Would it be harmful to wipe syringe needle before injecting with ethanol swab?

[transetpmedia]

I am someone who IM injections work far better than subq subjectively speaking. For the last couple of years I have been injecting in the lowers point of my outer quads daily and found this the best spot as there is basically no fat under the skin. Annoyingly scar tissue has built up there which I am certain is affecting the delivery of testosterone, it doesn't feel as good or smooth as when injected into muscle. I'm now looking to do higher up the quad whilst trying to minimize subcutaneous absorption. I am holding the needle in for a while and using z track to try and keep the oil in the muscle. I want to experiment with wiping the needle with an ethanol swab after withdrawing, to get any excess oil off the needle (and therefore avoid any being absorbed by the fat tissue on the way down). I presume that this wouldn't be harmful if the ethanol is dried after 10 seconds?

 

[transetpmedia]

I should point out thar I'm using a fixed needle. My dose is small so I found daily injections with a non fixed needle was hard to keep the dose stable each day.

 

[Vince]

If you are doing daily injection, you need to find more locations. You really don't want a bunch of scar tissue.

 

[madman]

I am someone who IM injections work far better than subq subjectively speaking. For the last couple of years I have been injecting in the lowers point of my outer quads daily and found this the best spot as there is basically no fat under the skin. Annoyingly scar tissue has built up there which I am certain is affecting the delivery of testosterone, it doesn't feel as good or smooth as when injected into muscle. I'm now looking to do higher up the quad whilst trying to minimize subcutaneous absorption. I am holding the needle in for a while and using z track to try and keep the oil in the muscle. I want to experiment with wiping the needle with an ethanol swab after withdrawing, to get any excess oil off the needle (and therefore avoid any being absorbed by the fat tissue on the way down). I presume that this wouldn't be harmful if the ethanol is dried after 10 seconds?

Would not even waste your time doing such!

The majority of that light coating of the oily solution will be cleared off the needle when you pull the syringe from the neoprene stopper.

Even then that miniscule amount of oily solution coating the needle surface will make a shitlick of a difference when the needle passes through the subcutaneous layer into the muscle.

Everyone and their brother injecting shallow or deep IM will have the needle travel through the subcutaneous layer before hitting the muscle!

No disrespect in any way but this is ridiculous fretting over such!

Pick a needle length such as 1/2" when injecting shallow IM or 1" if you want to go deeper.

All that really matters here is you inject shallow or deep IM end of story!

Also keep in mind when using an LDS insulin syringe fixed needle 27-29 G whether 1/2"or longer scar tissue will be minimized.

Much less trauma to the tissue then poking yourself with a 22-25 G needle!

 

[Systemlord]

I want to experiment with wiping the needle with an ethanol swab after withdrawing, to get any excess oil off the needle (and therefore avoid any being absorbed by the fat tissue on the way down).

You’re overthinking it, no way is that little drop of test the reason you’re not feeling it.

I found the deltoids to be the most painless injection site. The quads have too many nerves to hit.

You should be using 1 mL .1 increments 27 to 31 gauge insulin syringes with a non-dead space design.

 

[madman]

I am someone who IM injections work far better than subq subjectively speaking. For the last couple of years I have been injecting in the lowers point of my outer quads daily and found this the best spot as there is basically no fat under the skin. Annoyingly scar tissue has built up there which I am certain is affecting the delivery of testosterone, it doesn't feel as good or smooth as when injected into muscle. I'm now looking to do higher up the quad whilst trying to minimize subcutaneous absorption. I am holding the needle in for a while and using z track to try and keep the oil in the muscle. I want to experiment with wiping the needle with an ethanol swab after withdrawing, to get any excess oil off the needle (and therefore avoid any being absorbed by the fat tissue on the way down). I presume that this wouldn't be harmful if the ethanol is dried after 10 seconds?

If you are lean enough and have minimal adipose at the injection site chosen then you can easily get away with injecting shallow IM using a 1/2" (12.7 mm) needle length!

Throw in an LDS 30G insulin syringe x 1/2" and scar tissue at the injection site would be minimal.

Amazon.com

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Guidelines

Principles of subcutaneous injection technique for insulin and GLP-1 mimetics

Correct SCIT can be defined as one that consistently delivers injected medicine into the SC space with minimal discomfort.10 The SC space is the preferred site of injection as it can provide more consistent absorption of injected medicine. IM injection results in more variable absorption which can also be greatly affected by factors such as exercise. A network of blood vessels lie between the dermis and subcutaneous layer and serve as the site of absorption for medicines.11

Correct SC administration of diabetes injectable medications requires consideration of the following:

» Injection site.

» Needle length

» Use of a lifted skinfold.

» Angle of injection.




Choice of injection site

The most commonly recommended site for SC injections is the abdomen due to its convenience and tendency to more rapid and reproducible insulin uptake.2, 12 The buttocks, thigh and arms may also be used, however the risk of IM injection is higher with the thighs and arms, and the difference in absorption between sites needs to be considered for some types of insulin (older human insulins, eg Regular, NPH).2, 13 When using the abdomen,injections should not be given within 5 cm from the umbilicus.12

The buttocks offer the slowest rate of absorption, and have a higher SC tissue depth, so injecting with a skin fold is generally not required.12 If the person is able to reach this part of the anatomy for self-injection, SC injections can be safely performed with the correct needle length using a single handed technique.2, 11

Injection into the thigh has a higher risk of IM injection due the reduced depth of subcutis in this area and, if used, should be completed using a lifted skin fold.11, 14-16 The risk of IM injections into the thigh ranges from 6.7% in obese females to 58.1% in males with a body mass index (BMI) < 25 kg/m2 when an 8mm needle is used without a lifted skin fold.16 This is reduced with shorter needles, but remains a risk, particularly for slimmer individuals. Even with 4mm needles, it is estimated that 10.1% of injections into the thigh for males with a BMI < 25 kg/m2 will be given IM.16 Due to the vascularisation of the area, there is also a risk of rapid absorption of insulin from the thigh where exercise is performed shortly after injection.17, 18

The arms also have a reduced depth of subcutis, increasing the risk of IM injection even with very short(4mm) needles and a lifted skin fold is recommend for children and slim adults.11, 15, 16, 19 However it is almost impossible to perform this technique properly in those who are self-injecting.2 There is also difficulty consistently locating the injection into the correct part of the arm to ensure SC injection. The risk of IM injection at 90 degrees with a 4mm needle without a skinfold lift is estimated to range from 0.1% for obese females to 7.1% for males with a BMI < 25 kg/m2.16 This risk increases progressively with increasing needle length and is 50.5%in males with a BMI < 25kg/m2 with 8mm needle lengths.16

Choice of needle length

The choice of needle length should be one which will reliably deliver the medicine into the SC space without leakage or discomfort.2 Various options for pen and syringe needles are available to users of insulin and GLP-1 mimetics in Australia. Pen needles from 4mm to 12.7mm in length are currently available, and syringes with needles from 8mm to 13mm. However needles greater than 8 mm are no longer recommended due to the high risk of IM injection,2 so while they are still available on the NDSS, their use should be discouraged.

Until recently skin thickness (ST) was thought to depend on the weight or race of the individual. Recent studies have demonstrated that there is minimal difference in ST between adults of different age, gender, body mass index (BMI) and ethnicities. A study which compared skin and SC adipose tissue thickness in 388 US adults of varying BMI and ethnicities, found the mean of ST varies only from 1.7-2.7mm (95% CI) and is rarely greater than 3 mm.14 A small difference was found between sites, with thighs having the smallest ST (mean ST 1.9 mm), buttocks the largest (mean ST 2.4 mm), and the abdomen and arms falling in between (mean ST 2.2 mm for both areas). Males were noted to have marginally thicker skin than females, by up to 0.3mm. However BMI had minimal effect on ST, with a difference of 10 kg/m2 accounting for less than a 0.2mm change in ST. Children have been shown to have a smaller ST, which increases gradually from birth to adulthood.19, 23

The thickness of the SC adipose layer (subcutis), on the other hand is more variable. In the study above, mean SC adipose tissue (SCT) layer thickness was found torange from 9.8 mm to 16.2 mm (95% CI) across all sites,with mean SCT measurements of 10.4 mm in the thigh, 10.8mm in the arm, 13.9 mm in the abdomen and 15.5 mm in the buttocks.14 Unlike ST, there was a significant impact of BMI on SCT, with a change of 10 kg/m2 accountingfor a 4mm change in SCT. Females also had a greater (5.1 mm) mean SCT compared to males.

Combining the measurements of ST and SCT in this study, it was estimated that the majority of injections across the four commonly-used injection sites with a 5 mm needle at 90 degrees would be delivered into the SCT, with less than 2% estimated to be IM.14 For 6 mm, 8 mm and 12.7 mm needles, 5%, 15% and 45% of injections were estimated to be delivered IM. Even when injected at 45 degrees, 21% of injections with a 12.7 mm needle were estimated to be IM when injected at 90 degrees. On the other hand, injections at 90 degrees with a 4 mm needle were estimated to deliver insulin to the subcutaneous tissue > 99.5% of the time with minimal risk of intradermal (ID) injections.

Studies examining the effect of shorter (4-6 mm) needle lengths on glycaemic control, pain, insulin leakage, and other issues have found that shorter needles are safe,effective, and usually better tolerated.2 Furthermore, the use of 4mm needles for overweight and obese people is efficacious, with no loss of safety, efficacy or tolerability,and no evidence of worsening metabolic control.24-26 One study found no statistically significant difference between the efficacy of injections delivered into deep or shallow subcutis, supporting the fact that longer needles are not necessary for those with a greater amount of SCT.27, 28]

The use of shorter needles is particularly important in children. The distance from the skin surface to muscle has been estimated to be less than 4 mm in 10% of children, particularly in the 2-6 age group.19 Without a skinfold lift,it is estimated that 20% of injections would be given IM in this group, even with 4mm needles.19 This doubles with 5mm and triples with 6mm needles.

Current guidelines suggest there is no medical reason to recommend needles longer than 6mm for children, and needles longer than 8mm for adults.2 It is recommended that initial therapy should commence with shorter (4-6mm) needle lengths.2 According to the NDSS, in 2014-15 almost half (47.9%) of all pen needle users are using needles of 8 mm or longer, although the number now using 12mm or longer needles is only 2.8% and has fallen almost 40% since 2013-14. For syringe users, 30.3% are using needles of 12.7-13 mm although these make up only a small proportion of total needle use.

In the 2008-9 Insulin Injection Technique Questionnaire Survey it was found that 63% of participants had used the same needle length since commencing an injectable medicine.4 This highlights the importance of accurate initial education on appropriate needle length, and regular evaluation of IT in those administering injectable diabetes
medicines.


Recommendations for adults include:

» Use of shorter pen needles (4 mm, 5 mm or 6 mm) for all adults, including those who are obese.

» Injection at a 90 degree angle is preferred when smaller needle lengths are used.

» Very slim adults may need a lifted skin fold at all sites, even with shorter needle lengths.

» Injections into the arm or thigh may require a lifted skin fold with any needle length and are known to increase the risk of unintentional IM injections.

» If needles ≥ 8mm are used, they should be used with a lifted skin fold or injected at 45 degrees to decrease the risk of unintentional IM injections.