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PubMed2005

Performing subcutaneous injections: a literature review.

BACKGROUND: Persons using daily subcutaneous injections to administer medicine perform them in different ways and thereby increase the risk of skin complications related to the injection. It is often part of nurses' role to administer medicine and educate the patient in injection technique. Course literature in nursing education, commercial patient education pamphlets, and instructional leaflets do not give consistent advice regarding subcutaneous injection technique. AIM: The aim of this review was to identify the scientific foundation for the technical performance of subcutaneous injections. The question to be answered was: How should a subcutaneous injection be administered to achieve the right dose in the right place with minimum complications? METHOD: The review included a search in three databases, a screening process at abstract level, followed by a quality assessment of included articles. The quality assessment was done independently by two people and followed specific protocols. RESULT: A total of 38 articles were assessed for quality and covered information on dose, location, and complications of subcutaneous injection. The assessed studies are heterogeneous in design and describe different aspects of the subcutaneous injection technique. Therefore, the scientific foundation for technical performance is weak. However, several studies indicate that the amount of subcutaneous fat and appropriate needle length are of high importance for the drug to reach the target tissue. CONCLUSION: More research regarding effective subcutaneous injection technique needs to be done.

Adult↗
PubMed1988

Hypoglycemic effect of subcutaneously injected biosynthetic human proinsulin in healthy man.

The effects of equipotent subcutaneously injected amounts of biosynthetic human proinsulin and biosynthetic human NPH insulin on blood glucose levels were compared in healthy male volunteers. Mean blood glucose levels decreased to approximately 50 mg/dl after injection of NPH insulin and to 46 mg/dl after injection of proinsulin. This difference reached statistical significance only between 200 and 310 min. after injection. Blood glucose levels rose only marginally thereafter, but increased promptly after ingestion of the standard meal. No differences were observed between the groups. The serum insulin levels reflected the known time insulin curves after NPH injection. The maximum of the proinsulin levels occurred about 4 hours after the injection. Subcutaneous injection of equipotent amounts of biosynthetic human proinsulin and biosynthetic human insulin have similar effects on blood glucose levels.

Adult↗
PubMed2003

Metabolic responses of lactating dairy cows to single and multiple subcutaneous injections of glucagon.

Continuous, intravenous infusions of glucagon improve carbohydrate status in lactating dairy cows without increasing concentrations of plasma NEFA. The objective was to test whether single subcutaneous injections and multiple subcutaneous injections of glucagon delivered at 8-h intervals over 14 d improve the carbohydrate status in lactating dairy cows without increasing concentrations of plasma BHBA and NEFA. In a single-injection experiment, four midlactation cows each were injected with 2.5 and 5 mg of glucagon 1 wk apart. In a multiple-injection experiment, nine cows, assigned randomly to three treatments, were injected subcutaneously with 0, 2.5, or 5 mg of glucagon every 8 h for 14 d, beginning at d 8 postpartum. Single subcutaneous injections of glucagon increased concentrations of plasma glucagon and single and multiple subcutaneous injections of glucagon increased concentrations of plasma glucose, with larger increases at the 5-mg dosage. Injections of 5 mg of glucagon increased concentrations of plasma insulin in both experiments, whereas the 2.5-mg dosage increased plasma insulin only in the multiple-injection experiment. The response of glucose and insulin to injections of 5 mg of glucagon persisted throughout the 14-d injection period. Concentrations of plasma NEFA decreased in the single-injection experiment, and concentrations of BHBA decreased after 5 mg of glucagon was injected in the multiple-injection experiment. These results document that both single and multiple injections of 5 mg of glucagon over 14 d consistently improve the carbohydrate status of dairy cows and decrease concentrations of plasma NEFA and BHBA.

3-Hydroxybutyric Acid↗
PubMed1997

Focal necrotizing panniculitis and vascular necrosis in rats given subcutaneous injections of cocaine hydrochloride.

Subcutaneous injections of cocaine hydrochloride in sterile physiological saline were administered to rats at a dosage of 20 or 40 mg.kg-1. Resultant skin lesions included focal areas of alopecia (within 1 to 2 days) which progressed to necrosis (within 2 to 7 days). Histologically, the skin lesions were characterized by necrotizing panniculitis and vascular necrosis, with only small numbers of inflammatory cells. The lesions may be ischemic in nature, and associated with cytotoxic properties of cocaine.

Animals↗
PubMed1968

Memory impairment after subcutaneous injection of acetoxycycloheximide.

Subcutaneous injection of 240 micrograms of acetoxycycloheximide in mice rapidly produces marked inhibition of cerebral protein synthesis. Treated mice were trained to escape shock by choosing the lighted limb of a T-maze. When trained five or more minutes after injection, they had a normal capacity to learn. They remembered normally 3 hours after training, but 6 hours after training they had markedly impaired retention. Amnesia persisted thereafter. Injections immediately after training had a less marked but significant amnesic effect. These studies suggest that protein synthesis is not necessary for learning or for memory for 3 hours after training but that it is required for long-term memory. The protein synthesis which appears to be necessary for long-term e3memory occurs during training, or within minutes after training, or both.

Amnesia↗
PubMed1999

Comparison of monthly intramuscular injections of Sandostatin LAR with multiple subcutaneous injections of octreotide in the treatment of acromegaly; effects on growth hormone and other markers of growth hormone secretion.

OBJECTIVE: To compare the effects of monthly intra-muscular injections of a long acting preparation of octreotide, Sandostatin LAR, with multiple daily subcutaneous injections of octreotide and to study the interrelationships between mean 24 h growth hormone profile, serum total and free IGF-1 levels, 24 h urinary growth hormone levels and serum IGFBP-3. DESIGN: Patients were assessed by 24 h GH profile off octreotide or any other GH modifying drug therapy; on subcutaneous octreotide (200-600 micrograms daily in divided doses for six weeks); and 28 days after the second of two injections of Sandostatin LAR (20 mg by intra-muscular injection) administered 28 days apart. Serum total and free IGF-1, serum IGFBP-3 and 24 h urinary GH were also measured on each occasion. RESULTS: Sandostatin LAR was well tolerated. None of the patients reported any adverse effect and all completed the study uneventfully. Mean GH off treatment was 10.1 +/- 3.0 micrograms/l falling equally significantly (P < 0.05) during therapy with subcutaneous octreotide to 3.0 +/- 0.7 micrograms/l and Sandostatin LAR to 2.8 +/- 0.7 micrograms/l. Fasting 0900 h GH was significantly reduced (P < 0.05) on Sandostatin LAR (3.0 +/- 0.7 micrograms/l) compared with subcutaneous octreotide (5.1 +/- 1.2 micrograms/l). Mean total IGF-1 off treatment was 658.6 +/- 56.1 micrograms/l and was reduced to a comparable extent with subcutaneous octreotide and Sandostatin LAR (466.0 +/- 59.7 and 448.6 +/- 59.5 micrograms/l respectively; both P < 0.05). Free IGF-1 off treatment was 3.1 +/- 0.6 micrograms/l and was reduced equally by subcutaneous octreotide and Sandostatin LAR (1.2 +/- 0.2 and 1.2 +/- 0.2 micrograms/l; both P < 0.05). IGFBP-3 was reduced to a greater extent during Sandostatin LAR than during subcutaneous octreotide (4518.2 +/- 247.3 vs 5132.8 +/- 280.7 micrograms/l; P < 0.05). Twenty-four hour urinary GH excretion was reduced to a comparable extent with both therapies. Highly significant positive correlations were found between mean 24 h GH levels and free IGF-1 (r = 0.66, P < 0.0001) and 24 h urinary GH excretion (r = 0.94, P < 0.0001). The relationships between mean 24 h GH levels and total IGF-1 and IGFBP-3 although significant showed less powerful correlations. CONCLUSIONS: These results suggest that Sandostatin LAR is well tolerated and as effective as subcutaneous octreotide. In addition, urinary growth hormone and serum free IGF-1 may prove valuable for outpatient follow-up of acromegalic patients, as both correlate well with mean 24 h serum growth hormone levels.

Acromegaly↗
PubMed2006

[Security evaluation of subcutaneous injection with water-based dextran-coated magnetic fluid].

Water-based magnetic fluid was synthesized by using 50% dextran 40,000 as coated reagent. The acute toxicity and irritant of the magnetic fluid injected into mice subcutaneous tissues were examined. The lethal dosage 50 of dextran-coated magnetic fluid was 4409.61 +/- 514.93 mg/kg. Twenty four h after subcutaneous injecting with 30 mg/0.3 ml dextran-coated magnetic fluid, no more inflammation than hemangiectasia and leucocytes infiltration had been seen in subcutaneous tissues, 72 h later the reaction phenomena disappeared. While, injection with 30 mg/0.3 ml water-based oleate sodium-coated magnetic fluid, ulceration and break-off of cutis had been seen in the seventh days. That is to say, the dextran-coated magnetic fluid was safe and well tolerate, however, the oleate sodium-coated magnetic fluid was not fit to subcutaneous injection.

Animals↗
PubMed1992

Subcutaneous injection of oral cyclosporin A solution.

Cyclosporin A (CyA) is the agent of choice for immunosuppression in the majority of rodent organ and tissue allotransplantation experiments. Subcutaneous injection of suitably dissolved pure CyA powder preparation is the acceptable standard of drug administration. We investigated the possibility of using oral CyA solution in an injectable form and compared its availability with that of the standard solution in a rat model. Oral CyA solution diluted in placebo (olive oil) and standard solution prepared from pure compound were injected subcutaneously at a dose of 5 mg/kg/day to two groups of rats. Trough whole blood CyA concentrations were measured on day 10 following initiation of treatment. Blood CyA levels of the standard solution group (1,167 +/- 246 micrograms/liter, mean +/- SD) were virtually identical to those of the oral solution group (1,105 +/- 179 micrograms/liter; P greater than 0.05). In addition, the oral solution was easier to prepare and caused less injection site morbidity than the standard solution. We conclude that placebo-diluted oral CyA solution may be safely injected subcutaneously to rats and results in consistent blood levels, comparable to those achieved with standard solution prepared from pure compound.

Administration, Oral↗
PubMed2006

Pain perception after subcutaneous injections of media containing different buffers.

Several hormones are administered by daily subcutaneous injections. Pain caused by subcutaneous injection is an unpleasant condition, which can limit patient compliance. The objective of the present study was to evaluate the perception of pain by subcutaneous injection of two different and commercially available solutions for dispensing recombinant human growth hormone. The solutions are characterised by pH, conservation, and buffer. Isotonic saline was used as reference solution. Fifty-four healthy volunteers (mean age (+/-S.E.M.): 35.5+/-1.1 years) were recruited to the double-blind, randomised study. All injections were performed pairwise (right and left thigh) in one day by the same experienced nurse. Perception of pain was evaluated by the volunteers immediately after injection and 2 min. after injection into the thigh of three formulations, which differed with respect to pH and buffers (histidine, citrate and saline, respectively). Significantly more participants (38/54) found than the citrate buffer caused more pain than the histidine buffer immediately after injection (P=0.002). Histidine buffer did not cause more pain than saline (P=0.996). After 2 min., there was no difference between the histidine and the citrate buffer (P=1.00), nor between the histidine buffer and saline (P=1.00). In summary, the solution-containing citrate as buffer caused more pain after subcutaneous injection than the solution with histidine as buffer. Considering patient compliance, it seems advisable to employ histidine-buffered solution rather than citrate-buffered solution for dispensing recombinant human growth hormone by daily subcutaneous injections.

Adult↗
PubMed1982

H-Pro-[3H]Leu-Gly-NH2: plasma profile and brain uptake following subcutaneous injection in the rat.

Following subcutaneous injection of the tripeptide H-Pro-[3H]Leu-Gly-NH2 ([3H]PLG) in rats, the profile of intact peptide and its radioactively labeled metabolites was examined both in plasma and in brain tissue. [3H]PLG and metabolites were determined in trichloroacetic acid extracts by reverse-phase paired-ion HPLC. Maximal plasma levels of unmetabolized PLG were reached 6-8 min after administration, after which they decreased with an elimination half-life of 20 min. The uptake of [3H]PLG in the brain ranged from 0.0013% to 0.0017% of the administered dose per g tissue at 6-30 min following subcutaneous injection. After comparing these results with our previous findings with intravenous injection of [3H]PLG, it seemed likely that the subcutaneous route of administration might be more effective in eliciting CNS effects of PLG than the intravenous route of administration. The metabolite profiles in plasma and brain point to an initial cleavage of PLG at the NH2-terminal side and a very rapid degradation of the peptide intermediate H-Leu-Gly-NH2.

Animals↗
PubMed2004

Subcutaneous injection of mercury: "warding off evil".

Deliberate injection of mercury, especially subcutaneous injection, is rare but is seen in psychiatric patients, individuals who attempt suicide, those who are accidentally injected, and boxers who wish to build muscle bulk. Metallic mercury plays a major role in ethnic folk medicine. Neurologic and renal complications can result from high systemic levels of mercury, and subcutaneous injection usually results in sterile abscesses. Urgent surgical evacuation and close monitoring for neurologic and renal functions as well as chelation (if toxicity is indicated) are key aspects of treatment. Education of the adverse effects and dangers of mercury is important, especially in pregnant women and children. As increased immigration changes demographic patterns, proper disposal of mercury and preventing its sale and use should become urgent societal priorities. Psychiatric consultation should be obtained whenever appropriate.

Abscess↗
PubMed1979

Absorption kinetics of subcutaneously injected insulin. Evidence for degradation at the injection site.

The absorption of subcutaneously injected insulin was examined by injecting semisynthetic [3H] insulin in anaesthetized pigs and subsequently analysing the tissue excised from the injection site. Contrary to previously accepted views, a significant proportion of insulin was degraded at the injection site. The disappearance of intact [3H] insulin from the injection site followed a monoexponential function with a half-time of 59 min.

Absorption↗
PubMed1989

Radionuclide venography of lower limbs by subcutaneous injection: comparison with venography by intravenous injection.

We have proved that subcutaneous injection (SC) of a small dose of Tc-99m pertechnetate (1 to 2 mCi: 37 to 74 MBq) at acupuncture points (K-3 and B-60) may offer an alternative method of radionuclide venography (RNV) of the lower limbs. In this study, we compared intravenous (IV) RNV and SC-RNV in 22 consecutive cases with typical signs and symptoms suggesting venous abnormality of the lower limb(s) from March to May 1988. They are 11 male and 11 female, aged 47.7 +/- 15.7 years. Among the 44 limbs of the 22 cases, 4 were normal, 12 (27.3%) were found to have varicose veins in the legs only, 18 (40.9%) had partial stenosis of the deep veins (14 poplito-tibial and 4 superficial femoral), and 13 (29.6%) had complete stenosis of the deep veins (4 poplitotibial, 1 superficial femoral and 8 ilio-femoral. SC-RNV showed almost the same results as IV-RNV in 21 (47.7%), superior to IV-RNV in 22 (50%) (including 4.6% failure of IV-RNV), and inferior to IV-RNV in 1 (2.3%). We conclude that SC-RNV is definitely an alternative method of lower-limb venography. Since it is in most cases superior to IV-RNV, we suggest that it can take the place of IV-RNV in routine work.

Acupuncture Points↗
PubMed1998

Mast cell recruitment after subcutaneous injection of RANTES in the sole of the rat paw.

The effect of hrRANTES was studied after the injection in the sole of the rat paw, an area particularly rich in mast cells. Subcutaneous injections of RANTES 50 ng/10 microl produced an erythematous reaction which was inhibited by anti-RANTES antibody 50 microg/rat injected in the tail vein 30 min before hrRANTES 50 ng/10 microl was injected. In another set of experiments the animals were injected subcutaneously in the sole of the paw with PBS 10 microl (control), LPS (100 ng/10 microl) hrRANTES 50 ng/10 microl or anti-RANTES 50 microl/rat injected in the tail vein 30 min before hrRANTES 50 ng/10 microl was injected. The biopsies were analysed after 4 h and counted in an optic field. hrRANTES produced a strong recruitment of mast cells selectively coloured with 0.1% toluidine blue and inhibited by anti-RANTES antibody. In addition to the optical and electron microscope study, in some of the excised tissue Northern blot analysis for histidine decarboxylase (HDC) mRNA was performed to estimate the amount of histamine generation in the tissue of the injection sites. We found that subcutaneous injections of hrRANTES 50 ng/10 microl in the sole of the rat paw produced an accumulation of a great number of mast cells compared to PBS 10 microl (negative control) or LPS 100 ng/10 microl (positive control) after 4 h. The hrRANTES effect was inhibited by anti-RANTES antibody injected in the tail vein 30 min before hrRANTES exposure. Moreover, hrRANTES increased HDC mRNA and histamine generation.

Animals↗