To swab or not to swab prior to Insulin Injections

  1. 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
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  2. 27 Comments

  3. by   Smiley RN
    Hi! Here's a website from BD company regarding giving insulin injections and they advise swabbing site in a circular manner before injecting the insulin...

    http://www.bddiabetes.com/us/demos/injecting.asp

    hope this helps.....
  4. by   Silverdragon102
    hi,
    I have been taught initially to swab the site but later in years told not to, patients at home giving their own insulin don't swab and then used to complain when in hospital that it stung when we swabbed. I generally made sure the area was clean before I gave s/c and even now when I do venupuncture I don't swab and have never had a problem in over 5 years and thousands of patients
  5. by   karenG
    I think the general guidelines say dont swab... there are uk guidelines and I cant remember the web address- will check in on monday. Its thought not worth swabbing as you need to let the alcohol evaporate for it to actually do anything.........and how many of us would stand and wait for that to happen?

    Karen
  6. by   AussieKylie
    [FONT=Lucida Console]hi there

    Greatly appreciate your informative replies. I have taken it into consideration.

    best regards

    SN_2B_RN
  7. by   chris_at_lucas_RN
    ALWAYS SWAB!!! Remember microbiology? All the little microbes everywhere? They may occur naturally on human skin, but they never belong floating around fancy free in circulation or sub-Q! Ports need to be swabbed too!! (Can we all spell "nosocomial?")

    If you don't want the injection to sting, then let the alcohol dry before doing the injection. (Being both a wimp and a 13+ gallon blood donor, I am very into not being hurt when being stuck.)

    As for not swabbing before venipuncture? If anyone tried to do that to me, I'd stop them, call for a supervisor and get it done right. The last thing I want is some medical examiner explaining that the growth of some weird microbe in a heart valve or something (maybe weeks later....) caused my premature demise!!! (This has happened...though obviously not to me--yet.)

    Geez!
  8. by   redraccoon
    I'll have to find the reseach to quote it adequately... but I'll go ahead and add my two cents anyway...

    Where I work the standard of practice is not to swab.

    Why? Research shows that standard plain rubbing alcohol (the stuff almost always used to swab with) is only moderately effective on surface flora and it takes a full 30 minutes to reach its peak effectiveness.

    PICC lines and such are different with the area being prepped with a betadine solution or surgical prep solution before insertion.

    Standard injections the skin is cleaned with soap and water.

    Infection rate at injection sites? Negligible.
  9. by   chris_at_lucas_RN
    Standard injections the skin is cleaned with soap and water. Infection rate at injection sites? Negligible.
    I could live with this--soap and water probably is better overall than alcohol swab.

    I'm really curious about the "full 30 minutes to reach its peak effectiveness" thing, though. My understanding is that alcohol leaves no residual and thus there is no "barrier" type bacteriostatic action, as with betadine which stays on the skin after it dries. In both cases, the scrubbing action of the actual wiping enters into the effectiveness as well.

    My issue was with the suggestion that there would be no skin prep. That scares me. (I really like the soap and water idea--no need to kill 'em, just get 'em outta the way!)
  10. by   karenG
    Quote from chris_at_lucas
    ALWAYS SWAB!!! Remember microbiology? All the little microbes everywhere? They may occur naturally on human skin, but they never belong floating around fancy free in circulation or sub-Q! Ports need to be swabbed too!! (Can we all spell "nosocomial?")

    If you don't want the injection to sting, then let the alcohol dry before doing the injection. (Being both a wimp and a 13+ gallon blood donor, I am very into not being hurt when being stuck.)

    As for not swabbing before venipuncture? If anyone tried to do that to me, I'd stop them, call for a supervisor and get it done right. The last thing I want is some medical examiner explaining that the growth of some weird microbe in a heart valve or something (maybe weeks later....) caused my premature demise!!! (This has happened...though obviously not to me--yet.)

    Geez!
    ok thanks for being so kind about our practice!! BUT
    the 'UK guidance on best practice in vaccine administration' which is our gold standard says

    'skin cleansing is not necessary in socially clean patients. soap and water are adequate where a nurse feels skin cleansing is required. if spirit swabs are used the skin should be left to dry before the vaccine is administerd (this is essential for live vaccines which may be inactivated by alcohol) '

    so its ok not to swab before giving a vaccine and should be avoided if giving a live vaccine.

    Karen
  11. by   FROGGYLEGS
    Quote from karenG
    skin cleansing is not necessary in socially clean patients. soap and water are adequate where a nurse feels skin cleansing is required. if spirit swabs are used the skin should be left to dry before the vaccine is administerd

    Socially clean and spirit swabs....I love it! :hatparty: Seriously, I do and I'm not saying that to be sarcastic.

    I was taught to swab with alcohol, let dry, then stick. Everything changes eventually though so I wouldn't be surprised if I'm completely backwards.
  12. by   karenG
    I think the point here is that the best evidence says there is no need to swab, and in some instances may cause problems.......... not sure I want to explain to a patient that the reason the yellow fever vacc didnt work was because I used an alcohol swab. But I am very sure the RCN would hang you out to dry! I am a great believer in using the best evidence available. so I'm not swabbing. oh and my practice we gave 1700 flu vacc last year- not one infection!!

    Karen
  13. by   Silverdragon102
    Quote from karenG
    I think the point here is that the best evidence says there is no need to swab, and in some instances may cause problems.......... not sure I want to explain to a patient that the reason the yellow fever vacc didnt work was because I used an alcohol swab. But I am very sure the RCN would hang you out to dry! I am a great believer in using the best evidence available. so I'm not swabbing. oh and my practice we gave 1700 flu vacc last year- not one infection!!

    Karen
    Same here, I have lost count of the patients I have taken blood, Cannulated and injected without swab and none of them to the best of my knowledge had any infection. I would clean with soap and water patients I felt needed it

    Anna
  14. by   Audreyfay
    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.

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