IFN Dosing Procedure Question

Hey old-timers.... I was perusing the "official" dosing instructions for Pegasys on the pharma company site. After you poke yourself, you're supposed to pull back slightly on the plunger. They say if blood appears in the syringe, STOP and DISCARD the whole thing.

This seems rather odd. A couple questions:

1. I know this indicates you've hit a vein, but whats the big deal - why do you have to stop? It's still going in the old body.

2. Can't you just simply replace the needle and re-prime things?

3. Even further, why can't you just jab another spot and keep right on rocking? I mean, it's your own blood. It's not like you're gonna infect yourself.

Seems strange to me to waste such an expensive drug. Also, the study I'm in only dispenses my meds one month at a time - 4 syringes. So, when I use my last one, I have none left till I go back to the study site. In other words, once a month I get t a point where I have no extra IFN on hand if something goes wrong. They have said that would be addressed if and when the situation arose, ie, overnight it or whatever.

Any personal experience to share?

Thanks

Robert

[mikesimon]

I never saw any blood and I took 202 injections over the course of my treatment(s).
I never even thought about after a while and stopped pulling back on the plunger. I think it is highly unlikely that you'll draw blood unless you're trying to.

Mike

[FlGuy]

#'s 2 and 3 are workable solutions.  It never happened to me but I would not hesitate. There were a couple of times that I hit a nerve or something, a painful sensitive spot on my thigh.  I just went for another nearby spot.  I eventually switched to all-abs targets and didn't have that issue again.

[spectda]

Robert,
The pegintron redipen does not allow for pull back, so I think it's a non issue. I have hit some blood before. I even tasted it in my mouth when I did. It didn't do anything more then usual when this happened.
- Dave

[Trinity4]

Same here, never wasted a shot because of a little blood.  After the 2nd injection I quit looking.  Now granted, I had some bruises that were real beauties caused from hitting a capillary but who cares?  

[RobertBeWell]

Hmm. Wonder why they print in ALL CAPS TO STOP THE INJECTION AND DISCARD IT.

Actually, when I went over my Day 1 "Training" with the nurse, she never even mentioned pulling back. I only discovered it when I read the "official" instructions.

In other words, I did my first two shots without pulling back :-)

I'm using syringes, not the pen.

Thanks for the tip, I didn't think it was an issue. I'll just keep doing what I'm doing. I was just a bit concerned that I'm getting "different reactions" from the shot each time at the injection site. Week 1, I got a red raised ring. Week 2 I got numb, but no discoloration at all. I was thinking because maybe I hit a vein or something in week 2 and the med got all "sucked up" instead of staying in the leg fat where it belongs.

Robert

[RobertBeWell]

Ahh, good point Dave. If you can't pull back, then obviously it can't be that serious right?

Thanks

[Bali05]

i hate those syringes. the needle gage is fine but the plunger ect..
is just to small for my hands. If I try to pull back it automatically
moves the needles around in the tissue a little  potentially
breaking some capillaries and leaving black and blues.
It would be a lot easier to hold it steady if it where a little bit bigger.

Never waisted a shot either.

[RobertBeWell]

Same issue here Bali. Seems to me trying to "pull back" needlessly complicates things. I want that sucker in and out as fast as possible. I don't like the idea of it "dangling" there while I futz around with the plunger.

Way too small.

[sunshines76]

I remember my first shot - it was the "training day" with a nurse-practitioner. She didn't tell me to pull back either. Also, when I got the syringe out, a tiny amount of blood followed, she saw it and said it was ok. I remember asking her twice about it, as I had read the instructions before going to that appointment. It never happened to me again while on tx.

But it's a very interesting question, I'd like to know the answer to it too.

[babs824]

my nurse also said not to bother pulling back. also i inject in hip/butt area and have no marks from injections. i dab on tea trea oil after, my new best friend. babs

[RobertBeWell]

I'm guessing for most people it's more trouble than it's worth fumbling around with that needle dangling out of you. I'm just gonna forget about it.

Shot numero 3 this evening. Think I'll try a butt shot :-O

[child24angel]

? a Butt shot huh? good luck with that one ;)


Dave,
"I even tasted it in my mouth when I did ".

Dave, I don't know how to tell you this, butt,  I mean but,
you don't inject in the mouth.:) :) :)

Seriously, Good luck to all !!!

[willing]

lots of nurses hereabout so hopefully some will comment/correct but my understanding is that  there's a big difference between intravenous and subcutaneous drug administration. IFN is intended for subcutaneous - lots of time for that bulge to slowly diffuse through the body. IV is the fast lane - full dose will reach the heart and other major organs in a matter of seconds.What happens next may be interesting to find out, but perhaps it's best to try it on a small rodent first. It takes a bit of  effort or bad luck to inject in a vein but if you do it may be best to  follow  instructions and back out (there could be a good reason why they switched that part of the boilerplate to all caps).

[FlGuy]

"try it on a small rodent first"

An old recollection, I thought they got the stuff from a Chinese Chipmunk or something anyway.  Another old recollection: I think HR once wrote about the lack of harm in a vein.  Both memories are pretty dusty, though.

[chuckles333]

I don't know very much outside my own experiences so I have a question. Why would you be prescribed IFN in a syringe rather than a redipen? The redipen seems so much simpler to use.

[FlGuy]

I found Pegasys in pre-loaded syringe a little easier to use, just point and shoot.  For me the Redi-pen was a little cumbersone with the clicking, mixing and the fat plunger was a little more difficult with a gimpy thumb. But, both are fairly easy to manage for the job they do.

[spectda]

Of course this is true that INF is subcutaneous and not intravenous but hitting a few small capillaries is not exactly mainlining the stuff. I mean you go through a small blood vessel and it bleeds a very little and most of the stuff goes into the right place.

Why would they offer a redipen which offers no pullback option if this was dangerous.

[RobertBeWell]

My nurse assured me she wasn't the least concerned about it. In ten years of running clinical trials involving IFN, she's never seen an issue yet related to "hitting a vein" other than a bruised area.

She told me the chance of hitting a sizeable vein in a fatty area is between infinitesimal and none.

As to the syringe vs. pen, I never really though about it. I do, however, tend to like things that don't hide their workings. I would much prefer to see the medication go in, and know it worked, than press a button and trust the machine. Just my nature I reckon.

[blondie717]

Im suspose to pull back on my farm and house critters too. But non of them ever cooperate, not a one, there all still alive.

[spectda]

"Im suspose to pull back on my farm and house critters too. But non of them ever cooperate, not a one, there all still alive."

LOL! Your making it too easy!

[willing]

dunno, maybe the warning is something the lawyers insisted for infinitesimal CYA. As far as I know, based mostly  on observation of inept phlebotomists , you can't draw blood into a syringe from capillaries, no matter how many times you try. However my sources on the subject are not very reliable. See definition of "grace" from "Forms of Love" by Kim Addonizio:
http://writersalmanac.publicradio.org/index.php?date=2010/07/27

a nurse might be more helpful

[RobertBeWell]

It's probably the legal aspect. Plus, they sell an extra hit of the meds. Lawyers happy, shareholders happy. Whoo hoo!

[spectda]

see definition of "grace" from "Forms of Love" by Kim Addonizio:
http://writersalmanac.publicradio.org/index.php?date=2010/07/27

hahaha!

Here is a nurses answer to injecting insulin subcutaneously. I believe our needles are similar in size so it would apply to inf.

http://www.myfreestyle.com/fs/d/en_US/50.90:90/injecting-insulin---aspirate

Injecting Insulin – Aspirate? < Back to Articles
Section: Insulin
By: Judy Kohn, RN, BSN, CDE
Posted: 04.01.2009

Question:
When giving an insulin injection is it necessary to pull back slightly to check for blood before injecting the insulin?


"The term for pulling back slightly on the syringe plunger to check for blood before injection is called aspiration. That technique is used when injecting medication into the muscle (using a longer needle - i.e. 1 to 1 ½ -inches), called an intramuscular injection. The reason for aspirating in that situation is that muscle is more vascular; when medication is injected into muscle, the intention is to have the medication absorb slowly into the muscle and eventually into the blood stream-but not to go directly into the blood stream. So if blood appeared in the syringe before injecting intramuscularly, you would withdraw the needle and reinsert again into a different area.

However, insulin is injected with a much shorter needle (i.e. 5/16 to ½ -inch) into the subcutaneous tissue, which does not contain major blood vessels. To avoid hitting a vein, gently pinch up a two-inch or three-inch area of skin. Hold the syringe like a pencil close to the site, keeping your fingers off the plunger.

If you are overweight, it is best to use a regular, ½ -inch needle and to insert it straight in, at a 90-degree angle.
If you are a thin adult or are giving the injection to a small child with little fat, you would use a shorter needle (3/16" or 5/16 ") and would insert it at a 45-degree angle. This will prevent the insulin from being injected into muscle, causing it to be absorbed more quickly.
Note that if blood appears on the skin after you withdraw the needle, that does not mean you gave an intramuscular injection and/or hit a vein, but rather it is just likely the needle went through a tiny capillary.
As always, remember to review all this with your diabetes team. Your diabetes educator should supervise and review your injection technique to be sure it is appropriate for your situation."

[eureka254]

The bottom line seems to be whether you pull back or not, as long as you poke and inject you are assured potency.