On site rotation scheme, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.
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Practice · Administration · continued
Follow-up: A site rotation scheme that is easy enough to actually follow posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
That is consistent with mine, for whatever one more account is worth.
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fr.translation_mo, post #57: Leaving the needle in for a couple of seconds after depressing the plunger reduces leakage at the site. It costs nothing and it is the fix for the "some came back out" question. Go to post
I had written a reply contradicting post #61 and deleted it. Here is what survived.
The version of site rotation scheme that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.
a.schaeffer, post #44: That is a cleaner way of putting what I was circling around. Go to post
Confirming post #61 from a second method, which matters more than confirming it from a second person.
Angle of injection: 90 degrees into pinched tissue ensures subcutaneous placement. It is not always necessary and shallower angles can work, but 90 degrees into a small pinch is the safest technique to learn first.
A guess, clearly labelled as one.
Site reactions that appear immediately and settle within a day are described commonly here. Ones that appear a day later and spread are a different observation and worth describing to a clinician rather than a forum.
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a.delgado, post #54: Helpful, and short, which on this subject is harder than long. Go to post
Adding a small correction to the site rotation scheme summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
LJankowiak, post #46: I have no financial interest in anything named in this thread and I want to say so before I comment on site rotation scheme, because it is the sort of subject where it matters. Go to post
Answering the question post #65 raises rather than the one it answers.
A site rotation scheme that actually works: abdomen, outer thigh, back of arm, outer hip. Rotate through them in order, move a minimum 2 cm between consecutive sites, note the site with each dose. If a local reaction appears you have the history. If you rotate properly you will not get lipohypertrophy from overuse of one area.
The claim is narrower than it sounds, and deliberately so.
The arithmetic in post #69 is right; the assumption feeding it is the part to check.
Practical experience of site rotation scheme, offered as one case with the conditions stated, not as a general finding. Conditions first, because they are what make it interpretable.
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Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract.
I would be interested in a counterexample if anyone has one.
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a.wikstrom, post #60: If you have to inject at a different time of day than usual, that is a much smaller perturbation than it feels for a weekly compound with a week-long half-life. Go to post
The most useful thing anyone has posted about site rotation scheme in this category was a table of what had been measured and by whom. That is what I would want again.
Collapsed as off-topic by two members at trust level 3 or above
Where I part company with post #70, and it is a narrow parting.
I would rather this thread reach "we do not know" about site rotation scheme than reach a confident answer that nobody can support when asked.
I changed my mind about site rotation scheme after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.
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n.lehtinen, post #71: Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract. I would be interested in a counterexample if anyone has one. Go to post
Acknowledging rather than arguing. The reasoning holds as far as I can follow it.
Post #75 put the caveat in the right place and I want to underline it.
Rotate on a fixed sequence rather than choosing each week. A sequence you follow beats a scheme you improvise, and it produces a record you can read back.
Anyone who has looked at this more carefully, please correct the record.
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Post #76 answers the question as asked. The question underneath it is different.
Source for the site rotation scheme figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
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I read post #78 twice before replying, because I had assumed the opposite.
I disagree with the framing of site rotation scheme above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.
The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.
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Coming back to post #79, because the follow-up matters more than the original answer.
A note on how site rotation scheme gets discussed rather than on site rotation scheme itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.
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KAndersson, post #9: Bleeding at the injection site: normal and usually minimal. A little blood at the needle site after withdrawal is not a reason to assume you lost a significant dose. The needle passed through tissue and there is a small amount of bleeding in the tract. It reads as pedantry until the day it does not. Go to post
Agreed on all of that, and I have nothing to add to it.
Worth separating two things that post #83 runs together.
Note the site alongside the dose. If a local reaction appears three weeks later you will want to know where the previous four injections went.
Posting it because the silence on this was starting to look like agreement.
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m.haddad, post #1: A site rotation scheme that is easy enough to actually follow Writing it up because I had to work it out twice and would rather nobody else did. A follow-up question about site rotation scheme that I did not know to ask the first time. The earlier thread answered what I asked. What I should have asked is below, and I think it is the one… Go to post
Post #86 answers the question as asked. The question underneath it is different.
Checked the site rotation scheme claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.
This is the first time the answer has come with its own limits attached. Appreciated.
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Taking post #88 at face value and following it one step further.
I have three months of notes on site rotation scheme and the honest summary is that the trend is real and the week-to-week numbers are noise. I nearly drew the opposite conclusion from the first fortnight.
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This topic was referenced in
- Bleeding at the injection site: normal, and what to do about itPractice › Administration · 3 replies
- Air bubbles in a subcutaneous injection: the honest risk assessment — does this still hold?Practice › Administration · 30 replies
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