https://doi.org/10.1177/1932296817730378 Journal of Diabetes Science and Technology 2018, Vol. 12(2) 537 –538
© 2017 Diabetes Technology Society Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1932296817730378 journals.sagepub.com/home/dst Letter to the Editor
Correct technique in insulin delivery is an important aspect of a successful insulin therapy.1 Observed anomalies at
injec-tion sites are insulin leakage, pain, bleeding, inflammainjec-tion, bruising, lipoatrophy, and lipohypertrophy.2 Possible
con-cerns regarding incorrect insulin application technique include greater insulin leakage and back flow. Reflux from the injection site is by far the most frequently reported type of leaking patients report. Incidence is variable and etiology is unclear.3 Leakage influences patients’ perception of
insu-lin administration because patients are concerned whether they have received the correct dosage.
The 10-second waiting and Z-track techniques can be supplied to prevent any leakage of liquid in patients receiv-ing subcutaneous injections. It’s necessary to prevent medi-cation leakage and to get the full dose.4,5 The 10-second
waiting technique is recommended to prevent any leakage of liquid in patients receiving subcutaneous insulin injections. For the 10-second waiting technique, a 90° needle is directly inserted into the subcutaneous tissue and patients wait at least 10 seconds after the injection before the needle is with-drawn from the skin.1
For the Z-track technique, the cutaneous tissues are pulled 2 cm caudad before inserting a 90° needle into the subcuta-neous tissue after the button has been fully depressed, and then the needle is removed from the skin. When using the Z-track technique, you displace the tissue before you insert the needle. Once the needle is withdrawn, the tissue is restored to its normal position. This traps the drug inside the subcutaneous tissue and prevents any leakage.6
To prevent leakage, an injection should be performed with the Z-track insertion technique with a thin needle in the cuta-neous tissues. It was felt necessary to conduct this study to compare the effects on drug leakage of the 10-second wait-ing technique and the Z-track technique, which is claimed to be helpful in this regard.4,5
Recent studies have indicated that leakage of liquid from the skin did not occur when administering subcutane-ous tissue lateral to vertical lines drawn 5 cm away from the umbilicus 30 units/mL distilled water with shorter 4
mm prefilled pens needles by the Z technique. Studies have included both healthy volunteers and persons with diabetes, and their results have been consistent.4,5 Demirhan
et al4 found that in the healthy volunteers group with the Z
technique, mean Schirmer liquid leakage was 0.0 ± 0.0 mm, whereas with the 10-second waiting technique these values were 0.1 ± 0.7 mm, respectively. In their other works,5 the authors found that in the persons with diabetes
group with the Z technique mean Schirmer liquid leakage was 0.0 ± 0.0 mm, whereas with the standard 10-second waiting group these values were 0.4 ± 0.5 mm, respec-tively. When compared to the 10-second waiting tech-nique, the Z-track insertion technique did not have leakage of liquid from the skin with subcutaneous injections. This suggests that Z-tracking may be an alternative to the 10-second hold time. This is necessary to prevent medica-tion leakage and to get the full dose.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-ship, and/or publication of this article.
References
1. Frid AH, Kreugel G, Grassi G, et al. New insulin deliv-ery recommendations. Mayo Clin Proc. 2016;91(9):1231- 1255.
730378DSTXXX10.1177/1932296817730378Journal of Diabetes Science and TechnologyAltun
letter2017
1Department of Fundamentals in Nursing, İstinye University, Faculty of
Health Sciences, Cevizlibağ, İstanbul, Turkey
Corresponding Author:
İnsaf Altun, RN, MSN, PhD, Department of Fundamentals in Nursing, İstinye University, Faculty of Health Sciences, Cevizlibağ, İstanbul 34010, Turkey.
Email: ialtun@istinye.edu.tr
May the Z-Tracking Technique to Prevent
Any Leakage in Insulin Injection Be an
Alternative to the 10-Second Waiting
Technique?
İnsaf Altun, RN, MSN, PhD
1Keywords
538 Journal of Diabetes Science and Technology 12(2)
2. Kalra S, Mithal A, Sahay R, et al. Indian Injection Technique Study: injecting complications, education, and the health care professional. Diabetes Ther. 2017;8(3):659-672.
3. Præstmark KA, Stallknecht B, Jensen ML, Sparre T, Madsen NB, Kildegaard J. Injection technique and pen needle design affect leakage from skin after subcutaneous injections. J Diabetes Sci Technol. 2016;10(4):914-922.
4. Demirhan Y, Altun İ, Peker A, Çetinarslan B. Comparison of the “90° technique” and the “Z-track technique” in subcutaneous
injections. Paper presented at: 12th Symposium on Diabetes; 2016;Trabzon, Turkey.
5. Demirhan Y, Altun İ. Peker A, Çetinarslan B. Comparison of the “10 seconds waiting” and the “Z-track” injection tech-niques in subcutaneous insulin administration. Paper presented at: 53rd National Diabetes Congress, 19th National Diabetes Nursing Symposium; 2017;Girne, Cyprus.
6. Pullen RL Jr. Administering medication by the Z-track method. Nursing. 2005;35(7):24.