What's the reject rate for injection needles?
February 16, 2019 3:10 PM Subscribe
People who have to stick other people with needles for Medical Reasons, and especially people who have to stick themselves with needles, how often do you get a needle that just doesn't go in like normal?
I have to give myself weekly IM injections for the foreseeable future. I've been switching off between my thighs and it usually works OK, but occasionally I get a needle that just Doesn't. Want. To. Go. In. (I use the "I hate pain so I'm gonna just slide this in gingerly, and very slowly" method, rather than the "pretend it's a dart and get it over with" method.)
When things go well, I feel a first poke through the skin, a second poke through something shortly after that, and then I just ease it through whatever's underneath that (fat & muscle, I guess) with no pain (except that time I hit a nerve and jerked the needle back out). But on probably 5-10% of the needles, I can't get through the first or second pokes, and I'm too timid to just stab it. So I swap on a new needle, and that usually fixes it.
Am I just being an overly-sensitive ninny, or are there really differences between (new, 25G) needle tips? I can't see anything obvious, altho the very point of a "bad" needle might be curled back a bit (which I can see being bad at slicing a tiny painless hole in my leg).
Bonus questions for people who have to stick themselves or others:
* I understand that aspirating to check for hitting a vessel is no longer recommended, since the chances of such a hit are really low. But I think I've hit vessels a couple times in a year (based on odd physiological symptoms after those injections, that don't occur most times), so I've taken to doing that check anyway. Do you check? Or does it just not matter for whatever you're injecting? (My injection volume is ~0.7ml, so it's not like I'm mainlining a whole bicycle-pump-load of goop.)
* Most weeks I complete my shot with no blood at all, but once in a while I get a surprising amount of bleeding after pulling the needle out. (To be fair, "surprising" is probably less than 0.1ml, but it's still enough to make my alcohol wipe look like I cleaned up a murder scene.) I'm guessing those times, I've hit (and gone completely through) a small vein, which bleeds a little more than the normal hole in just muscle. Is that a reasonable guess as to what's happening? Any RN-tested tricks to know how to miss veins in this situation?
I have to give myself weekly IM injections for the foreseeable future. I've been switching off between my thighs and it usually works OK, but occasionally I get a needle that just Doesn't. Want. To. Go. In. (I use the "I hate pain so I'm gonna just slide this in gingerly, and very slowly" method, rather than the "pretend it's a dart and get it over with" method.)
When things go well, I feel a first poke through the skin, a second poke through something shortly after that, and then I just ease it through whatever's underneath that (fat & muscle, I guess) with no pain (except that time I hit a nerve and jerked the needle back out). But on probably 5-10% of the needles, I can't get through the first or second pokes, and I'm too timid to just stab it. So I swap on a new needle, and that usually fixes it.
Am I just being an overly-sensitive ninny, or are there really differences between (new, 25G) needle tips? I can't see anything obvious, altho the very point of a "bad" needle might be curled back a bit (which I can see being bad at slicing a tiny painless hole in my leg).
Bonus questions for people who have to stick themselves or others:
* I understand that aspirating to check for hitting a vessel is no longer recommended, since the chances of such a hit are really low. But I think I've hit vessels a couple times in a year (based on odd physiological symptoms after those injections, that don't occur most times), so I've taken to doing that check anyway. Do you check? Or does it just not matter for whatever you're injecting? (My injection volume is ~0.7ml, so it's not like I'm mainlining a whole bicycle-pump-load of goop.)
* Most weeks I complete my shot with no blood at all, but once in a while I get a surprising amount of bleeding after pulling the needle out. (To be fair, "surprising" is probably less than 0.1ml, but it's still enough to make my alcohol wipe look like I cleaned up a murder scene.) I'm guessing those times, I've hit (and gone completely through) a small vein, which bleeds a little more than the normal hole in just muscle. Is that a reasonable guess as to what's happening? Any RN-tested tricks to know how to miss veins in this situation?
I'm an RN. I've actually never encountered this problem! I don't give a lot of IM injections in my current job, but as a student I did a one-semester clinical where I gave 5-10 IM injections twice a week for about two months. I'm wondering if maybe on the 5-10% of failures, you are possibly holding the skin less tight? This seems like the biggest failure point to me. (I've failed at both IM and subcutaneous injections, which I give more frequently, when the z-track and/or pinch of skin I have is not under enough tension.)
The difference in my experience could be variation depending on brand of needles--I've always used the same type, and it may not be what you have. Medical supplies are definitely of varying quality across brands.
I don't aspirate to check for vessels; do you find you are more sore post-injection when you do this? My understanding is that the issue with aspiration is causing more trauma to surrounding tissue. I think your guess that when you see more bleeding you have gone through a vessel is probably accurate, but I personally don't know any tricks to avoid it... will be following this thread with interest to see if others do!
posted by snorkmaiden at 3:41 PM on February 16, 2019 [2 favorites]
The difference in my experience could be variation depending on brand of needles--I've always used the same type, and it may not be what you have. Medical supplies are definitely of varying quality across brands.
I don't aspirate to check for vessels; do you find you are more sore post-injection when you do this? My understanding is that the issue with aspiration is causing more trauma to surrounding tissue. I think your guess that when you see more bleeding you have gone through a vessel is probably accurate, but I personally don't know any tricks to avoid it... will be following this thread with interest to see if others do!
posted by snorkmaiden at 3:41 PM on February 16, 2019 [2 favorites]
Response by poster: Are you drawing the injection from a vial yourself...
Yes, but with a different needle (they gave me 21G needles for drawing and 25G for injecting).
do you find you are more sore post-injection when you do this?
No, but it's possible I'm not pulling on the piston hard enough to detect a vessel hit, or else I'm just careful/lucky enough not to let the needle jab around in the muscle while I'm doing it. I haven't ever found that I've hit a vessel when I checked, so I'm either not checking right or I haven't hit one at a time when I checked.
[Thanks, and I promise not to thread-sit too diligently!]
posted by tee-man at 4:00 PM on February 16, 2019 [1 favorite]
Yes, but with a different needle (they gave me 21G needles for drawing and 25G for injecting).
do you find you are more sore post-injection when you do this?
No, but it's possible I'm not pulling on the piston hard enough to detect a vessel hit, or else I'm just careful/lucky enough not to let the needle jab around in the muscle while I'm doing it. I haven't ever found that I've hit a vessel when I checked, so I'm either not checking right or I haven't hit one at a time when I checked.
[Thanks, and I promise not to thread-sit too diligently!]
posted by tee-man at 4:00 PM on February 16, 2019 [1 favorite]
I did a lot of injections (300+) and had some needles that just wouldn't go in sharp. The vials were $10 each so I grit my teeth anyway, and it was a case of very stretched skin and sliding at an angle. I think it happens but it's also if you're going in tentatively and somewhere with previous scar tissue or thicker skin, that can be harder. It definitely gets easier with practice.
I bruise a lot, and the only thing that helped was direct pressure to stop bleeding immediately after injection and ice on the area.
posted by dorothyisunderwood at 4:58 PM on February 16, 2019
I bruise a lot, and the only thing that helped was direct pressure to stop bleeding immediately after injection and ice on the area.
posted by dorothyisunderwood at 4:58 PM on February 16, 2019
Nurse here, given hundreds if not thousands of IM injections and taught hundreds to inject themselves. Please don't aspirate. I think your more painful injections are because you have caused tissue trauma. Aspirating subcutaneously or intramuscularly is not necessary and causes trauma.
Regarding the "toughness" of your skin, you have certainly noticed that your needles are beveled, that is the needle tip has an angle. Are you making sure that the tip of the needle, the sharpest tip is entering the skin first? Typically, considering the angle you'd use when injecting in your thigh, the sharpest tip should lead to ensure that it pierces the skin first. Kind of hard to explain without a diagram, but a needle is not an arrow, where the sharpest point is in the center, it's to one side. That's what needs to pierce the skin first for a smooth and painless injection. This is easy, a simple rotation of the syringe to locate the bevel at the best angle.
And don't tense up. Try your best to relax the muscle. Less resistance equals a less traumatic and less painful injection.
posted by citygirl at 5:32 PM on February 16, 2019 [4 favorites]
Regarding the "toughness" of your skin, you have certainly noticed that your needles are beveled, that is the needle tip has an angle. Are you making sure that the tip of the needle, the sharpest tip is entering the skin first? Typically, considering the angle you'd use when injecting in your thigh, the sharpest tip should lead to ensure that it pierces the skin first. Kind of hard to explain without a diagram, but a needle is not an arrow, where the sharpest point is in the center, it's to one side. That's what needs to pierce the skin first for a smooth and painless injection. This is easy, a simple rotation of the syringe to locate the bevel at the best angle.
And don't tense up. Try your best to relax the muscle. Less resistance equals a less traumatic and less painful injection.
posted by citygirl at 5:32 PM on February 16, 2019 [4 favorites]
Mod note: tee-man, can I edit your question to remove the word "pansy"? We're getting some complaints.
posted by Eyebrows McGee (staff) at 5:40 PM on February 16, 2019
posted by Eyebrows McGee (staff) at 5:40 PM on February 16, 2019
Response by poster: Thanks again, everyone. In case it improves the utility of this Q/A for posterity:
* My "training wheels" injections were pre-loaded syringes with 27G needles. Had no problems with any of them, and 27G is really thin, so I found that they'd slide in under their own weight after poking through the skin. Nice. The DIY setup has 25G injection needles; I guess the 27G needles are more expensive.
* I haven't been stretching the skin before jabbing; I'll try that next time. I was told to use the full needle length (25-30mm, I guess), and I've been injecting close to perpendicular (leading with the point of the slash tip).
* I don't get much pain post-injection (sometimes minor soreness a few days later), and honestly, very little pain during injection either. Today's shot went really smoothly (after a needle swap) and is not sore at all. I just wish I knew the trick to repeat that every week!
posted by tee-man at 6:11 PM on February 16, 2019
* My "training wheels" injections were pre-loaded syringes with 27G needles. Had no problems with any of them, and 27G is really thin, so I found that they'd slide in under their own weight after poking through the skin. Nice. The DIY setup has 25G injection needles; I guess the 27G needles are more expensive.
* I haven't been stretching the skin before jabbing; I'll try that next time. I was told to use the full needle length (25-30mm, I guess), and I've been injecting close to perpendicular (leading with the point of the slash tip).
* I don't get much pain post-injection (sometimes minor soreness a few days later), and honestly, very little pain during injection either. Today's shot went really smoothly (after a needle swap) and is not sore at all. I just wish I knew the trick to repeat that every week!
posted by tee-man at 6:11 PM on February 16, 2019
This is a bit of a weird comment, because it's two plugs, but I've been doing weekly IM injections for the last few years. By far my favorite needles have been the BD SafetyGlides. BD's syringes also feel really nice, and the piston is always great. How to get them depends on what state you're in, I think. Living in California, you can get them online from somewhere like Vitality Medical without a Rx. The website will prompt you for to upload a prescription, but you don't actually need to. A year's worth of syringes and needles costs ~100 bucks.
posted by lilies.lilies at 6:46 PM on February 16, 2019 [2 favorites]
posted by lilies.lilies at 6:46 PM on February 16, 2019 [2 favorites]
I have to inject myself daily. At one point, the pharmacy didn’t have my usual brand of profiled syringes. They gave me a different brand, and there was a big difference in ease of injection. I’ve never had a needle not go in though.
Also, just FYI, I always put an ice pack on the area to numb it first, and that helps.
posted by FencingGal at 6:51 PM on February 16, 2019 [1 favorite]
Also, just FYI, I always put an ice pack on the area to numb it first, and that helps.
posted by FencingGal at 6:51 PM on February 16, 2019 [1 favorite]
Not quite the same, but I have been injecting insulin for years and have had bad results with needles that have curved a bit or blunted with use (I don't replace the needles every time I inject because it's a waste and they're made of plastic, so I make the most of them, but they do get blunt). I also find that going in at exactly 90 degrees cuts down the discomfort enormously (see odinsdream's comment above).
posted by Martha My Dear Prudence at 12:27 AM on February 17, 2019
posted by Martha My Dear Prudence at 12:27 AM on February 17, 2019
When I wasdoing IVF, I just requested our doctor perscribe the needle I prefered once I had a preference. There are needles you can and can't use for various things but because you have a preference and the medicine works in the other one, it may be trivial to get it at your pharmacy.
The reason the injection needle change was pharmacy and supplier- not really on the insurance side. Once it was specified i got exactly what I wanted.
posted by AlexiaSky at 6:07 AM on February 17, 2019
The reason the injection needle change was pharmacy and supplier- not really on the insurance side. Once it was specified i got exactly what I wanted.
posted by AlexiaSky at 6:07 AM on February 17, 2019
I stick needles in others all day long and the only time I have had a problem is when I reuse the same needle (as in having to attempt an IV more than once). As others have said above paying attention to your technique will help, and if possible using a 27g needle will help. Although I primarily start IVs, I do a fair number of IM injections and other things like nerve blocks and the occasional subcutaneous injection.
posted by TedW at 9:30 AM on February 17, 2019 [1 favorite]
posted by TedW at 9:30 AM on February 17, 2019 [1 favorite]
Reporting in as someone who IM's themself in the thigh biweekly (my takeup needle is 18G and the one going in my leg is 23G, for what it's worth).
Seconding the advice about holding your skin taut - it takes some getting used to, but it makes a difference. (Also seconding BD as a needle brand, those things are legit.)
My doc sent me home with really great documentation from UofM about IM injection - and lucky you, it's online! Gives good advice about finding a good injection site, how to reduce pain, the whole bit. I found it enormously helpful.
posted by The demon that lives in the air at 10:52 AM on February 17, 2019 [2 favorites]
Seconding the advice about holding your skin taut - it takes some getting used to, but it makes a difference. (Also seconding BD as a needle brand, those things are legit.)
My doc sent me home with really great documentation from UofM about IM injection - and lucky you, it's online! Gives good advice about finding a good injection site, how to reduce pain, the whole bit. I found it enormously helpful.
posted by The demon that lives in the air at 10:52 AM on February 17, 2019 [2 favorites]
This thread is closed to new comments.
posted by WasabiFlux at 3:30 PM on February 16, 2019 [2 favorites]