Subcutaneous Injection Administration Research Articles

The effect of education provided with the escape room game on nursing students' learning of parenteral drug administration

AimThe present study was conducted to determine the effect of education provided to first-year nursing students with the escape room game on their learning of parenteral drug administration. BackgroundThe use of escape room games in education supports formal education in providing students with professional knowledge and skills. DesignA randomized controlled study design was used in this study. MethodThe current study was conducted with 72 first-year nursing students. Data were collected with the Descriptive Characteristics Questionnaire (DCQ), Parenteral Drug Administration Information Test (PDAIT), Parenteral Drug Administration Sub-Checklists (PDASC) and Game Evaluation Form (GEF) between May and June 2022. The initial knowledge and skills of all students participating in the study were measured after completing the parenteral drug administration theoretical course and laboratory skills course. Students were assigned to the intervention (n=36) and control (n=36) groups by the stratified block randomization method according to their initial knowledge and skill measurements. Unlike the control group, the intervention group played the escape room game once in groups of four. The control group was allowed to work freely in the laboratory during this period. The final knowledge and skills of the intervention and control groups were measured immediately after the intervention. Students' skills were measured with an objective structured clinical examination. ResultsIt was determined that the post-test knowledge level of the students in the intervention group and their post-test skill mean scores for drug withdrawal from an ampoule, subcutaneous injection administration, intradermal injection administration and intravenous push drug administration were higher than those of the students in the control group (p<0.05). Additionally, Intervention group students evaluated the escape room game positively. ConclusionThis study concluded that the escape room game supported formal education and could be used in teaching parenteral drug administration.

Investigation of pharmacokinetic properties of a PEGylated bilirubin nanoparticle in male Sprague-Dawley rats using liquid chromatography-quadrupole time-of-flight mass spectrometry

Polyethylene glycol (PEG) was introduced into synthetic bilirubin 3α and a PEGylated bilirubin 3α nanoparticle (BX-001N, Brixelle®) was developed for the first time. An in vitro microsomal stability study, in vivo PK studies with intravenous bolus (IV) and subcutaneous injection (SC), and a semi-mass balance study of BX-001N were investigated to evaluate its pharmacokinetic (PK) properties in male Sprague-Dawley (SD) rats using developed liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-qTOF/MS). Following IV administration at 10 or 30 mg/kg, BX-001N showed very low clearance (0.33–0.67 mL/min/kg) with predominant distribution in the vascular system (Vd = 51.73–83.02 mL/kg). BX-001N was also very stable in vitro liver microsomal stability study. Following SC administration at 10 or 30 mg/kg, the bioavailability of BX-001N in plasma at 10 mg/kg was around 43% and showed the less dose-proportionality at 30 mg/kg dose. BX-001N was mainly excreted via the urinary pathway (86.59–92.99% of total amount of parent drug in excreta; urine and faeces) not via the biliary one.

Administration of Subcutaneous Injections: Nurses can help family caregivers enhance their knowledge, experience, and skill in managing injectable treatments.

Administration of Subcutaneous Injections: Nurses can help family caregivers enhance their knowledge, experience, and skill in managing injectable treatments.

Administration of Subcutaneous Injections: Nurses can help family caregivers enhance their knowledge, experience, and skill in managing injectable treatments.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Foundation. Results of focus groups conducted as part of the AARP Foundation's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The second video can be accessed at http://links.lww.com/AJN/A75.

Addendum to British Society for Haematology guideline on the investigation, management and prevention of venous thrombosis in children (Br. J. Haematol. 2011; 154: 196-207).

Addendum to British Society for Haematology guideline on the investigation, management and prevention of venous thrombosis in children (Br. J. Haematol. 2011; 154: 196-207).

Acute behavioural and physiological responses of sheep to S/C ivermectin injection

Acute behavioural and physiological responses of sheep to S/C ivermectin injection

CARer-ADministration of as-needed subcutaneous medication for breakthrough symptoms in homebased dying patients (CARiAD): study protocol for a UK-based open randomised pilot trial

BackgroundWhile the majority of seriously ill people wish to die at home, only half achieve this. The likelihood of someone dying at home often depends on the availability of able and willing lay carers to support them.Dying people are usually unable to take oral medication. When top-up symptom relief medication is required, a clinician travels to the home to administer injectable medication, with attendant delays. The administration of subcutaneous injections by lay carers, though not widespread practice in the UK, has proven key in achieving home deaths in other countries.Our aim is to determine if carer-administration of as-needed subcutaneous medication for four frequent breakthrough symptoms (pain, nausea, restlessness and noisy breathing) in home-based dying patients is feasible and acceptable in the UK.MethodsThis paper describes a randomised pilot trial across three UK sites, with an embedded qualitative study. Dyads of adult patients/carers are eligible, where patients are in the last weeks of life and wish to die at home, and lay carers who are willing to be trained to give subcutaneous medication. Dyads who do not meet strict risk assessment criteria (including known history of substance abuse or carer ability to be trained to competency) will not be approached. Carers in the intervention arm will receive a manualised training package delivered by their local nursing team. Dyads in the control arm will receive usual care. The main outcomes of interest are feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. Interviews with carers and healthcare professionals will explore attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The study has obtained full ethical approval.DiscussionThis study will rehearse the procedures and logistics which will be undertaken in a future definitive randomised controlled trial and will inform the design of such a study. Findings will illuminate methodological and ethical issues pertaining to researching last days of life care.The study is funded by the National Institute for Health Research (Health Technology Assessment [HTA] project 15/10/37).Trial registrationISRCTN, ISRCTN 11211024. Registered on 27 September 2016.

Education Program for Diabetic Elderly Patients About Subcutaneous Injection and Blood Sugar Test

The goal of gerontology is not only to determine ways of prolonging life but also to improve the quality of care for the older persons and to ensure that they will become active and productive personnel. The administration of subcutaneous injection (SC) is used when there is a need for medication to be absorbed more slowly and have prolonged effect as for insulin. Blood sugar test is important method to measure and follow level the sugar of the blood. Aim of this study was to assess the effect of an educational program for diabetic elderly patients about subcutaneous injection and blood sugar test. Sample: The present study included all diabetic elderly patients in Geriatric Home and Geriatric Club in Beni- Suief city. The research design was a quasi-experimental one with pre, post and follow-up tests. Tools: The investigators used three tools for data collection; tool I: A structured knowledge test, tool II: The observation checklist sheet, and tool III: A structured attitudes' sheet. Results: the study results showed that, more than three quarters were range from 60 to less than 65 years, while less than one fifth were from 65: < 70 years, all of them never attended any previous training program. There are highly statically significant differences in the studied sample practices of these measures between pretest and immediate post-test and also between pretest and late follow-up test. Conclusion: Before the educational program the majority of the studied sample had poor knowledge related to subcutaneous injection and sugar blood test. The studied sample knowledge and skills in the field of the elderly care improved immediately after exposure to the educational program, while after four months their knowledge declined. Recommendations; Developing planning, and implementing a training program related the elders' care needs for non paramedical personnel for improving health care outcomes.

Administration of Subcutaneous Injections.

: This article is the second in a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The second video can be accessed at http://links.lww.com/AJN/A75.

APL-2, a Complement C3 Inhibitor for the Potential Treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH): Phase I Data from Two Completed Studies in Healthy Volunteers

BackgroundParoxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, potentially life-threatening disease characterized by complement-mediated hemolytic anemia. PNH arises from a somatic mutation resulting in impairment of an anchor protein responsible for the expression of numerous proteins at the cell surface of the red blood cells, including CD55 and CD59, two complement inhibitory proteins. The subsequent uncontrolled activation of the complement system leads to both intravascular hemolysis triggered by the membrane attack complex (MAC) and extravascular hemolysis, or cell opsonization, mediated by C3b accumulation at the cell surface. Eculizumab, an anti-C5 antibody, is available as a treatment for PNH, however some patients continue to be transfusion-dependent as a result of on-going activation of C3, upstream of C5. Due to the key position of C3 in the complement cascade, APL-2, a cyclic peptide inhibitor of C3, may prevent both intravascular and extravascular hemolysis and could therefore be potential treatment for PNH and beneficial for patients still requiring transfusions despite standard of care treatment.AimsThese initial phase I studies were designed to assess the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of single and multiple doses of APL-2 administered by subcutaneous injection (SC) in healthy adult volunteers.MethodsBoth studies were conducted at a single center (Australia) and were double-blind, placebo-controlled designs. Subjects were monitored for up to 43 days following single dosing and 84 days following multiple dosing. Safety was assessed by intensive clinical monitoring. Serial blood sampling was performed for the determination of APL-2 concentrations in serum. Blood samples were also obtained to determine relevant markers of complement activity (C3, CH50 and AP50). Additional relevant PD markers (intact C3, iC3b, C3a, C4a and C5a) were measured in latter Cohorts. Prior to multiple dosing subjects received Neisseria meningitides, Streptococcus pneumoniae, and Haemophilus influenzae Type B (Hib) vaccinations.ResultsIn total 51 subjects were enrolled into the two studies. Twenty-four subjects received APL-2 as a single dose (ranging from 45 to 1,440mg) and 7 subjects received placebo. Sixteen subjects received repeated daily doses of APL-2 for 28 consecutive days (ranging from 30 to 270 mg/day) and 4 subjects received placebo. There were no serious adverse events (SAE's), treatment emergent adverse events (TEAEs) leading to study drug discontinuation, or severe adverse events reported. There were no clinically relevant changes in vital signs, ECG findings or safety laboratory tests. Following single and multiple doses APL-2 exposure increased linearly with increasing dose up to the highest doses tested and APL-2 serum concentrations were close to steady-state after 28 days of daily dosing. A reduction in AP50 was seen following a single dose of 1440mg APL-2 and following multiple daily doses of 180 and 270 mg.ConclusionThe studies concluded that pharmacological doses of APL-2 were safe and well tolerated and that APL-2's PK/PD profile supports daily SC administration. In addition, daily APL-2 doses of 180mg and 270mg significantly reduced hemolytic activity as early as eight days after the start of dosing, and this inhibition was maintained through the dosing period. PK data from these studies has been used to develop a PK/PD model which has been used to aid dose selection in the subsequent studies in PNH patients. DisclosuresGrossi:Apellis Pharmaceuticals Inc: Employment, Equity Ownership. Bedwell:Apellis Pharmaceuticals Inc: Consultancy. Deschatelets:Apellis Pharmaceuticals Inc: Employment, Equity Ownership. Edis:Apellis Pharmaceuticals Inc: Employment, Equity Ownership. Francois:Revon Systems Inc: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Liberate Medical Inc: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Apellis Pharmaceuticals Inc: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees. Johnson:Apellis Pharmaceuticals Inc: Consultancy. Richardson:Apellis Pharmaceuticals Inc: Consultancy. Tan:Apellis Pharmaceuticals Inc: Consultancy. Vega:Apellis Pharmaceuticals Inc: Employment, Equity Ownership.

Administration of Subcutaneous Injections.

This article is the second in a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The second video can be accessed at http://links.lww.com/AJN/A75.

Using Standardized Patients in Nursing Education: Effects on Students' Psychomotor Skill Development.

The present study used a quasi-experimental design to examine the effects of using standardized patients for the psychomotor skills development of nursing students. The performance of the experimental group in blood pressure measurement was significantly higher than that of the control group; however, there was no significant difference between the groups with regard to their administration of subcutaneous injections. The results indicated that standardized patients can be integrated into nursing education for developing psychomotor skills of students.

Subcutaneous injections: preventing needlestick injuries in the community

Community nurses provide care to patients in a variety of settings, for example health centres, community hospitals, patients' homes, residential and nursing homes. Administering subcutaneous injections to patients in the community is an everyday activity for many nurses in clinical practice. Many problems related to being 'sharps safe' are common to both community nurses and hospital staff. The majority of subcutaneous injections administered in the community are for patients with diabetes. Reducing needlestick injuries after the administration of subcutaneous injections in the community remains paramount to all NHS staff. This article provides information on what national standards to employ when administrating subcutaneous injections and what safety practices should be undertaken for good sharps management. Staff administering subcutaneous injections in the community need to ensure that they are updated on the latest developments in safety needle devices in order to prevent needlestick injuries and provide safe, effective and individualised care for their patients.

Subcutaneous injection of water-soluble multi-walled carbon nanotubes in tumor-bearingmice boosts the host immune activity

The immunological responses induced by oxidized water-soluble multi-walled carbonnanotubes on a hepatocarcinoma tumor-bearing mice model via a local administration ofsubcutaneous injection were investigated. Experimental results show that thesubcutaneously injected carbon nanotubes induced significant activation of thecomplement system, promoted inflammatory cytokines’ production and stimulatedmacrophages’ phagocytosis and activation. All of these responses increased the generalactivity of the host immune system and inhibited the progression of tumor growth.

Administering subcutaneous injections to children: what does the evidence say?

The administration of subcutaneous injections to babies, children and adolescents is a fundamental nursing task and one that should be underpinned by an evidenced-based practice. The subcutaneous route is used routinely with children to administer a wide variety of pharmacological preparations including vaccinations, anticoagulants, analgesics, insulin, growth hormones and some anti-carcinogen agents (Torben et al, 2006). These medications are predominantly administered via injection or continuous infusion. Subcutaneous injection technique varies greatly among nurses and children who self-administer, ranging from the angle of insertion (a 45-degree angle to a 90-degree angle) to the use of an elevated skin-fold or not. The variation in the selection of needle lengths may also result in the possibility of intramuscular injections rather than achieving a true subcutaneous injection (Prettyman, 2005). Paediatric nursing text books (Trigg and Mohammed, 2006), journal articles (Annersten and Willlman, 2005; Tubiana-Rufi et al, 1999) and patient instruction leaflets often give conflicting or inconsistent advice regarding subcutaneous injection technique. The administration of subcutaneous injections can cause stress, anxiety and pain to children (Trigg and Mohammed, 2006) often leaving them apprehensive about receiving future medications, or even becoming noncompliant with medical care (Ellis and Bentz, 2007). Injection pain is often the result of injury to the nerve fibre endings located in the skin and tissue from mechanical trauma caused by the needle puncture. Kuzu and Ucar (2001) have noted that site-pain causes the patient physical and psychological discomfort and bruising often limits possible sites for subsequent injections. This article examines the literature that guides clinical practice and considers recent changes in relation to the administration of subcutaneous injection in children, while acknowledging that there is little evidence-based practice to support the formulation of recommendations regarding the technical aspects of subcutaneous administration (Annersten and Willman, 2005). This paper examines the nurse’s role in administration of subcutaneous medications.

Comparison of plasma pharmacokinetic profile of ivermectin following administration of subcutaneous injection (Baymec®) and oral tablet (Efektin®) in goats

The pharmacokinetic behaviour of ivermectin (IVM) has been investigated more extensively than that of the other members of the macrocyclic lactones, as IVM was the first avermectin used commercially and is the most widely used endectocide across animal species. IVM is available as oral, subcutaneous and topical formulations in the market to use in a wide variety of animal species. The pharmacokinetic behaviour of IVM is significantly affected by route of administration, formulation of the drug and interspecies variation (Lo et al., 1985). The previous studies showed that subcutaneous injection is a more efficient route for these drugs in terms of drug bioavailability in sheep, cattle and goats compared with oral and topical administration (Scott et al., 1990; Gayrard et al., 1999; Laffont et al., 2001; Lespine et al., 2003). In contrast to these observations, a recent study in dogs indicated that oral administration of IVM and doramectin injectable formulations displayed higher maximum plasma concentrations and similar persistence compared with subcutaneous administrations at the same dosage (Gokbulut et al., 2006a). This difference probably accounts for the different oral formulations of IVM as oral drench formulation was used in the previous studies, whereas injectable formulation administered in dogs. Hence, the differences in the oral formulations could affect the kinetic disposition of IVM. However, there is no available study on the comparative plasma disposition of oral tablet versus subcutaneous administration of IVM in goats. This study was designed to compare the plasma disposition of IVM in goats following oral (tablet) and subcutaneous administration at the same dosage. A total of 10 (four male and six female) cross-bred goats, 5–6 months old and weighing 18–26 kg, were used in the study. The animals were housed and fed twice with an appropriate quantity of feed during the experiment period. Water was supplied ad libitum. This study was approved by Animal Ethic Committee of University of Adnan Menderes. The animals were allocated into two groups of five such that the mean weight and sex of animals in each group was similar. Group I (IVM-SC) received subcutaneously the commercially available injectable solution of IVM (Baymec , 1% w/v, Bayer, Turkey) and group II (IVM-OR) received orally tablet formulation of IVM (Efektin , 10 mg/tablet, Sanovel, Turkey) at a dosage of 200 lg/kg bodyweight. Heparinized blood samples (5 mL) were collected 1 day prior to drug administration and 1, 2, 4, 8, 12, 16, 24, 32, 48, 72, 96 h and 6, 9, 12, 15, 20 25, 30, 35 and 40 days post-treatment. Blood samples were centrifuged at 2000 g for 20 min and plasma was transferred to plastic tubes. All the plasma samples were stored at )20 C until determination of drug concentration. The parent compound of IVM in plasma was analysed using validated high-performance liquid chromatography (HPLC) with a liquid–liquid phase extraction procedures. Plasma concentrations were measured by minor modification of the methods of Scott and McKellar (1992) and Gokbulut et al. (2001, 2005). A mobile phase consisting of acetonitrile and methanol (66:34 v/v) was delivered (Agilent 1100 Series QuatPump, Waldron, Germany) at a flow rate of 1.3 mL/min. A Nemesis nukleosil C18 column (4 l, 150 · 4.6 mm) (Phenomenex, Cheshire, UK) with nucleosil C18 guard column (Phenomenex) was used for an analysis of IVM. Fluorescence detection (Agilent 1100 Series, FLD Waldron, Germany) was at an excitation wavelength of 365 nm and an emission wavelength of 475 nm. The analytical method used for IVM in goat plasma was validated prior to the start of the studies. Calibration graphs for IVM were prepared (linear range 0.1–100 ng/mL). The slope of the lines between peak areas and drug concentration was determined by least squares linear regression and showed a correlation coefficient at 0.9994. The mean baseline noise at the peak retention time plus three standard deviations was defined as the detection limit (0.04 ng/mL). The mean baseline noise plus six standard deviations was defined as the limit of quantification. The limits of quantification of the assay were 0.15 ng/mL. The mean extraction recoveries were 80.9% (inter assay CV 3.46%). The plasma concentration vs. time curves obtained after each treatment in individual animals were fitted with the WinNonlin J. vet. Pharmacol. Therap. 30, 489–491, doi: 10.1111/j.1365-2885.2007.00888.x. SHORT COMMUNICATION

012–Evidence-Based Practice Project: Subcutaneous Aspiration

Problem/Background: Inconsistent nursing practice in aspiration during administration of subcutaneous injections was identified. To promote patient safety, a subcommittee was formed to investigate and find evidence relating to aspiration when administering subcutaneous injections.