Diabetes Care Training

Injection Technique Overview

Aim

To equip patients with the knowledge and skills required for safe and effective insulin administration.

Objectives

• To promote awareness of the importance of the correct choice of insulin device.

• To promote awareness of suitable injections sites.

• To promote awareness of correct injection technique with particular reference to needle length.

• To promote awareness of correct disposal of needles

• To minimise the risk of cross infection during the administration of insulin.

• To promote awareness of manufactures guidelines for storing insulin.

• To enable patients and carers to identify and rectify problems.

Assessing for Suitable Device

There are several insulin devices available. it is important to ensure that the most suitable is prescribed since individuals needs vary. Factors which influence choice are intellectual ability, concurrent medical problems which may affect memory, visual impairment and conditions such as arthritis which may affect dexterity.

Injection sites

Insulin can be injected in the following sites:

The site of insulin injection affects the rate of absorption: insulin is absorbed most rapidly from the arm, followed by the abdomen, and finally the leg.

Most people find the abdomen the most convenient especially at first. It is important to rotate injection sites to avoid fatty lumps developing.

Needle length

Needles are available in sizes ranging from 5mm up to 12.7mm.

Most patients use an 8mm needle. Insulin is administered into the subcutaneous fat, that is just below the skin. It may be necessary to perform a lifted skin fold to avoid an inadvertent intramuscular injection.

The lifted skin fold should be performed when using needles of 12mm or above to avoid an inadvertent .

Air Shot

Before each injection check insulin flow, dial 2 units shake pen hold insulin pen vertically, with the needle pointing upward, depress plunger and check insulin appears at the end of needle.

Inserting needle

The Pen device should be shaken to ensure insulin is mixed correctly and then the required dose dialled up. The skin is stretched if an 8mm needle is used. If patient is very thin or using a 12mm needle a lifted skin fold is performed to avoid giving an intramuscular injection.

The needle should be inserted fully into the skin at an angle of 90 degrees and then the plunger depressed.

When administering doses less than 30 units remove needle after 5 seconds, if administering a dose exceeding 30 units remove the needle after 10 seconds.  This is to ensure patient receives all of the required dose.

Disposal of needles

A BD safe clip device should be used for safe disposal of needles. Needles should not be disposed of in household waste.

Hygiene

Hands should be washed prior to injection

Normal skin cleanliness is important but antiseptic is not required

Infection at injection sites is rare but to minimise further avoid contamination of needles by removing the inner cap immediately before injecting. If the needle is inadvertently contaminated, a new one should be used.

Storage

• Pens should be stored in fridge between 4-8 deg C.

• Current insulin should be at room temperature - not to exceed 25 deg C.

• Insulin should not be kept at room temperature for more than 1 month

• Keep insulin and needles out of reach of children.

• Avoid using insulin past the expiry date.

Common Problems

Bruising – this can be minimised by using a fresh needle for each injection.

Bleeding – a small amount of bleeding from the injection site is inevitable.

Itching at injection site - possible accompanied by swelling and redness may be due to irritation from needle lubricant, this may require a change of needle type.

Local allergic reaction to insulin or preservative – this may require changing to a different type of insulin. Any adverse reactions will also need to be reported to the drug company.

Needle bending – this can be minimised by ensuring the correct angle for inserting and removing needle is used.  Damaged/bent needles should not be used for injecting.

Rare Problems

Needle breaking – needles are becoming finer and consequently are more likely to break. Patients should be encouraged to change their needles after a single use. In the event of a needle breaking during the administration of insulin, the injection site should be circled with a pen and the patient should attend A&E immediately.

Correct dose not injected leading to elevated blood glucose - This may be a consequence of improper device use. Check to ensure that:

• Correct dose administered by checking volume of insulin.

• Plunger has been fully depressed and not rotated.

• Pen is shaken prior to injection

Needlestick Injuries

If a needle stick injury occurs the following advice should be adhered to:

• Encourage bleeding

• Wash with running water as soon as possible, dry and cover with plaster

• Notify manager (staff)

• Attend A & E (patients and general public)

Psychological Factors

Many people are apprehensive initially when told that insulin treatment is required.

Many have misconceptions regarding the sites of injections, length of needle, and volume of liquid to be injected.

For others, thoughts surrounding a loss of health predominate. Most people adapt to giving injections. Particular difficulties should be discussed with Doctor or Nurse.