BD AutoShield Duo Pen Needle Trouble-Shooting

After completion of the injection, insulin may be seen on the surface of the skin. It is important to understand the reasons; if the injection was performed correctly insulin on skin may be a residue of test dose. However, insulin on the skin may result from incorrect administration and may lead partial or incomplete insulin dose. This may be for several reasons:

Following test dose, insulin droplets are held in shield of pen needle. When the pen needle is placed on the skin these droplets of insulin drop onto skin surface.

Insulin on the Surface of the Skin Linked to Needle Priming

Some clinicians flick the pen and pen needle away from themselves to expel any insulin held within the pen needle shield. However this is not strictly necessary and a few drops of insulin on the skin surface for example approximatly 2 units are quite normal at the end of the injection and do not indicate any problems or pen needle leakage or backflow of insulin from the tissues onto the skin surface.

Ensure that the lifted skin fold is firmly held throughout the injection from pen needle insertion to withdrawal of the pen needle when injection is complete.

Premature Release of Skin Fold During Injection

Clinician releases the lifted skin fold before the injection is complete; loss of contact between the pen needle and the skin surface will activate the pen needle shield prematurely thus only a partial dose is delivered to the patient and significant residual insulin is seen on skin surface.

Ensure that the pen needle is held firmly against the skin surface throughout the injection from needle insertion to withdrawal of the pen needle when injection is complete.

Pen and Needle Lifted Away From the Skin During the Injection

Clinician unwittingly lifts the pen away from the skin surface during the injection such that the pen needle shield activates prematurely and thus only a partial dose is delivered to the patient and significant residual insulin is seen on skin surface. The pen and needle only need be lifted away from the skin surface by a few millimeters to activate the shield.

Prepare the patient by explaining fully the procedure and gaining full consent. Place the patient semi recumbent position to help ensure comfort and to minimize movement.

Patient Recoiling or Flinching Away From the Needle Tip

Patient not prepared and the pen needle touching or entering their skin causes them to react by recoiling or flinching away from the needle tip as it was inserted thus shield activated thus only a partial dose is delivered to the patient and significant residual insulin is seen on skin surface Even a very small movement by the patient will lead to shield activation.

Push pen needle through skin and into patient’s subcutaneous tissues. Ensure that the pen and pen needle are held firmly against the skin surface throughout the injection from pen needle insertion to withdrawal of the pen needle when injection is complete.

Accidental Activation of the Pen Needle Shield

Clinician injects patient with pen needle but almost immediately and before the injection is given lifts pen needle away from the skin surface by a few millimetres and accidentally activates the shield then pushes back against the skin, like a small bounce and continues to inject unaware that needle is not in patient tissues thus no dose or only a partial dose is delivered to the patient and significant residual insulin is seen on skin surface.

Choose an injection site with firmer subcutaneous tissues and or use a lifted skin fold – ensuring you keep fingers and thumb 2.5cm apart.

Subcutaneous Tissue which Yields During Injection

The soft elastic subcutaneous tissues of the patient can gently yield under the pressure of the pen and needle. The tissues yield during the injection causing the pen needle shield to activate prematurely thus only a partial dose is delivered to the patient and significant residual insulin is seen on skin surface.


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