Insulin Injection Technique

[Isadora_Faye]

For any type of Insulin, I learned: pinch the skin, DO NOT aspirate, and inject at a 45 degree angle. We learned only to inject at a 90 degree angle if the person had a lot of subcutaneous fat. We learned, in fact, never to aspirate with subcutaneous (only IM). We also learned to stabilize the needle after insertion with the nondominant hand, therefore losing the "pinch" before actually injecting the insulin (pinch skin with left hand, insert needle with right hand, stabilize needle with left hand and skin goes from pinched to flat, then inject with right hand). What is your evaluation of this method?

Now that I am in clinicals and actually having to do these injections, I have done a little research on my own time. It seems the general consensus is to pinch the skin and inject insulin at a 90 degree angle (only injecting at 45 degrees if the person is very thin).

I just would like to know from all you expert nurses where I can find the "best practice" information for insulin/subcutaneous injection technique, or if you know you can just tell me. I feel like I am getting conflicting information depending on where the information comes from.

Basically I am curious about which angle - 45 or 90. I learned 45 always with 90 as an exception, but now I am thinking I should adopt the 90 degree always with 45 as the exception. Also - keep the pinch throughout or is it only important to have the pinch while inserting the needle?

Thanks!

[jmgrn65, RN]

I was taught and still do 90Degrees unless no sub q, as far the pinch, maintaining pinch while giving injection not sure why you need to stablize the injection doesn't take any time to give. Does this help?

[Isadora_Faye]

You are saying to maintain the pinch throughout the injection? I believe we were taught to stabilize the needle because it prevents the needle from moving at all once inserted.

[jmgrn65, RN]

here is from BD ( the people that make insulin syringes etc)

Most people pinch up a fold of skin and insert the needle at a 90° angle to the skin fold. To pinch your skin properly, follow these steps:

Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter mini-pen needle to inject, you don't have to pinch up the skin when injecting at a 90° angle; with this shorter needle, you don't have to worry about injecting into muscle.)

Insert the needle.

Hold the pinch so the needle doesn't go into the muscle.

Push the plunger (or button if you're using a pen) to inject the insulin.

Release the grip on the skin fold.

Remove the needle from the skin.

Note that not everyone injects at a 90° angle. If you inject into an area of the body that has less fat, you may need to inject at less than a 45° angle, to avoid injecting into a muscle. The angle you should use to insert the syringe or pen needle into your body depends on your body type, the injection site, and the length of the needle that you use. Your healthcare professional can help you determine the right angle of injection for you.

Does this help?

[jmgrn65, RN]

I have given injections for many years...I don't thing there is a need to stablize that is just one more thing for you to have to do. The needle isn't that long it isn't going to move.

[Daytonite, BSN, RN]

hi, isadora_faye!

here is a link to the subcutaneous injection procedure from lane community college http://teach.lanecc.edu/nursingskills/injmeds/subq.htm the site supports the technique you described in your post. you can also link into a video of the procedure at the top of this webpage if you have a real player and the time to wait for the download (if you have a dial up connection--it's faster if you have dsl).

another site: http://www.brcn.edu/skillslab/skillslabpages/sophomores/subcutaneouscards.pdf - the principles and technique of administering a subcutaneous injection

at this webpage http://flightline.highline.edu/drydberg/injections.htm is a link for "subcutaneous injections" where you can see the technique this school teaches.

the main idea is to keep everything sterile. i pinch up the skin mostly because of a fear of going beyond the subcuteous layer of skin. however, i'm sure that the nurses who work in surgery will tell us that the subcutaneous layer of skin is a lot thicker than we imagine it is. i give my cat insulin twice a day with the same insulin syringes that humans use and at first i was worried of getting into the muscle. i pinch up a hunk of fur and skin behind her elbows, spread the hair and inject at a 90-degree angle. i never aspirate and she never flinches. i don't know if i have a good cat or if i just give good shots. ha! ha! i was always told that you want to get insulin as deep into the sq tissue as you can, thus the 90-degree angle.

welcome to allnurses! :welcome:

[madwife2002, BSN, RN]

I have given injections for many years...I don't thing there is a need to stablize that is just one more thing for you to have to do. The needle isn't that long it isn't going to move.

:yeahthat:

[NRSNFL]

Hi, I had to give myself insulin injections for about 4 months through my pregnancy and from a patient standpoint, comfort rules and I always gave myself a shot at 90% angle, pinching (no release until after I withdrew). I do know that I was advised if I gave myself a shot in an area where there was a lesser amount of body fat (do they realize they were talking to a 6 mos pregnant woman?) to go in at 45 degrees. Sounds like we're all pretty consistant here.