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:

Smiley RN

7 Posts

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.....:)

Silverdragon102, BSN

1 Article; 39,477 Posts

Specializes in Medical and general practice now LTC.

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

karenG

1,049 Posts

Specializes in midwifery, ophthalmics, general practice.

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

AussieKylie

410 Posts

hi there

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

best regards

SN_2B_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!

Specializes in Surgical.

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.

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!)

karenG

1,049 Posts

Specializes in midwifery, ophthalmics, general practice.
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

FROGGYLEGS, LPN

236 Posts

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! 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.

karenG

1,049 Posts

Specializes in midwifery, ophthalmics, general practice.

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

Silverdragon102, BSN

1 Article; 39,477 Posts

Specializes in Medical and general practice now LTC.
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

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