90
Commentary Prevention of Insulin Leakage After Subcutaneous Injection Most persons with diabetes who
re-
quire insulin are initially instructed in injection technique by a licensed When nurses administer an intheir usual procedure for needle withdrawal is to place an alcohol swab over the needle and apply gentle pressure to the site as the needle is withdrawn. 1,2 Consequently, the immediate covering of the injection site is a common element of insulin injection. nurse.
jection,
Although useful to prevent bleeding after most injections, this common procedure is probably contraindicated for insulin injection. If insulin leaks from the tissues at the injection site, it is unknowingly absorbed into the swab. Because insulin effects are closelv dose related, an unknown loss of insulin through leakage can be the source of unpredictable elevations in blood glucose levels and inappropriate subsequent
divided and given concurrently. Injections that are too shallow or that are intradermal may leak. Correct depth of injection for each body part is important and needs to be individualized. 3. Any grasp on the tissues should be released before depressing the plunger of the syringe, this avoids squeezing out the insulin. 4. Insulin should always be injected slowly to allow the tissues to
dosage adjustments. It is important for diabetes educators to instruct all persons taking insulin not to cover the insulin injection site immediately. If leakage occurs, it needs to be documented with the expectation that relevant blood glucose values may be elevated. In some cases, a partial dose of insulin may need to be repeated. A review of the literature since 1982 revealed no significant reference to insulin leakage; however, the common practice of covering the injection site would prohibit knowledge of the occurrence. Personal experience has shown that some persons leak insulin rather commonly. Others do not. A number of practical &dquo;tips&dquo; can be given to persons who experience insulin
leakage: 1. Large volumes of insulin are more likely to leak. Insulin doses can be
Downloaded from tde.sagepub.com at Bobst Library, New York University on April 20, 2015
2.
expand. 5. The needle should remain in the tissue for 30 to 60 seconds after injection and then be rapidly withdrawn. Slow withdrawal (which is common) allows a tract for the insulin to follow back to the skin surface. 6. If these methods do not help, use a modified Z-track method for injection. Pull the skin surface very slightly to one side before inserting the needle .2 Follow the above guidelines. Particularly important is rapid withdrawal of the needle, thus allowing the skin surface to seal over the needle tract. When these procedures are followed, frequency of insulin leakage can nearly always be decreased.
—Carol A. Broadway, ARNP, MSN, CDE
Tallahassee Diabetes and
Endocrinology Clinic 1330 Miccosukee Road Tallahassee, FL 32308 Reference 1. Brunner LS, Suddarth DS, Bare BG, Boyer MJ, Smeltzer SCO, cds. Textbook of medical-surgical
nursing. Philadclphia: JB Lippincott. 1988.
2. Dison N. Clinical nursing techniques. St Louis:
CV Mosby, 1979.
Commentary Prevention of Insulin Leakage After Subcutaneous Injection Most persons with diabetes who
re-
quire insulin are initially instructed in injection technique by a licensed When nurses administer an intheir usual procedure for needle withdrawal is to place an alcohol swab over the needle and apply gentle pressure to the site as the needle is withdrawn. 1,2 Consequently, the immediate covering of the injection site is a common element of insulin injection. nurse.
jection,
Although useful to prevent bleeding after most injections, this common procedure is probably contraindicated for insulin injection. If insulin leaks from the tissues at the injection site, it is unknowingly absorbed into the swab. Because insulin effects are closelv dose related, an unknown loss of insulin through leakage can be the source of unpredictable elevations in blood glucose levels and inappropriate subsequent
divided and given concurrently. Injections that are too shallow or that are intradermal may leak. Correct depth of injection for each body part is important and needs to be individualized. 3. Any grasp on the tissues should be released before depressing the plunger of the syringe, this avoids squeezing out the insulin. 4. Insulin should always be injected slowly to allow the tissues to
dosage adjustments. It is important for diabetes educators to instruct all persons taking insulin not to cover the insulin injection site immediately. If leakage occurs, it needs to be documented with the expectation that relevant blood glucose values may be elevated. In some cases, a partial dose of insulin may need to be repeated. A review of the literature since 1982 revealed no significant reference to insulin leakage; however, the common practice of covering the injection site would prohibit knowledge of the occurrence. Personal experience has shown that some persons leak insulin rather commonly. Others do not. A number of practical &dquo;tips&dquo; can be given to persons who experience insulin
leakage: 1. Large volumes of insulin are more likely to leak. Insulin doses can be
Downloaded from tde.sagepub.com at Bobst Library, New York University on April 20, 2015
2.
expand. 5. The needle should remain in the tissue for 30 to 60 seconds after injection and then be rapidly withdrawn. Slow withdrawal (which is common) allows a tract for the insulin to follow back to the skin surface. 6. If these methods do not help, use a modified Z-track method for injection. Pull the skin surface very slightly to one side before inserting the needle .2 Follow the above guidelines. Particularly important is rapid withdrawal of the needle, thus allowing the skin surface to seal over the needle tract. When these procedures are followed, frequency of insulin leakage can nearly always be decreased.
—Carol A. Broadway, ARNP, MSN, CDE
Tallahassee Diabetes and
Endocrinology Clinic 1330 Miccosukee Road Tallahassee, FL 32308 Reference 1. Brunner LS, Suddarth DS, Bare BG, Boyer MJ, Smeltzer SCO, cds. Textbook of medical-surgical
nursing. Philadclphia: JB Lippincott. 1988.
2. Dison N. Clinical nursing techniques. St Louis:
CV Mosby, 1979.
