Injection Techniques Questionnaire (ITQ) WorldWide Results 2014-2015 Needle Gauge
BACKGROUND
All needles are at least twice as long as the skin is thick
More than twice as long
31G =.26mm Surface = 1 A = π x r 2
More than 70% greater area 29G =.34mm 31G =.26mm Surface X 1,71 Surface = 1 A = π x r 2
Centre for Sensory-Motor Interaction, Denmark: Egekvist H, Bjerring P, Arendt-Nielson L. Pain and mechanical injury to human skin following needle insertions. European Journal of Pain. 3:41-49, 1999
Results: penetration force
GAUGE
GAUGE
SPEED
SPEED
SPEED
SPEED
ANGLE
Pain
30G: 0,3112mm 31G:0,2604mm 32G:0,2350mm Surface X 1,76 Surface X 1,23 Surface = 1
STUDY OBJECTIVES Compare four different pen needle types THIN Wall 31Gx8mm vs normal Wall 31Gx8mm THIN Wall 31Gx5mm vs normal Wall 31Gx6mm Evaluate comfort and pain perception by using TW vs normal Wall pen needles
Rate pain perception on: the penetration of pen needle into skin With Normal Wall With Thin Wall no answer 1% no answer 1% not at all painful 19% not at all painful 70% hardly painful 57% painful 19% hardly painful 27% very painful 3% painful 2% extremely painful 2%
24
Bench testing The penetration force in a skin substitute was on average 23 % lower with the 5-bevel pen needles vs similar 3-bevel pen needles,
Make IT Easy Extra Thin-Wall Pen Needle Clinical Study Results Michael Gibney
NEXT Clinical Study - Results
What can we say based on these studies? The pain of an injection is reduced by: A smaller gauge needle An extra-thin wall A 5-bevel tip More rapid insertion
DESCRIPTIVE STATISTICS
What needle gauge did nurses observe? NEEDLE GAUGE % as per Nurse 29 3.0 30 13.5 31 47.6 32 35.8 31
How is Gauge associated with Needle Length? (both Nurse-Observed; results as %) Gauge NEEDLE LENGTH 29 30 31 32 4 mm 0 1.0 10.6 88.4 5 mm.5 3.2 80.6 15.6 6 mm 3.0 7.1 69.8 20.1 8mm 1.2 41.5 51.6 5.7
Gauge Percentages by Country (1) Country 29 30 31 32 USA 2.7 23.0 33.7 40.6 Canada.4 3.0 19.4 77.2 Russia.0 74.3 25.7.0 South Africa.0 12.4 71.4 16.2 Netherlands.0 3.4 65.5 31.0 Belgium.0.0 59.3 40.7 France 4.0 2.4 84.8 8.8 Spain 6.3.8 90.6 2.3 Italy 1.2.4 42.0 56.3 Switzerland.0 24.0 60.0 16.0 Austria.0 63.5 36.5.0
Gauge Percentages by Country (2) Country 29 30 31 32 UK 2.0 5.9 40.5 51.7 Denmark.0.0.0 100.0 Sweden.0.0 100.0.0 Poland.0 25.0 69.6 5.4 Germany.7 2.9 65.7 30.7 Perú.0.0 85.7 14.3 Mexico.0.0 100.0.0 Argentina.0 39.0 27.1 33.9 Brazil 44.3 20.0 29.7 5.9 Chile.0 95.2 4.8.0 Colombia.0 75.0 21.4 3.6
Gauge Percentages by Country (3) Country 29 30 31 32 Venezuela 52.4 23.8 19.0 4.8 Malaysia.0.0 91.7 8.3 Australia 2.3 9.3 30.2 58.1 Indonesia.0 15.4 46.2 38.5 Philippines 15.2 15.2 36.4 33.3 Singapore.0 34.8 56.5 8.7 S. Korea.6 1.1 40.0 58.3 China.6 4.3 61.2 33.9 Turkey.0 29.5 29.9 40.7 India.0 3.9 61.3 34.9 Ireland.0.0 42.9 57.1
Gauge Percentages by Country (4) Country 29 30 31 32 Finland.0 3.9 69.7 26.3 Czech Republic.0 45.1 53.5 1.4 Nicaragua.0.0 100.0.0 Taïwan.0.0 15.2 84.8 Saudi Arabia 10.4 18.8 28.8 42.1 United Arab Emirates 9.5 19.0 59.5 11.9 TOTAL 3.0 13.5 47.6 35.8
COMPARATIVE STATISTICS: DEMOGRAPHICS
Is Needle Gauge associated with Diabetes Type? Needle Gauge 29 30 31 32 T1DM 52 209 782 703 DM type % 3.0% 12.0% 44.8% 40.3% T2DM 115 513 1860 1286 % 3.0% 13.6% 49.3% 34.1% p = 0.076
Is needle gauge associated with age category of respondent? Needle Gauge 29 30 31 32 Adult 130 673 2335 1580 % 2.8% 14.3% 49.5% 33.5% Adolescent 4 30 139 151 Respondent % 1.2% 9.3% 42.9% 46.6% Child 10 9 55 80 % 6.5% 5.8% 35.7% 51.9% 3 rd Party 22 13 29 105 % 13.0% 7.7% 17.2% 62.1% p < 0.000
COMPARATIVE STATISTICS: ASSOCIATIONS
Is Needle Gauge associated with patient-reported LH? Gauge Lipohypertrophy Yes Lipos (patient reported) more frequent with largest diameter gauge, p = 0.002 No 29 63 106 37.3% 62.7% 30 229 527 30.3% 69.7% 31 894 1766 33.6% 66.4% 32 580 1425 28.9% 71.1%
Is Needle Gauge associated with Nurse-Observed LH? Gauge Lipohypertrophy Yes Lipos (Nurse-Observed) more frequent with largest diameter gauge, p < 0.000 No 29 60 103 36.8% 63.2% 30 220 486 31.2% 68.8% 31 824 1618 33.7% 66.3% 32 525 1361 27.8% 72.2%
Is Gauge associated to Pen Needle Reuse (patient reported)? Needle Gauge 29 30 31 32 Yes 24 308 1212 870 Reuse % 48.0% 52.8% 54.8% 45.1% No 26 275 998 1060 % 52.0% 47.2% 45.2% 54.9% Less PN reuse with 32 gauge, p < 0.000
Is Gauge associated to Pen Needle Reuse (nurse reported)? Needle Gauge 29 30 31 32 Yes 60 406 1522 889 Reuse % 35.7% 54.0% 57.4% 44.6% No 108 346 1131 1103 % 64.3% 46.0% 42.6% 55.4% Less PN reuse with 32 gauge, p < 0.000
Is Gauge associated to Syringe Reuse? Needle Gauge 29 30 31 32 Yes 38 144 442 110 Reuse % 28.1% 45.6% 48.3% 24.4% No 97 172 473 340 % 71.9% 54.4% 51.7% 75.6% Less syringe reuse with 32 gauge, p < 0.000
Is Needle Gauge associated with pain? Needle Gauge 29 30 31 32 Yes 75 346 1275 926 Pain % 48.4% 49.3% 52.5% 50.4% No 80 356 1154 912 % 51.6% 50.7% 47.5% 49.6% At 29G are we at pain-detection threshold?, p = 0.304
30G: 0,3112mm 31G:0,2604mm 32G:0,2350mm Surface X 1,76 Surface X 1,23 Surface = 1
Is Needle Gauge associated with bleeding? Needle Gauge 29 30 31 32 Yes 90 432 1545 1071 Pain % 52.6% 57.7% 58.4% 53.9% No 81 317 1099 915 % 47.4% 42.3% 41.6% 46.1% p = 0.013
Is Needle Gauge associated with Leaking from Site? Needle Gauge 29 30 31 32 Yes 59 264 968 760 Leaking from Site % 35.1% 35.2% 36.6% 38.4% No 109 487 1679 1221 % 64.9% 64.8% 63.4% 61.6% p = 0.370
Is Needle Gauge associated with Hypoglycemia? Needle Gauge 29 30 31 32 Yes 97 419 1522 1113 Hypos % 56.7% 55.9% 57.2% 55.7% No 74 330 1138 887 % 43.3% 44.1% 42.8% 44.4% p = 0.743
Is Needle Gauge associated with Correct Rotation? Needle Gauge 29 30 31 32 Yes 85 496 1818 1459 Correct Rotation % 52.1% 68.7% 70.0% 73.9% No 78 226 778 514 % 47.9% 31.3% 30.0% 26.1% p < 0.000
Conclusions (1) Needle gauge over the last decade has shifted significantly towards lower diameters (31 and 32G) This shift has tracked the move to shorter needle lengths, although not as dramatically. There is still a great deal of country variation in the distribution of different needle gauges. Adolescents and children use the thinnest gauge (32G) more frequently than adults.
Conclusions (2) For unknown reasons LH seems to be less frequent with 32G than the other gauges. Correspondingly, needle reuse seems to be lower with this gauge, while correct rotation seems to increase in frequency as the gauge thins. 32G needles are associated with less bleeding, but there are no apparent differences in injection pain, hypoglycemia or leaking from the site as a function of needle gauge. It may be that at or near 29G we reach the threshold for pain detection in the majority of patients.