Limits...
Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections.

Kim L, Nevis I, Potts R, Eeuwes C, Dominic A, Kim HL - Allergy Asthma Clin Immunol (2014)

Bottom Line: The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared.Body mass index was found to be a significant predictor of skin-to-muscle-depth.These patients are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada.

ABSTRACT

Background: Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Ideally, it should be administered into the subcutaneous space in the mid-posterolateral upper arm. Injections are commonly given using a standard allergy syringe with a needle length of 13 mm. Therefore, there is a risk of intramuscular administration if patients have a skin-to-muscle depth <13 mm, which may increase the risk of anaphylaxis. The objective of this study was to determine whether the needle length of a standard allergy syringe is appropriate for patients receiving subcutaneous immunotherapy.

Methods: Ultrasounds of the left posterolateral arm were performed to measure skin-to-muscle depth in 200 adults receiving subcutaneous immunotherapy. The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared. The proportion of patients with skin-to-muscle depths > 4 mm, 6 mm, 8 mm and 10 mm were also calculated. Multivariable logistic regression was performed to identify predictors of skin-to-muscle depth.

Results: Of the 200 patients included in the study, 80% had a skin-to-muscle depth ≤13 mm; the majority (91%) had a skin-to-muscle depth >4 mm. Body mass index was found to be a significant predictor of skin-to-muscle-depth.

Conclusions: Most patients receiving subcutaneous immunotherapy have a skin-to-muscle depth less than the needle length of a standard allergy syringe (13 mm). These patients are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis. Using a syringe with a needle length of 4 mm given at a 45° angle to the skin may decrease this risk.

No MeSH data available.


Related in: MedlinePlus

Image of ultrasound showing skin-to-muscle depth (STMD).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4017082&req=5

Figure 2: Image of ultrasound showing skin-to-muscle depth (STMD).

Mentions: Based on the findings of this current study, we feel that some modifications to routine clinical practice may be warranted to reduce the risk of inadvertent intramuscular administration of allergen immunotherapy. Firstly, an ultrasound could be performed on all patients receiving SCIT in order to confirm their STMD. This approach would ensure that healthcare workers administering the injections are aware of the real depth to the intramuscular space. The potential drawbacks to the routine use of ultrasounds, however, are their associated costs and the expertise and time required to complete the procedures. Nonetheless, we feel that it would be straightforward for most allergists to learn how to read these relatively simple ultrasounds (see Figure 2). The cost of ultrasound machines has also decreased recently making this technology financially attainable in most medical clinics.


Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections.

Kim L, Nevis I, Potts R, Eeuwes C, Dominic A, Kim HL - Allergy Asthma Clin Immunol (2014)

Image of ultrasound showing skin-to-muscle depth (STMD).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4017082&req=5

Figure 2: Image of ultrasound showing skin-to-muscle depth (STMD).
Mentions: Based on the findings of this current study, we feel that some modifications to routine clinical practice may be warranted to reduce the risk of inadvertent intramuscular administration of allergen immunotherapy. Firstly, an ultrasound could be performed on all patients receiving SCIT in order to confirm their STMD. This approach would ensure that healthcare workers administering the injections are aware of the real depth to the intramuscular space. The potential drawbacks to the routine use of ultrasounds, however, are their associated costs and the expertise and time required to complete the procedures. Nonetheless, we feel that it would be straightforward for most allergists to learn how to read these relatively simple ultrasounds (see Figure 2). The cost of ultrasound machines has also decreased recently making this technology financially attainable in most medical clinics.

Bottom Line: The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared.Body mass index was found to be a significant predictor of skin-to-muscle-depth.These patients are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada.

ABSTRACT

Background: Allergen-specific subcutaneous immunotherapy is an effective treatment for certain allergic disorders. Ideally, it should be administered into the subcutaneous space in the mid-posterolateral upper arm. Injections are commonly given using a standard allergy syringe with a needle length of 13 mm. Therefore, there is a risk of intramuscular administration if patients have a skin-to-muscle depth <13 mm, which may increase the risk of anaphylaxis. The objective of this study was to determine whether the needle length of a standard allergy syringe is appropriate for patients receiving subcutaneous immunotherapy.

Methods: Ultrasounds of the left posterolateral arm were performed to measure skin-to-muscle depth in 200 adults receiving subcutaneous immunotherapy. The proportion of patients with a skin-to-muscle depth >13 mm vs. ≤13 mm was assessed and baseline characteristics of the two groups were compared. The proportion of patients with skin-to-muscle depths > 4 mm, 6 mm, 8 mm and 10 mm were also calculated. Multivariable logistic regression was performed to identify predictors of skin-to-muscle depth.

Results: Of the 200 patients included in the study, 80% had a skin-to-muscle depth ≤13 mm; the majority (91%) had a skin-to-muscle depth >4 mm. Body mass index was found to be a significant predictor of skin-to-muscle-depth.

Conclusions: Most patients receiving subcutaneous immunotherapy have a skin-to-muscle depth less than the needle length of a standard allergy syringe (13 mm). These patients are at risk of receiving injections intramuscularly, which may increase the risk of anaphylaxis. Using a syringe with a needle length of 4 mm given at a 45° angle to the skin may decrease this risk.

No MeSH data available.


Related in: MedlinePlus