• Lead RN, CDE with St. Joseph’s Primary Care Diabetes Support Program • RN CDE specializing in diabetes for 18 years • RN BScN from Ryerson Polytechnic and Western University
Highlights of Amanda’s work in diabetes include: • 2018 – Diabetes Canada Regional HCP Award • 2018 – Expert Committee member,
Diabetes Canada Clinical Practice Guidelines Dissemination and Implementation Committee. • 2017 – Responsible for maintaining Ontario Division of Diabetes Tool Box Canada, a diabetes web application • 2015 – Raised $25,000 and cycled 850 km(climbed > 20, 000 vertical meters) in 7 days from Nice to Geneva in support of Team Type 1’s work in Rwanda • 2013 –
Expert Committee member, 2013 Canadian Diabetes Association Clinical Practice Guidelines • 2011- Peer Review Member of FIT(Forum for Injection Technique) • 2003 to present – South Western Ontario (London) Diabetes Educator Section Chapter Chair • 2002 to present – Member of Provincial, National and Global Diabetes Advisory Boards
I am now going to demonstrate how to perform a safe injection technique with a pre filled insulin pen and the AutoShield Duo Needle in the institutional setting.
First you want to wash your hands and collect the equipment. You then want to prepare the insulin pen for injection by removing the cap from the insulin pen and viewing the appearance of the insulin, which should be clear and colorless.
One should always check the expiration date written on the pen, check the label affixed to the pen to ensure the correct identification of the patient and never use the same pen for more than one patient. If there is no patient identifier or if it does not have an expiry date do not use the insulin pen. If the insulin is a cloudy insulin (for example NPH or mixed insulin) you have to reverse 10x and roll in your hands 10x and then check the appearance of the insulin which should be uniformly cloudy.
The next step is to clean the hub of the insulin pen with an alcohol swab. Once the insulin pen is ready, you want to attach the needle. First remove the paper tab, from the needle, hold the pen horizontally and turn the needle clockwise. Stop when you feel resistance and remove the outer cover from the needle. It is important to then check that the needle is correctly attached and to prime the needle. To do this, turn the insulin dose dial to 2 units, point the pen up and push on the plunger. You should see a droplet or spray, if not repeat the previous step.
For a new insulin pen, 6 to 8 units may be required before seeing a droplet or spray.
Once the pen and needle are ready, one must select the required insulin dose by turning the dose dial to the prescribed dose. Follow your hospital policy and procedures by double checking the prescribed dose with another nurse, unless otherwise advised by your local authority.
When you are ready to make the injection, choose the site for the injection. The abdomen provides the best absorption, the largest site and the least chance for an intra muscular injection. Always inject in an area free of bumps, bruising, scar, stretch marks etc. Clean the skin with an alcohol swab and let dry. Hold the pen with the dose figures in front of you and inject 90 degrees without making a skin fold.
The “Pinch Method” can be used in very young children or patients with very low body fat to reduce the risk of an intra muscular injection. When injecting push in and penetrate the skin, but do not press too hard which could cause pain or increase the risk of an intramuscular injection. Press the plunger and make sure that the dose is all administered and that the dial returns to zero. A click will be heard once the dose has been administered. Then wait 10 seconds and remove the needle from the skin. A second click will be heard which means that the safety mechanism has been activated. If the dose has not been administered completely, put a new needle on and repeat the process beforehand. Do not be concerned if there is some liquid on the skin, after the injection, as this is most likely from the initial priming of the needle.
Once the injection is done, a red indicator strip appears at the end of the needle confirming that the needle has been used. Unscrew counterclockwise and remove the needle from the pen, a third click will be heard. The internal needle is now protected, by an orange device, thus eliminating the risk of accident. Then place the used needle in a biohazard/sharps container provided for this purpose.
Before proceeding, in real time, with a patient, I would encourage you to use demo materials to practice the steps that I have just walked you through. This will give you the confidence to perform safe injection technique with a pre filled insulin pen and the AutoShield Duo Needle.
Presenter: Ms. Amanda Mikalachki, Nurse, London, ON
Local Practitioners: Nurse