Novolog flexpen

[dak26]

Hello,

My hospital recently switched to the NOVOLOG FLEXPEN. I, personally disllike this method. My coworkers are feeling much of the same way. I would like to hear responses regaurding personal experiences with using this method. Here are my concerns .

1. I never know if the pt is getting the set units as desired. I have on occasional given the shot to find some squirt out somehow even though I beleive I have correctly followed all steps. The pt even has visable blood from the needle puncture. If the pt got some , how do I know how much. I leave at 730 am we typically give insulin at 700am.So unless we repeat accuchecks how do we know?

2. I trust myself to draw up the correct amount of desired insulin, and because the needle is much more visible than that off the flexpen. I know my units have been injected.How reliable is this mechanical device?

3. A coworker received a needle stick giving the pen sq in the belly, she feels it was lack of actual visabilty of the needle and the pen being akward.

I have searched the web trying to find as much info on the actual safety of the nurses and pt.

Please all advice welcome.

Thanks to all that respond in advance

[zoo*moon, BSN, RN]

all our insulin is given from pens now, even lantus. i hate the insulin pens. i feel they are very undependable. i'm never sure if i gave all the units and when the number is high, you can't give it all in one push- i don't have enough strength. one night i had to change needles to push the rest of the units in. and on top of my own doubts, the patient will almost always say "i didn't feel anything. are you sure i got my insulin?"

i say well your skin isn't wet so yes you did. one night i did have to do several accuchecks to make myself and the pt feel better. i much prefer using a syringe. those plungers are much easier to use/push. and you are able to see the needle go into the skin!

[classicdame, MSN, EdD]

Very interesting post. The science behind the pens indicates they are actually MORE accurate than syringes/vials, which is one reason the hospitals are going towards that method. Another reason is because the patient is more likely to get the correct medication since it is only being used by one individual. Third, the patient is learning how to administer their own meds, which is a big step for them. However, it sounds like your unit would benefit from an inservice by the Lantus or Novolog reps. They can provide good information. As a nurse, diabetic and diabetic educator I recommend this approach. Further, send your comments to the drug mfg. on their individual websites. Lantus recently revised their pen to accommodate suggestions made by the public.

[grace90, LPN, LVN]

I dislike them at this point, mainly because I am not used to 'em and wonder if the pt is getting all of the insulin. I guess I"ll get used to 'em. We just switched to 'em a couple months ago.

[queenjean]

I hate them!!! We've use them for a year or more now. My complaints:

I've had pt's hands slip, and then you hear the dial click right before they depress the button. So, with their hand slip, they've changed the dose, but because it was in the same motion as dispensing, you have no idea what they got. I even did this myself once, with the larger ones that have the clock-like dial on the front.

In our pts who have fragile skin, the circle around the needle often leaves bruises or even breaks the skin. The rep told us we were pressing too hard--well, the rep doesn't know crap, because I have been very careful about that, and you simply HAVE to apply a certain amount of pressure to depress the safety mechanism in order for the needle to actually pierce the skin. On many of the sicker pts, that's enough to cause skin breakdown.

Frankly, I've never had a pt who has said they like this method better. I've even had them refuse to receive insulin in this manner, and send someone for their supply at home. I have a couple of diabetic friends, and they all will not use these pens.

[medicrnohio, RN]

I really liked the insulin pens. We don't use them at my current job. I found them to be very accurate. It is necessary to hold the pen on the patients skin for about 30 seconds to allow the full dose of insulin to be given, especially with larger doses. I agree with the poster above that suggested an inservice from company reps.

[bookworm1]

My son had to use a pen during school hours before he went on the pump. I preferred to use the standard needles at home d/t the reasons posted above. Always had to waste a unit each time we used it to prime the needle and had to push down so hard on the button that I was afraid of hurting him. The pen is so fat that we had to use two hands to hold it steady and push the button. We still have to keep a pen at school for emergencies because the school nurse prefers the safety of the pens over the standard syringe. I believe this is probably due to the fact that drug use is rampant and the school is afraid of the syringes getting stolen.

[NicoleERRN, RN]

The only thing i found difficult about them was actually depressing the plunger, it was very tough, i feel that if they changed that maybe, the pen is not so bad. I can work with the dials and dosages...

[lsyorke, RN]

Hubby switched to the pen last year. It took a while to get used to, but we love it now! You have to hold it different that you hold a syringe. It's more like an overhand hold with a full hand, and yes, you have to give it a few seconds before you remove the needle. I've never had a problem with skin breaking(that is pushing WAY to hard) or marks.

It's MUCH more convenient for him to carry than syringes and vials. He's had no problem with accuracy of dosing.

He would never go back to syringes!

[queenjean]

I've never had a problem with skin breaking(that is pushing WAY to hard) or marks.

Maybe in an otherwise healthy person; but in an 80+ with fragile skin, we see skin breakdown a lot. Our CNS told us the same thing, that we were pushing too hard; so we invited her to try it--she left marks and had some skin breakdown on some of our more fragile pts, too.