BD AUTOSHIELD™ DUO SAFETY 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:

Insulin on skin surface linked to test dose Releasing the skin fold during injection

Releasing the pressure on the pen during injection

The patient pulls away and activates the shield

Needle shield touches the skin and accidently activates the needle

The patient has soft Skin

Insulin on the surface of the skin linked to needle priming

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.

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.

 

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 lifted skin fold is firmly held throughout the injection from pen 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.

 

 

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.

 

 

 

 

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.

 

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.

 

 

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.

 

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.

 

 

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.

 

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

 

 




The BD Diabetes Learning Center describes the causes of diabetes, its symptoms, and diabetes complications such as retinopathy and neuropathy. This site contains detailed information about blood glucose monitoring, insulin injection and safe sharps disposal. Interactive quizzes, educational literature downloads and animated demonstrations help to teach diabetes care skills.

Important Note: The content of this website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Do not disregard your doctor's advice or delay in seeking it because of something you have read in this website.

Unless otherwise noted, BD, BD logo and all other trademarks are property of Becton Dickinson and Company. © 2017 BD