TY - JOUR
T1 - Inadvertent intramuscular injection risk with subcutaneous insulin injections and risk predictors in adults
T2 - a cross-sectional sonographic study
AU - Liyanage, U. A.
AU - Mathangasinghe, Y.
AU - Liyanage, C. K.
AU - Wijewickrama, E. S.
AU - Mahathanthila, D.
AU - Dharmawansa, A. J.
AU - Jeyerajesingham, S.
AU - Warapitiya, D. S.
AU - Wijayabandara, M. D.M.S.
AU - Kempitiya, B. C.T.A.N.W.M.R.C.S.
AU - Aravinthan, A.
AU - Jayasekara, L. M.D.T.
AU - Gunawardena, N.
AU - De Abrew, W. K.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Research Society for Study of Diabetes in India.
PY - 2023/10
Y1 - 2023/10
N2 - Background: The use of inappropriately long needles for subcutaneous insulin injection increases the risk of inadvertent intramuscular injection. Aims: To estimate the inadvertent intramuscular injection risk at potential subcutaneous insulin injection sites and to identify the determinants of this risk in adults. Methods: A descriptive cross-sectional study was conducted on adult patients between the ages of 18 and 70 years who were admitted to the National Hospital of Sri Lanka. Skin-to-muscle distance and dermal thickness of potential insulin injection sites were measured using ultrasonography to estimate the intramuscular injection risk. Results: A total of 185 patients were included in the study. The estimated risk of inadvertent intramuscular injections with insulin needles of any length was considerably higher at the mid-arm and mid-thigh compared to the abdomen. The risk of inadvertent intramuscular injection was approximately 60% with 13-mm needles without a skin fold at the arm and thigh. The abovementioned risk was approximately halved when the needle length was 8 mm. We developed formulae to predict the skin-to-muscle distance with or without a raised skin fold based on assigned sex at birth and anthropometric parameters. Conclusions: There is a high inadvertent intramuscular injection risk with currently used needles (8 and 13 mm) with U-100 syringes in our population even with a raised skin fold. To minimize this risk, 13-mm needles should be avoided when injecting insulin subcutaneously especially to the limbs. Sex and anthropometric parameters can be used to predict the distance from skin to muscle surface; hence, the selection of needle length could be personalized based on the derived formulae.
AB - Background: The use of inappropriately long needles for subcutaneous insulin injection increases the risk of inadvertent intramuscular injection. Aims: To estimate the inadvertent intramuscular injection risk at potential subcutaneous insulin injection sites and to identify the determinants of this risk in adults. Methods: A descriptive cross-sectional study was conducted on adult patients between the ages of 18 and 70 years who were admitted to the National Hospital of Sri Lanka. Skin-to-muscle distance and dermal thickness of potential insulin injection sites were measured using ultrasonography to estimate the intramuscular injection risk. Results: A total of 185 patients were included in the study. The estimated risk of inadvertent intramuscular injections with insulin needles of any length was considerably higher at the mid-arm and mid-thigh compared to the abdomen. The risk of inadvertent intramuscular injection was approximately 60% with 13-mm needles without a skin fold at the arm and thigh. The abovementioned risk was approximately halved when the needle length was 8 mm. We developed formulae to predict the skin-to-muscle distance with or without a raised skin fold based on assigned sex at birth and anthropometric parameters. Conclusions: There is a high inadvertent intramuscular injection risk with currently used needles (8 and 13 mm) with U-100 syringes in our population even with a raised skin fold. To minimize this risk, 13-mm needles should be avoided when injecting insulin subcutaneously especially to the limbs. Sex and anthropometric parameters can be used to predict the distance from skin to muscle surface; hence, the selection of needle length could be personalized based on the derived formulae.
KW - Intramuscular injection risk
KW - Needle
KW - Sri Lanka
KW - Subcutaneous insulin
KW - Subcutaneous soft tissue thickness prediction
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85142928350&partnerID=8YFLogxK
U2 - 10.1007/s13410-022-01144-6
DO - 10.1007/s13410-022-01144-6
M3 - Article
AN - SCOPUS:85142928350
SN - 0973-3930
VL - 43
SP - 731
EP - 736
JO - International Journal of Diabetes in Developing Countries
JF - International Journal of Diabetes in Developing Countries
IS - 5
ER -