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Practice · Administration · continued

Follow-up: A site rotation scheme that is easy enough to actually follow posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

MR
m.ramosTL2 Moderator15 Sep 2024#31

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

24 likes 22mo
DN
desiccant_notesTL2Member16 Sep 2024#32
ambient_draft, post #17: Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract. Go to post

A genuinely late dose: the labelling generally says that if the next dose is more than a couple of days away, take it as soon as you notice. If the next dose is close, skip it and resume the schedule. The reasoning follows from the long half-life; you are perturbing a slowly moving average.

0 likes in reply to #17 22mo
MI
m.ilungaTL2 Moderator16 Sep 2024#33

Drawing up with one needle and injecting with another: a reasonable practice if you have extra needles. Fresh needle for injection reduces tissue drag and can decrease discomfort. Not necessary, but not harmful either.

1 like 22mo
CB
careful_beginnerTL1Member17 Sep 2024#34

On post #30 — agreed on the reasoning, with one qualification.

Air bubbles in a subcutaneous injection: the honest risk assessment is low. Tiny air bubbles in subcutaneous tissue do not behave like an air embolism in a blood vessel. A few air bubbles are not a reason to restart the entire injection.

7 likes 22mo
AL
a.lindqvistTL2 Moderator17 Sep 2024#35

This follows post #32 rather than contradicting it.

Cold solution and stinging: warming the vial in your hands for a minute before injection reduces the stinging sensation substantially. This is the simplest thing to try if injections are uncomfortable.

32 likes 22mo
JV
j.vandermolenTL3Regular17 Sep 2024#36
t.steenkamp, post #15: post #14 answers the question as asked. The question underneath it is different. Pinch or no pinch: the decision depends on needle length and on your own anatomy. A longer needle (8 mm and up) reaches subcutaneous tissue easily without a pinch. A shorter needle (4-6 mm) is safer with a gentle pinch. The pinch size matters less than… Go to post

Pinch or no pinch: the decision depends on needle length and on your own anatomy. A longer needle (8 mm and up) reaches subcutaneous tissue easily without a pinch. A shorter needle (4-6 mm) is safer with a gentle pinch. The pinch size matters less than people think; the injection angle matters more.

0 likes in reply to #15 22mo
SR
s.roosTL2 Moderator18 Sep 2024#37

A site rotation scheme that actually works: abdomen, outer thigh, back of arm, outer hip. Rotate through them in order, move a minimum 2 cm between consecutive sites, note the site with each dose. If a local reaction appears you have the history. If you rotate properly you will not get lipohypertrophy from overuse of one area.

3 likes 22mo
GV
g.valckenaereTL3Regular18 Sep 2024#38

Injecting into an area that has become firm: lipohypertrophy — thickened fatty tissue from repeated injection in one area — changes local tissue absorption. Avoid injecting into areas that are noticeably firm or lumpy and allow those areas to recover for at least a few months.

11 likes 22mo
FR
f.rasmussenTL2 Moderator19 Sep 2024#39

Leak-back after withdrawal: a small amount of liquid on the skin after withdrawal is ordinary. Whether you lost a "meaningful" dose depends on concentration and your target dose, but some leak-back is universal and does not need to be treated as an error.

0 likes 22mo
PN
priorauth_notesTL2Regular19 Sep 2024#40

Coming back to post #38, because the follow-up matters more than the original answer.

Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract.

1 like 22mo
AK
ak.kravchenkoTL220 Sep 2024#41
IT
integrator_traceTL2Member20 Sep 2024#42

This follows post #39 rather than contradicting it.

Cold solution and stinging: warming the vial in your hands for a minute before injection reduces the stinging sensation substantially. This is the simplest thing to try if injections are uncomfortable.

19 likes 22mo
NK
n.kirchnerTL2 Moderator20 Sep 2024#43
desiccant_notes, post #32: A genuinely late dose: the labelling generally says that if the next dose is more than a couple of days away, take it as soon as you notice. If the next dose is close, skip it and resume the schedule. The reasoning follows from the long half-life; you are perturbing a slowly moving average. Go to post

Injecting into an area that has become firm: lipohypertrophy — thickened fatty tissue from repeated injection in one area — changes local tissue absorption. Avoid injecting into areas that are noticeably firm or lumpy and allow those areas to recover for at least a few months.

4 likes in reply to #32 22mo
AS
a.schaefferTL2Member21 Sep 2024#44
taper_shift, post #24: Picking up post #21: that is the part I would want checked first. Injection discomfort: comes from needle gauge (finer = less discomfort), volume (smaller = less discomfort), temperature (room temperature or warmed is less uncomfortable than cold), and technique (smooth, purposeful injection is less uncomfortable than hesitant). All… Go to post

Angle of injection: 90 degrees into pinched tissue ensures subcutaneous placement. It is not always necessary and shallower angles can work, but 90 degrees into a small pinch is the safest technique to learn first.

0 likes in reply to #24 22mo
NL
ne.laurentTL2 Moderator21 Sep 2024#45

Coming back to post #43, because the follow-up matters more than the original answer.

Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract.

0 likes 22mo
L
LJankowiakTL3Regular22 Sep 2024#46

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

26 likes 22mo
SL
s.lundgrenTL2 Moderator22 Sep 2024#47
priorauth_notes, post #40: Coming back to post #38, because the follow-up matters more than the original answer. Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract. Go to post

Pinch or no pinch: the decision depends on needle length and on your own anatomy. A longer needle (8 mm and up) reaches subcutaneous tissue easily without a pinch. A shorter needle (4-6 mm) is safer with a gentle pinch. The pinch size matters less than people think; the injection angle matters more.

8 likes in reply to #40 22mo
AD
ambient_draftTL3Regular22 Sep 2024#48

post #47 answers the question as asked. The question underneath it is different.

A site rotation scheme that actually works: abdomen, outer thigh, back of arm, outer hip. Rotate through them in order, move a minimum 2 cm between consecutive sites, note the site with each dose. If a local reaction appears you have the history. If you rotate properly you will not get lipohypertrophy from overuse of one area.

2 likes 22mo
PN
p.novakTL2 Moderator23 Sep 2024#49

Leak-back after withdrawal: a small amount of liquid on the skin after withdrawal is ordinary. Whether you lost a "meaningful" dose depends on concentration and your target dose, but some leak-back is universal and does not need to be treated as an error.

0 likes 22mo
TK
t.kulkarniTL3Regular23 Sep 2024 · edited#50
e.ndiaye, post #10: Injecting into an area that has become firm: lipohypertrophy — thickened fatty tissue from repeated injection in one area — changes local tissue absorption. Avoid injecting into areas that are noticeably firm or lumpy and allow those areas to recover for at least a few months. Go to post

Injection discomfort: comes from needle gauge (finer = less discomfort), volume (smaller = less discomfort), temperature (room temperature or warmed is less uncomfortable than cold), and technique (smooth, purposeful injection is less uncomfortable than hesitant). All four are under your control.

0 likes in reply to #10 22mo
AD
appeals_deskTL3Regular24 Sep 2024#51

Air bubbles in a subcutaneous injection: the honest risk assessment is low. Tiny air bubbles in subcutaneous tissue do not behave like an air embolism in a blood vessel. A few air bubbles are not a reason to restart the entire injection.

21 likes 22mo
AK
a.kirchnerTL2 Moderator24 Sep 2024#52
m.amankwah, post #29: On post #25 — agreed on the reasoning, with one qualification. Angle of injection: 90 degrees into pinched tissue ensures subcutaneous placement. It is not always necessary and shallower angles can work, but 90 degrees into a small pinch is the safest technique to learn first. Go to post

On post #48 — agreed on the reasoning, with one qualification.

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

0 likes in reply to #29 22mo
LI
l.ibarraTL2Regular24 Sep 2024#53

Drawing up with one needle and injecting with another: a reasonable practice if you have extra needles. Fresh needle for injection reduces tissue drag and can decrease discomfort. Not necessary, but not harmful either.

2 likes 22mo
AD
a.delgadoTL2 Moderator25 Sep 2024#54

A genuinely late dose: the labelling generally says that if the next dose is more than a couple of days away, take it as soon as you notice. If the next dose is close, skip it and resume the schedule. The reasoning follows from the long half-life; you are perturbing a slowly moving average.

9 likes 22mo
MH
m.haddadTL225 Sep 2024#55
KM
k.marchandTL2 Moderator26 Sep 2024#56
s.roos, post #37: A site rotation scheme that actually works: abdomen, outer thigh, back of arm, outer hip. Rotate through them in order, move a minimum 2 cm between consecutive sites, note the site with each dose. If a local reaction appears you have the history. If you rotate properly you will not get lipohypertrophy from overuse of one area. Go to post

Worth separating two things that post #52 runs together.

Cold solution and stinging: warming the vial in your hands for a minute before injection reduces the stinging sensation substantially. This is the simplest thing to try if injections are uncomfortable.

30 likes in reply to #37 22mo
FT
fr.translation_moTL2Translator · FR26 Sep 2024#57
t.kulkarni, post #50: Injection discomfort: comes from needle gauge (finer = less discomfort), volume (smaller = less discomfort), temperature (room temperature or warmed is less uncomfortable than cold), and technique (smooth, purposeful injection is less uncomfortable than hesitant). All four are under your control. Go to post

A genuinely late dose: the labelling generally says that if the next dose is more than a couple of days away, take it as soon as you notice. If the next dose is close, skip it and resume the schedule. The reasoning follows from the long half-life; you are perturbing a slowly moving average.

1 like in reply to #50 22mo
EN
e.nilsenTL2 Moderator26 Sep 2024#58

Drawing up with one needle and injecting with another: a reasonable practice if you have extra needles. Fresh needle for injection reduces tissue drag and can decrease discomfort. Not necessary, but not harmful either.

5 likes 22mo
JM
j.mwangiTL4 Moderator27 Sep 2024#59

post #58 answers the question as asked. The question underneath it is different.

Pinch or no pinch: the decision depends on needle length and on your own anatomy. A longer needle (8 mm and up) reaches subcutaneous tissue easily without a pinch. A shorter needle (4-6 mm) is safer with a gentle pinch. The pinch size matters less than people think; the injection angle matters more.

0 likes 22mo
AW
a.wikstromTL2 Moderator27 Sep 2024#60

Injection discomfort: comes from needle gauge (finer = less discomfort), volume (smaller = less discomfort), temperature (room temperature or warmed is less uncomfortable than cold), and technique (smooth, purposeful injection is less uncomfortable than hesitant). All four are under your control.

0 likes 22mo