Hep C Discussion Forum

hrsetrdr · Guru

RE: Injection dilemma

bauhaus76 · Senior Member

Judy S the one i got has a trasparent liquid and thats it it kind of goes down i see a red stripe coming up and its finish!! i must say that i have read that pegassys has higher SVR( alpha 2a) component than peg-intron (alpha 2 b )...just saying....i dont know whats the protocol but the insurance companys always try the low cost options has i have experienced with my riba (the first time they wanted to give me a generic and no brand med..i was so pissed that i call them and said if i would not get what its suposed to be (increasing my chances) i would rather stop!! so the basterds send me the brand med and take the other riba back again...so from now im always suspicious....LOL ironic enough it must be from the meds!! hahahaha

-- Edited by bauhaus76 on Monday 25th of June 2012 10:27:00 AM

-- Edited by bauhaus76 on Monday 25th of June 2012 10:38:02 AM

-- Edited by bauhaus76 on Monday 25th of June 2012 10:42:00 AM

bauhaus76 · Senior Member

hi guys i have a pen from pegassys ..inside thers a trasparent liquid,i take of the blue cap press a blue button on top ..wait 10 seconds the button goes back by itself and thats it....

-- Edited by bauhaus76 on Monday 25th of June 2012 09:52:07 AM

-- Edited by bauhaus76 on Monday 25th of June 2012 10:21:59 AM

Judy S · Senior Member

The RediPen is similar to an EpiPen, but you need to push down the top to mix the white powder with the water. (This is after a warming period of about 15 mins after removing from fridge.) Then wipe down the tip with alcohol, screw on the needle, and adjust to your proper dose. Then it's just wiping injection site with alcohol and slowly injecting, then holding for a count of 5, like you would for Z-track in the hip.

I actually prefer the simple syringe; that way I can easily see everything. It's what I have for my Neupogen injections.....those go into my thighs. (I use sides of abdomen below belly button for PegIntron.) And I do aspirate with the Neupogen and do bevel-up.

PegIntron RediPen is just too weird.....very unusual to inject myself with my thumb on "plunger", lol.

Tim, I think I pass by you on the way to Vegas. I drive through LittleRock first, past the Hungarian Store. (I am Hungarian; came to US at age 5.)

hrsetrdr · Guru

So how does actual use of the Redipen compare with a 'traditional' syringe? Is it sort of like an EpiPen® ? As for injection sites I'm just sticking the area above the belt-line, on either side plus the outboard area of the thighs.

Looks like we're both denizens of the Mojave Desert, I'm about 45 miles from Palmdale, going East on HWY 138.

Judy S · Senior Member

I've got Kaiser out here in Palmdale, California and I get the PegIntron Redipen. There's no way to aspirate (draw back plunger) with the Redipen.

I'm a CMA (Certified Medical Assistant.....I work with doctors) and back in Med Assist school, we did 2 hours of lab, 5 days a week for a year. That's when we gave each other injections (SQ, IM, Z-track, Intradermal) and did Phlebotomy (blood draws of different areas). We were pin cushions, as we were both the patient AND the CMA. (You give and you take). We had to give and receive at least 3 injections and 3 blood draws daily, in different areas.

In school, we Always had to aspirate and go bevel up.....we got marked off if we ever forgot. But remember..........we practiced SQ on the back of upper arms, like where allergy shots are given. The purpose of bevel up is to ensure that the liquid gets into the fattiest part of the arm, not leak under the skin. IM (intramuscular) was in shoulder, so same thing. Z-track is in the hip, so we had to pinch and form a "Z" then hold in for 5 secs.....it's ALL for the purposed of the most amount of med getting into the largest area of body and staying there.

For all of US, we have different SQ areas. I doubt any of us are using the backs of our arms? We stick to abdomen and thighs. Those are the most fatty areas, so chance of hitting a vein are super slight, nearly impossible, really. In school they would make you aspirate but it's Not necessary in our circumstance. You won't hit an artery with a needle this size, 99% sure you won't hit a vein, and if you hit a capillary you'll get a little bruise and survive it just fine.

LadyAlaise · Senior Member

I did ask my Liver spec office about the pulling back on the plunger to make sure there is no blood; they looked at me like I had three heads and said Nooooo. No need to do that; and they told me not to.
When I do inject I never paid attention to the bevel down or up thing; I bruise, get red anyways lol
I just swipe with alchohol pad, pucker up the flesh; try to keep needle at 45* angle, have the shot warmed up a bit from fridge, and slowly inject then take it out and dispose in my sharps box. put a bandaid on the shot site; sometimes will bleed, and continue on lol

Margo · Senior Member

LadyAlaise wrote:
they never told me about them; I get the regular prefilled syringes....

Not missing much Renee, only a headache:)

LadyAlaise · Senior Member

they never told me about them; I get the regular prefilled syringes....

Margo · Senior Member

bauhaus76 wrote:
hi guys i was wondering why the new inj are not available in your countrys,i mean i got this ones that look like a insuline shot..i press the button and it shots by himself.i see no nedles.nothing at al...its not fair. good luck to al of you...

Yes we have, it's called a redipen was available only for Pegintron now it's available for Pegasys as well. I actually find regular syringes easier, I messed a few redipens last time and insurance company wasn't happy...

hrsetrdr · Guru

bauhaus76 wrote:
hi guys i was wondering why the new inj are not available in your countrys,i mean i got this ones that look like a insuline shot..i press the button and it shots by himself.i see no nedles.nothing at al...its not fair. good luck to al of you...

The Redipen type devices are available in the U.S., it's just that my healthcare provider(Kaiser Permanante) has not as yet adopted usage of them.

bauhaus76 · Senior Member

hi guys i was wondering why the new inj are not available in your countrys,i mean i got this ones that look like a insuline shot..i press the button and it shots by himself.i see no nedles.nothing at al...its not fair. good luck to al of you...

davesf · Senior Member

Ha perhaps I'm doing it wrong. I always fold my needle guard back to get it out of the way. I could easily inject bevel up or down. When I'm done I snap the needle guard all the way down so it clicks into place shielding the needle. I've been thinking of the needle guard as a rough equivalent to recapping to prevent poking anyone with the dirty needle accidently before it gets to the sharps container.

Did a quick search to see if there were any answers to the bevel up or down question. Here's one study that seems to favor bevel down slightly

http://www.annallergy.org/article/S1081-1206%2810%2963222-X/abstract

I'd say stick to whatever you're doing if it works. The whole routine is getting kind of boring so I might live a little crazy and reverse my technique this week just because.

Shep · Guru

Battle Hym of the Republic--next dart! Can I stand on my right leg though??

hrsetrdr · Guru

I think that determining the bevel direction is alot easier than I realized- as shown in the following picture, the bevel is facing UP, and because of the needle guard the syringe can only be held in the proper way:

Edit: Dart #8 for me is due tomorrow...funny how the weeks fly by when you have a shot to look forward to at the end of the week. cry

-- Edited by hrsetrdr on Thursday 7th of June 2012 06:01:00 AM

Sunrise747 · Senior Member

I never draw back. I've found that standing on my left leg and humming "The Battle Hymn of the Republic" ensure I never hit a vein. Try it! You will be amazed. "Mine eyes have seen the glory..."

kiwi · Senior Member

yaaaay. we got it sussed. we rock.

hrsetrdr · Guru

Thanks, I figured that sometime before the end of treatment I'd get the hang-of-it, and become a real pro!

mallani · Guru

Yep- just as in the photo.

hrsetrdr · Guru

...like thus-ly

...as the tip enters the skin?

mallani · Guru

Just to clarify- if you're standing up, as I always am, the point of the needle enters the skin first. The bevel will be pointing forwards, towards the skin surface. Make sure you put the needle on firmly, hold the syringe up and tap the cylinder of the needle, and gently push plunger to expel any air. There are usually one or two drops of liquid that will be expelled with the air. Make sure the syringe is at room temperature . I have only ever used the lower abdominal wall . Happy darts!

hrsetrdr · Guru

kiwi wrote:
i thought it was bevel up, so the pointiest bit is the bit that gets you first...?
if its down, you get it all flat on your skin. i would say its UP....

(AND I SURE NEED GLASSES FOR THAT)

O.K., I can picture that, just need to go to Rite-Aid and get some stronger readers!

kiwi · Senior Member

i thought it was bevel up, so the pointiest bit is the bit that gets you first...?

if its down, you get it all flat on your skin. i would say its UP....

(AND I SURE NEED GLASSES FOR THAT)

krowdog · Senior Member

Bevel = cut side.

"bevel of the needle facing the skin surface..." yes, when in the inserted position.

"...so the pointiest bit is the bit that gets you first..." yes.

-- Edited by krowdog on Tuesday 5th of June 2012 02:33:26 AM

hrsetrdr · Guru

mallani wrote:
Hi Tim, I'm a retired medico, and have had 2 previous double therapy stints when you had to inject interferon 3 times a week. I've actually worked out I have injected myself with interferon 324 times! Pegasys is meant to be injected subcuteously where there are no significant veins or arteries. If you pinch up a fold of skin and insert the needle to the hilt at 45degrees to the skin, there is no chance you will hit a blood vessel of significance. There is no need to pull back on the plunger, just inject slowly with the bevel of the needle facing the skin surface. Pull the needle straight out and press lightly on the injection site with a cotton ball for a few minutes. Good luck.

Geno1b, week 12, on triple therapy with Vict., undet. at week8

-- Edited by mallani on Sunday 3rd of June 2012 03:28:15 PM

-- Edited by mallani on Sunday 3rd of June 2012 03:28:46 PM

So, that would be "bevel down" correct? My NP told me to inject "bevel up", which I'.m not sure if I've done or not, since I cannot even see the bloody bevel, even with wearing my reading glasses. confuse

Margo · Senior Member

Never heard about pulling back the plunger either and I've done 48 shots last time and 5 so far this time. Don't stress yourself out about it, you can see your veins peaking through the skin, just make sure to avoid them:)otherwise the needle is so short, don't worry about it. If there would be any danger or issue, believe me, the doctor would never let you inject yourself and would always be under nurses supervision.

kiwi · Senior Member

haha learned a new one CYA... took me a few to get it. lol

yeh mate, my nurse never said a thing about drawing the plunger back at all. was just to make sure the bevel was right and in ya go... i think if ya get the bevel wrong (and i need glasses for that now omg) it hurts more is all.

take it easy mate. i had one big bad bruise i think i went thru a tiny blood vessel, but thats one time out of 30 so far. so i think we are sweet...

hrsetrdr · Guru

Well, I appreciate all your replies, I feel so much better about doing the injection in the manner that seemed to be intuitively sensible. I have noticed how 'dogmatic' the Kaiser personnel come off, on various issues. I'm sure Kaiser's Legal Affairs division schools them well. Of course, that's true with all corporations now days, have to CYA on all counts, to avoid legal actions.

Phil G · Senior Member

I do Pegintron instead of Pegasys. With the Redipen system, there is absolutely no way to pull back on the plunger, so how important could it be?

krowdog · Senior Member

Hi Hrsetrdr,

I tried the "pull back the plunger, check for a vein thing" a few times, but quit due to bruising, etc. I hated the idea of wiggling the syringe around with the needle still stuck in there.

I got curious what would happen in a "'main-line" injection. I had heard everything from "It wouldn't matter" to "You'd die instantly" After a LOT of searching, I found some original studies done on rats, and monkeys. They used IV injections to test the half life time. There was no mention of animal fatalities or problems. I quit worrying about it after that.

I would expect, that in the event of an accidental I.V. injection, you would get harder, faster side effects.

If it was a serious problem, I'm sure there would be A LOT more attention put on this, since it's bound to happen. Like Kelly, no-one said anything to me, although I did read it.

If you are sure to inject into fat, it would be very hard to hit a vein anyway.

Brad

mallani · Guru

Hi Tim, I'm a retired medico, and have had 2 previous double therapy stints when you had to inject interferon 3 times a week. I've actually worked out I have injected myself with interferon 324 times! Pegasys is meant to be injected subcuteously where there are no significant veins or arteries. If you pinch up a fold of skin and insert the needle to the hilt at 45degrees to the skin, there is no chance you will hit a blood vessel of significance. There is no need to pull back on the plunger, just inject slowly with the bevel of the needle facing the skin surface. Pull the needle straight out and press lightly on the injection site with a cotton ball for a few minutes. Good luck.

Geno1b, week 12, on triple therapy with Vict., undet. at week8

-- Edited by mallani on Sunday 3rd of June 2012 03:28:15 PM

-- Edited by mallani on Sunday 3rd of June 2012 03:28:46 PM

Kellyw · Senior Member

Ive never done it. I wasn't told to do to. Just FYI . hard to do alone and pull back on plunger

hrsetrdr · Guru

Even though I've already done 7 shots, I still am awkward with doing the injection. Specifically, the part where the plunger needs pulled back, to check whether you've hit a vein or not. I am not good at that at all, have poor manual dexterity, I guess. I've skipped that step altogether, for the last 3 shots, I just pinch-up an inch(or so) of fat[not hard to do] and plunge the injection in. The last time I tried to pull back the plunger the needle came out of my skin twice...so I had 3 needle punctures at the same injection site. hmm

Am I running a 'health risk' by skipping this step? Any suggestions on "how-to" retract the plunger of the syringe properly?

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