To swab or not to swab prior to Insulin Injections - page 2
:wavey: 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... Read More
Jun 14, '04Occupation: nurse practitioner in general practice Specialty: midwifery, ophthalmics, general practice ; Joined: Aug '02; Posts: 2,516; Likes: 154I'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!
Jun 14, '04Occupation: Registered Nurse Specialty: Medical and general practice now LTC ; From: CA ; Joined: Feb '01; Posts: 63,815; Likes: 14,819Hi 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.
Jun 14, '04Joined: Feb '03; Posts: 900; Likes: 45Ok...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?
Jun 18, '04Joined: Jun '04; Posts: 2Hi
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.
Dec 1, '04Occupation: staff nurse Specialty: 18 year(s) of experience in medical with other stuff chucked in! ; From: UK ; Joined: Sep '04; Posts: 155; Likes: 80Quote from SN_2B_RNI read in the nursing standard that alcohol swabs interfere with the working of the insulin, so i never swab prior to injecting.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.
Jan 9, '05Joined: Dec '04; Posts: 11,695; Likes: 14,914Quote from Emma-Jane FarmerI 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.I read in the nursing standard that alcohol swabs interfere with the working of the insulin, so i never swab prior to injecting.
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,
Jan 16, '05Joined: Aug '03; Posts: 66I 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.
Jan 25, '05Joined: Nov '04; Posts: 229; Likes: 7Some 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.......................
Apr 12, '05Occupation: Staff Nurse in a Long Term Care facility Joined: Apr '05; Posts: 69; Likes: 1Hi 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.
May 6, '05Joined: Mar '05; Posts: 16Hey 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
May 9, '05Occupation: RN Joined: May '05; Posts: 22My hospital policy in San Francisco is to wipe area clean with alcohol swab, then dry with sterile gauze for insulin injections and blood sugar checks. This is because of nosocomial infections (a co-worker of mine just discovered she has MSRA on her skin after her poison oak lesions got infected... she most likely got the MSRA from work). When the patients go home, we instruct them to wash well with soap and water.
With venipucture, we'd most definitely wipe very well with alcohol swabs. The rubbing action is apparently what actually gets rid of most of the nasty bugs, not the actual alcohol. Anyway, that IV line is going to be sitting in someone's vein for at least 3 days (we must change ours every 3 days), so you can imagine if someone's skin appeared to be clean, but really wasn't (I've wiped grime of dark-skinned patients who appeared clean).
We had a true in-house story about a patient who fell and got a scratch on their elbow (luckily the RN reported it to the MD and wrote this down). Turns out, the MD did nothing about it and ended up getting sued after the patient died from sepsis... Extremely unlikely to happen, but can. Now, that is probably the other reason we swab - to add another piece of clarity in case anyone sues! Of course, the other reason we do so is from evidence based practice... which obviously has produced different results from our UK counterparts.
In general, I think we are pretty anal about preventing nosocomial infections in the US. We wash incessantly or use alcohol based cleaning solution - everytime we go in and out of a room, everytime we touch a patient, everytime... all due to evidence based practice. Actually, recently it's been found that the alcohol based cleaning solution is much more effective than just soap and water but one must rub very well as it is the rubbing that actually gets rid of most of the germs... I'm interested to find out what the policy is in the UK as I had a patient from the UK not long ago who said he was amazed how often we cleaned our hands compared to UK nurses. Of course, I have no way of knowing if that is the reality (that perhaps our studies have returned different results), or if the nurses were not following policy.
May 13, '05Joined: Nov '04; Posts: 155; Likes: 8This text is taken from the procedure at my hospital (I wrote it!). Note the 30 seconds, not 30 minutes.
Skin Preparation (IM & SC)
Cleaning the skin with an alcohol swab reduces bacteria but studies by Dann (1969) and Koivisto & Felig (1978) suggest that omitting this practice does not result in higher rates of infection. Additionally, swabbing before an SC injection pre-disposes the skin to be hardened by the alcohol.
The Trust now accept that, if the patient is physically clean and the nurse maintains a high standard of hand hygiene, skin preparation is unnecessary. For effective skin preparation, clean the area with an alcohol swab for 30 seconds and allow to dry for a further 30 seconds (Simmonds 1983). Injections given before the skin dries not only increases pain on needle entry as the alcohol penetrates the skin surface, but bacteria are not rendered inactive and may be inoculated into the injection site (Springhouse Corporation 1993).
- Dann, TC 1969 Routine skin preparation before injection. An unnecessary procedure. Lancet ii, 96-98
- Koivisto VA, Felig P (1978). Is skin preparation necessary before insulin injection? Lancet I, 1072-1073
- [font='Times New Roman']Simmonds BP (1983) CDC guidelines for the prevention and control of nosocomial infections: guidelines for prevention of intravascular devices. American Journal of Infection Control 11, 5, 183-189
- [font='Times New Roman'][font='Times New Roman']Springhouse Corporation (1993) Medication Administration and IV Therapy Manual. Second edition. Pennsylvania, Springhouse Corporation
Hope it helps.
Jun 19, '05Joined: Jun '05; Posts: 1Swabbng removes microbes from the injection site, but the wetness of the alcohol can cause airborne microbes to attach to the skin, so do not blow or fan to dry the alcohol site. Apply in a cirular motion and allow to dry. good question with much controversy. take care. wear gloves. wash well and frequently.