo-Gutiérrez I, Agudo-Ugena J, Morros-Pedrós R, Violán C. Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis. Int J Nurs Stud 2016; 60:121-32. [PMID: 27297374 DOI: 10.1016/j.ijnurstu.2016.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/30/2016] [Accepted: 04/20/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many people with diabetes often reuse disposable needles for subcutaneous insulin injection. We aimed to identify, critically appraise and summarize the available evidence about the safety of this practice. DESIGN Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES MEDLINE (via PubMed), CINALH (via EBSCO), SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials and Open Grey were searched from their inception to December 2015, with no language restrictions. REVIEW METHODS Epidemiologic and experimental studies assessing adverse effects of reusing needles in people of any age or sex, with or without diabetes, were included. Two reviewers independently assessed the methodological quality of included studies using a multi-design tool. RESULTS In total, 25 studies were included. All studies had a high risk of bias and data from only nine studies could be pooled. Five studies showed no association between infection at site of injection and reuse of needles (risk difference=-0.00; 95% confidence interval=-0.12-0.11; P=0.99); heterogeneity between these studies was substantial (I(2)=66%; P=0.02). Five cross-sectional studies showed an association between lipohypertrophy and needle reuse (risk difference=0.16, 95% confidence interval=0.05-0.28, P=0.006); there was strong evidence of heterogeneity between these studies (I(2)=87%; P<0.001). Pooled data of two studies with no evidence of heterogeneity between them showed more perceived pain among reusers (risk difference=0.24; 95% confidence interval=0.06-0.43; P=0.006). Reusing a pen needle or disposable syringe-needle was not associated with worse glycaemic control. CONCLUSIONS There is currently no clear scientific evidence to suggest for or against the reuse of needles for subcutaneous insulin injection. This practice is very common among people with diabetes; consequently, further research is necessary to establish its safety.
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Affiliation(s)
- Edurne Zabaleta-Del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Department of Nursing, Universitat de Girona, c/ Emili Grahit 77, 17071 Girona, Spain.
| | - Bogdan Vlacho
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain.
| | - Lina Jodar-Fernández
- Primary Health Care Centre Cornellà 2 (Sant Ildefons), Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Av. República Argentina s/n (cantonada Av. de Sant Ildefons), 08940 Cornellà de Llobregat, Spain.
| | - Ana-María Urpí-Fernández
- Primary Health Care Centre Carles I, Àmbit d'Atenció Primària Barcelona-Ciutat, Institut Català de la Salut, c. de la Marina, 168, 08018 Barcelona, Spain.
| | - Iris Lumillo-Gutiérrez
- Emergency Primary Care Centre El Castell, Consorci Castelldefels Agents de Salut (CASAP), c. Guillermo Marconi, 9 bxs, 08860 Castelldefels, Spain.
| | - Josep Agudo-Ugena
- Primary Health Care Centre La Mina, Àmbit d'Atenció Primària Barcelona-Ciutat, Institut Català de la Salut, c. del Mar, s/n, 08930 Sant Adrià de Besòs, Spain.
| | - Rosa Morros-Pedrós
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | - Concepción Violán
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
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Ramadan WH, Khreis NA, Kabbara WK. Simplicity, safety, and acceptability of insulin pen use versus the conventional vial/syringe device in patients with type 1 and type 2 diabetes mellitus in Lebanon. Patient Prefer Adherence 2015; 9:517-28. [PMID: 25848231 PMCID: PMC4383149 DOI: 10.2147/ppa.s78225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the simplicity, safety, patients' preference, and convenience of the administration of insulin using the pen device versus the conventional vial/syringe in patients with diabetes. METHODS This observational study was conducted in multiple community pharmacies in Lebanon. The investigators interviewed patients with diabetes using an insulin pen or conventional vial/syringe. A total of 74 questionnaires were filled over a period of 6 months. Answers were entered into the Statistical Package for Social Sciences (SPSS) software and Excel spreadsheet. t-test, logistic regression analysis, and correlation analysis were used in order to analyze the results. RESULTS A higher percentage of patients from the insulin pen users group (95.2%) found the method easy to use as compared to only 46.7% of the insulin conventional users group (P 0.001, relative risk [RR]: 2.041, 95% confidence interval [CI]: 1.178-3.535). Moreover, 61.9% and 26.7% of pen users and conventional users, respectively, could read the scale easily (P 0.037, RR 2.321, 95% CI: 0.940-5.731), while 85.7% of pen users found it more convenient shifting to pen and 86.7% of the conventional users would want to shift to pen if it had the same cost. Pain perception was statistically different between the groups. A much higher percentage (76.2%) of pen users showed no pain during injection compared to only 26.7% of conventional users (P 0.003, RR 2.857, 95% CI: 1.194-6.838). CONCLUSION The insulin pen was significantly much easier to use and less painful than the conventional vial/syringe. Proper education on the methods of administration/storage and disposal of needles/syringes is needed in both groups.
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Affiliation(s)
- Wijdan H Ramadan
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
- Correspondence: Wijdan H Ramadan, Department of Pharmacy Practice School of Pharmacy Lebanese American University PO Box 36 - F 53, Byblos, Lebanon, Tel +961 9 547 249 Ext 2267, Fax +961 9 547 256 Ext 2897, Email
| | - Noura A Khreis
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Wissam K Kabbara
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
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Sim KH, Hwang MS, Kim SY, Lee HM, Chang JY, Lee MK. The appropriateness of the length of insulin needles based on determination of skin and subcutaneous fat thickness in the abdomen and upper arm in patients with type 2 diabetes. Diabetes Metab J 2014; 38:120-33. [PMID: 24851206 PMCID: PMC4021299 DOI: 10.4093/dmj.2014.38.2.120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/26/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. METHODS First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. RESULTS The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. CONCLUSION It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes.
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Affiliation(s)
- Kang Hee Sim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Moon Sook Hwang
- Department of Nursing Science, Woo Suk University, Wanju, Korea
| | - Sun Young Kim
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Hye Mi Lee
- Department of Nursing, Samsung Medical Center, Seoul, Korea
| | - Ji Yeun Chang
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Moon Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hansen B, Matytsina I. Insulin administration: selecting the appropriate needle and individualizing the injection technique. Expert Opin Drug Deliv 2011; 8:1395-406. [PMID: 21864222 DOI: 10.1517/17425247.2011.614229] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Patients with diabetes who receive insulin therapy often fail to meet their targets for metabolic control with insulin injections. Their inadequate glycemic control may be related to incorrect injection procedure. AREAS COVERED This review examines the latest data related to insulin injection and needle characteristics, which play an integral role in patient satisfaction. Searches of Medline and Cumulative Index to Nursing and Allied Health Literature databases were conducted. Results show that optimal insulin injection can facilitate glycemic control in pediatric and adult patients. In general, needles shorter than 8 mm are appropriate for normal weight, obese pediatric and adult patients. However, body mass index, gender, race, age and injection site can influence the depth of subcutaneous tissue and thus, the desired needle size and injection technique. Although the abdomen, thighs and buttocks are all recommended injection sites, abdominal injections disperse insulin slightly more rapidly than thigh injections. EXPERT OPINION Wider acceptance of needles shorter than 6 mm will occur with more evidence of their safety and efficacy, particularly in children. Development of shorter and thinner needles to make injections even easier and less burdensome may be expected in the future.
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Affiliation(s)
- Birtha Hansen
- Aarhus University Hospital, Medical Endocrinology Department MEA, Noerrebrogade 44, 8000 Aarhus C, Denmark.
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Frid A, Hirsch L, Gaspar R, Hicks D, Kreugel G, Liersch J, Letondeur C, Sauvanet JP, Tubiana-Rufi N, Strauss K. The Third Injection Technique Workshop in Athens (TITAN). DIABETES & METABOLISM 2010; 36 Suppl 2:S19-29. [PMID: 20933206 DOI: 10.1016/s1262-3636(10)70003-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The first Injection Technique workshop brought together endocrinologists and injection experts from around the world in Strasbourg in 1997. From its work came groundbreaking recommendations which advanced best practices in areas such as the use of a skin fold when injecting. The second Injection Technique workshop, with an expanded format including nurses and diabetes educators, took place in Barcelona in 2000. The initial stimulus to use shorter injecting needles can be said to date from this meeting. The third Injection Technique workshop was held in Athens in September 2009 and involved 127 experts from across the globe. After a comprehensive review of all publications since 2000 as well as several unpublished studies, the attendees divided into smaller groups to debate and draft new injecting recommendations based on the new data and their collective experience. This paper summarizes all the formal presentations given at this practical consensus workshop.
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Affiliation(s)
- A Frid
- Endocrinologist, Clinic of Endocrinology, Skåne University Hospital, Malmö, Sweden
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Frid A, Hirsch L, Gaspar R, Hicks D, Kreugel G, Liersch J, Letondeur C, Sauvanet JP, Tubiana-Rufi N, Strauss K. New injection recommendations for patients with diabetes. DIABETES & METABOLISM 2010; 36 Suppl 2:S3-18. [PMID: 20933208 DOI: 10.1016/s1262-3636(10)70002-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM Injections administered by patients are one of the mainstays of diabetes management. Proper injection technique is vital to avoiding intramuscular injections, ensuring appropriate delivery to the subcutaneous tissues and avoiding common complications such as lipohypertrophy. Yet few formal guidelines have been published summarizing all that is known about best practice. We propose new injection guidelines which are thoroughly evidence-based, written and vetted by a large group of international injection experts. METHODS A systematic literature study was conducted for all peer-reviewed studies and publications which bear on injections in diabetes. An international group of experts met regularly over a two-year period to review this literature and draft the recommendations. These were then presented for review and revision to 127 experts from 27 countries at the TITAN workshop in September, 2009. RESULTS Of 292 articles reviewed, 157 were found to meet the criteria of relevance to the recommendations. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include The Role of the Professional, Psychological Challenges, Education, Site Care, Storage, Suspension and Priming, Injecting Process, Proper Use of Pens and Syringes, Insulin analogues, Human and Pre-mixed Insulins, GLP-1 analogs, Needle Length, Skin Folds, Lipohypertrophy, Rotation, Bleeding and Bruising, Pregnancy, Safety and Disposal. CONCLUSION These injecting recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure comfortable, effective and largely complication-free injections.
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Affiliation(s)
- A Frid
- Endocrinologist, Clinic of Endocrinology, Skåne University Hospital, Malmö, Sweden
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Abstract
AIMS This study aimed to compare the accuracy of SoloSTAR(sanofi-aventis, Paris, France) and FlexPen (Novo Nordisk, Bagsvaerd, Denmark) to deliver doses of insulin when used by insulin/device-naive people attending a local healthcare practice. METHODS For the determination of dose accuracy, SoloSTAR containing insulin glargine (lot 672) and FlexPen containing insulin aspart (lot SH70557) were used for all tests. The participants were given instruction by an independent monitor on how to use the pens. To be consistent, users were trained to hold the pens in situ for 10 s at the end of injection to ensure that the full dose was injected. Forty-eight subjects performed three dose deliveries of 20 units (into a sponge) with each pen type. The method of injecting into a sponge aimed to mimic real-life practice; this approach is commonly used to ensure the patient has a correct injection technique before the patient self-administers the injection. RESULTS The delivery (n = 144) of individual doses of 20 units was not statistically different (P = 0.187) between SoloSTAR (mean +/- SD, 19.75 +/- 0.30 units) and FlexPen (19.80 +/- 0.33 units). In total, 2% of doses from both devices were <19 units; 98% were within 19-21 units. CONCLUSIONS Both SoloSTAR and FlexPen were similarly accurate when used by device-naive subjects to deliver 20-unit doses of insulin. This is likely to have beneficial clinical effects in terms of glycemic control, as well as improved patient confidence that insulin pens accurately deliver doses of insulin.
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Arendt-Nielsen L, Egekvist H, Bjerring P. Pain following controlled cutaneous insertion of needles with different diameters. Somatosens Mot Res 2006; 23:37-43. [PMID: 16846958 DOI: 10.1080/08990220600700925] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM Needle injections are used daily by millions of people around the world for the administration of various drugs (e.g., insulin), venepuncture, and some neurophysiological procedures. The aim of this paper was to study the influence of the outer needle diameter on the pain evoked by controlled needle insertion. METHODS An automated needle injection system was used to perform a series of insertions where velocity, angle of insertion, and depth of injection were controlled. The frequency of pain following needle insertions (23G, 27G, 30G, 32G) was recorded together with the pain intensity (measured using the visual analogue scale--VAS) and the occurrence of bleeding. RESULTS The outer needle diameter was positively and significantly correlated to the frequency of the insertion pain; for example, 63% of insertions with 23G needles caused pain, 53% of insertions with 27G and 31% of insertions with the thinnest (32G) needle (p < 0.0001) caused pain. The thickest needle caused most insertions associated with bleeding. Bleeding insertions were approximately 1.3 times more painful (as indicated by VAS scores) than insertions without concomitant bleedings (p = 0.004). CONCLUSION By decreasing the outer diameter of a needle, the frequency of insertion pain can be reduced and may encourage patients to adhere to demanding injection regimens such as recurrent insulin administration.
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Affiliation(s)
- Lars Arendt-Nielsen
- Department of Health Sciences and Technology, Aalborg University, Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction, Aalborg, Denmark.
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Larbig M, Forst T, Forst S, Lorra B, König K, Fittkau T, Pfützner A. Evaluation of the insulin application system Autopen 24®. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdi.877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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