To swab or not to swab prior to Insulin Injections

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Hi Enquiring to find out since the internet is not helping me out much. There seems to be a debate about whether to alcohol swab the injection site prior to giving Insulin injection? I have asked my teachers at Uni and they say not to swab due to tissue scarring. I have been trying to find that rationale on the net but nothing of it.

Hoping someone can help me to resolve the issue.

best regards

SN_2B_RN :confused:

Specializes in Everything but psych!.

The only way alcohol is even effective is if a "30 - 60 second scrub" is done to rub off the top layer of skin. Otherwise it really does not do anything. In the hospital, it is always hospital policy to clean the area with alcohol and let it dry before doing the injection or venipuncture.

I always teach patients that at home they should not use alcohol. It dries out the skin and toughens it. At home it is best to wash with soap and water, even for blood sugar checks. But when giving insulin, if the person feels their skin is clean, it is not necessary to wash it. With the research studies, if a person is in a difficult position to open up buttons to give insulin, it can even be given right through the clothing, with no risk for infection.

Specializes in midwifery, ophthalmics, general practice.

I'm always amazed at the differences in practice between the USA and Britian. I cant speak for secondary (hospital) care but in general practice I know of nobody who would swab!! we'd probably blanche at the thought of it!! whats so interesting is we use evidence based practice and I am sure this is the case in the states.. so its interesting in the different conclusions reached!

Karen

Specializes in Medical and general practice now LTC.

Hi Karen,

I can speak from Secondary care and for the 1998 I have never unless situation required swabbed before cannulation, venupuncture and injections (plus BM's) and this practice just continued into Primary care. Was once told by a consultant that research had been done and proved that aslong as the patient's skin was clean, swab was not necessary.

Anna

Ok...I guess I'm "old school" and live in 'Hickville USA'...all this is news to me...surely I'm not the only one...lol...live and learn huh? :)

Hi

As a paediatric nurse here in the UK. I see a lot of newly diagnosed type 1 diabetes in kids. It has been, for many years, standard practice not to use an alcohol swab for skin prep. There does not seem to be an evidence base to suggest that not swabbing causes harm. These kids spend most of their lives out in their communities injecting insulin up to 4 times a day (depending on regime). None use alcohol swabs. But maybe todays insuling pen devices are less prone to causing problems than old fashioned needles and syringes. I haven't seen those used in years.

Kel.

Specializes in medical with other stuff chucked in!.
Hi Enquiring to find out since the internet is not helping me out much. There seems to be a debate about whether to alcohol swab the injection site prior to giving Insulin injection? I have asked my teachers at Uni and they say not to swab due to tissue scarring. I have been trying to find that rationale on the net but nothing of it.

Hoping someone can help me to resolve the issue.

best regards

SN_2B_RN :confused:

I read in the nursing standard that alcohol swabs interfere with the working of the insulin, so i never swab prior to injecting.

Emma

I read in the nursing standard that alcohol swabs interfere with the working of the insulin, so i never swab prior to injecting.

Emma

I don't know about interfering with insulin but I do know that swabbing interferes with finger sticks. I just finished an RN Update program in which we had several weeks of skills lab time. I'm diabetic so I had no trouble using the glucometers. I never swab my own fingers but for the sake of compliance, I thought I'd go along with the lab protocol. That is, until I got the part where the instructions said to discard the first drop of blood. :uhoh3:

I had to do a lot of inquiring to find out the rationale behind that goofy move. Was it like letting water run a few seconds to clear impurities from the pipes? No one seemed to know. Eventually, we found out that swabbing can often leave enough alcohol behind to cause that first drop to start hemolyzing.

Here's what I explained to my instructor.

1.Diabetics often do finger sticks 3-5 times a day. It's hard enough to keep your fingers in decent shape without adding the skin-drying properties of alcohol.

2.Residual alcohol can compromise test results if a) you don't allow a good 30 seconds for it to dry, or b) if you "discard" that first drop by wiping it away with a swab (which defeats the whole purpose of discarding!).

3.There are a good many patients and situations that make getting that *first* drop a challenge. Going after a second drop would be insane.

4.You can kill two birds with one stone if you skip the swabbing. If you're not introducing alcohol onto the skin, you omit the unwanted drying of tissues which are traumatized enough, thank you very much, AND you avoid damaging and having to discard that first precious drop.

I wash my hands. I have the patients wash theirs. For those still in bed, I use a nice warm wash cloth which helps vasodilate their capilaries, and away we go.

I do swab for insulin with patients but not when injecting my own. I have injected from both a syringe and a pen through clothing (under the table in restaurants--most times, no one even knows I'm doing it) and have never had any kind of irritation or infection.

Hope this helps,

Miranda F. :)

I reply to this thread in two capacities, both as a nurse and someone whose family member has diabetes. My views and opinions are however the same regardless.

I have been taught never to swab prior to giving a diabetic insulin, for several reasons.

1. Your average diabetic does not swab prior to insulin at home.

2. The alcohol in swabs eventually makes skin tough, dry and hard and thus can make it very painful for a diabetic to inject themsleves with insulin, let alone another person doing it for them.

Providing you, the patient or whoever may be giving the insulin washes their hands then the risks are minimal.

Some very good rationales given here. We are swabbing in hospital but not if the patient is self - administering. The rationale being that inside a hospital there is greater risk of abnormal bacteria and infection but now I have read your replies I might just think about our policy some more.......................

Some very good rationales given here. We are swabbing in hospital but not if the patient is self - administering. The rationale being that inside a hospital there is greater risk of abnormal bacteria and infection but now I have read your replies I might just think about our policy some more.......................

Hi there,

I thought I was the only one who didn't swab, so did not reply to a thread I read from the USA that said to swab. Anyway, in case anyone is interested there is another good site PRODIGY guidelines. They also go on about to clean or not to clean a healing wound, there must be guidance in there as well regarding swabbing before injecting or cannulating a patient.

Hey all, I thought I would just add the Queensland point of view...... We are told not to swab the site for an insulin injection, but we have to swab for cannulation and veni-puncture.... someone earlier said that 'alcohol interferes with insulin' (I hope I quoted that right) I would be very interested in this, as we swab the insulin vials before we draw up the insulin

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