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nebido injection
tigger1

1112 Posts

Posted:  23-Mar-2017 14:23
We have a chap been getting this injection for years from us and we have always given deep IM with green needle over 1-2 minuets (either warm room temp or warmed in water first). We have had a letter from his consultant saying he complained that the last 2 injections were more painful than previous and the consultant has asked us to give using a blue needle next time. I am curious to hear if anyone has had to do this ? It is my collegue who is going to have the pleasure next week but I am sceptical that it will go through a 23 guage needle at all. We have another young lad on the same injection and no problems with him.
karen.rudd

12002 Posts

Posted:  23-Mar-2017 14:27
Not sure it would be less painful through a narrower needle if you could squeeze it through? Might be worth speaking to manufacturers?

Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
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paj51

100 Posts

Posted:  23-Mar-2017 14:48
I have 2 patients on this and I use a white needle, both at patients request as they reported much less painful than the green I'd normally used.
Also if they've been having for years there is probably a build up of scar tissue which is also more painful to inject into.

One of my patients I give in his thigh again at his request as he didn't like it given into his buttock, there seems to be no problem with this and I've been seeing him for the last 9 years.

paj51
anon-i-mouse

312 Posts

Posted:  23-Mar-2017 15:02
surely going through a thinner gauge needle will mean its a thinner 'stream' of the nebido but that the pressure needed to push it in will be greater hence it will hurt more!?! isn't that why depo provera come with a white needle?

bigger needle = lower PSI (pounds per square inch pressure .... theres me trying to sound like an engineer!>?[xx(])
busby

561 Posts

Posted:  23-Mar-2017 15:39
For intramuscular use.

The injections must be administered very slowly (over two minutes). Nebido is strictly for intramuscular injection. Care should be taken to inject Nebido deeply into the gluteal muscle following the usual precautions for intramuscular administration. Special care must be taken to avoid intravasal injection (see section 4.4 under “Application”). The contents of an ampoule / vial are to be injected intramuscularly immediately after opening. (For the ampoule see section 6.6 for instructions on opening the ampoule safely).

It is unlikely to reach a muscle using a blue needle therefore if you give it you are going against manuf advice.


busby
Lilywhite

1405 Posts

Posted:  23-Mar-2017 15:55
I agree with the above - I don't have experience with this particular drug but in my experience of injecting it's the pressure rather than the needle guage that tends to have the most affect on pain experienced by the patient - finer needle requires increased pressure.

Please be aware this is my opinion only based on the evidence I have seen, and not meant to be taken as direction
tigger1

1112 Posts

Posted:  23-Mar-2017 19:21
Thanks all, the consultant has been discussing it in letter form with the other practice nurse who has been doing them less time than me. I think I might ring and speak to him in person and see what his rationale is and if it's just a case of he has never actually administered it personally so doesn't know what it is like. Thanks again for the reassurance that I am not having a senior moment and missing something.
tigger1

1112 Posts

Posted:  24-Mar-2017 12:43
thought you might be interested in the conversation I had with the consultant about this issue. I explained my reservation and that our blue needles are only 1 inch long and used on baby deltoids and my concern was that these would not reach muscle mass. The patient in question is a normal build 25 yr old. He was very pleasant and said he understood the nurses in clinic use green generally but that he often gives it with a blue, he maintains it is no problem drawing up and that the narrower guage makes sure it is not given too quickly. He confirmed that this is what he wants given and how and said just make sure that the needle is inserted so that the skin is depressed i.e as far as it will go ( lets hope it doesnt snap at the hilt). I have documented all of this and marked it as a patient specific instruction from a named consultant. As I say it is my collegue who will be giving it and I will wait with baited breath to see how it goes.
pjkaz

904 Posts

Posted:  24-Mar-2017 16:10
I administer 1ml/per minute.

Kaz..
Teddy75

45 Posts

Posted:  26-Mar-2017 18:53
Never given it before and have a gent booked in tomorrow. Do I get him to stand or lie down on couch?? I'll see what he's been doing before when he's been having them. I'm glad I read this post.
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mumnurselover

1425 Posts

Posted:  26-Mar-2017 20:42 Log in to like this post
Scary reading and proves you should never take another nurse's word for anything. I have been giving this to 2 men for over 10 years, my training was the old way see one, do one, get on with it, i saw 2 nurses give this both the same technique, obviously one nurse showed the new nurse who then both showed me. Patient stand up, use green needle to draw up and change to another green needle and give IM, neither mentioned time to give it and they and now i give it in about 20 seconds. No complaints no problems and both like the fact i am the quickest to give. As a new PN i supposed it seems ok and correct and one thing i did not check up on.
Reflective study i will change the way i give this.

tigger1

1112 Posts

Posted:  26-Mar-2017 21:33
It makes interesting reading to read the patient web site and hear the experiences of the people recieving it rather than giving it. There are those who like it done quick and cold, some like it slowly and warmed up, some self administer and the biggest issue is not the pain of the injection but the pain the next day. I will continue following the scp apart from this case where we have a specific psd from the consultant and at the request if the patient. One funny thing he said was " the endocrine nurses bang it in with a green needle " I'm sure they would love to hear their technique described like this.
Markie

6 Posts

Posted:  27-Mar-2017 08:34
Hi, I always use a Blue needle, I have quite a few patients on Nebido, some prefer to stand others lay down, it's however they feel comfortable? Don't want to jinx myself but never had any complaints. I use a slow push-stop-push-stop method of administering. don't know if this helps?
Markie
Nessa

49 Posts

Posted:  27-Mar-2017 15:56
I give through green needle to ensure it is intra-muscular, and do it slowly (1ml/ minute), as giving it faster can cause light headedness. Patients choice as to whether they stand or lie. I personally prefer them to lie down, then i can sit down and give it slowly whilst having a bit of a chat!

Nessa
lynsey1904

5 Posts

Posted:  27-Mar-2017 16:52
I was always taught to warm it up and draw up with green but give with a blue over 1-2 mins although with blue needles I have that the pressure sometimes means the needle comes off and fluid leaks ( only happened twice in 10 yrs) we give to about 3 men now and they stand like depo patients with their weight off that leg - one finds it painful the other does not.
We don't have spare white needles like what comes with the depo injections so use blue.
Flower

1297 Posts

Posted:  27-Mar-2017 22:10
I watched the Nebido video on the manufacturers website some years ago. Clearly says to give slowly. risk of embolus if given too quick
Teddy75

45 Posts

Posted:  27-Mar-2017 22:18 Log in to like this post
Gave today- very slowly over 2 minutes. very happy no pain or other complaints reported. Left my consulting room happy. He didn't know I'd never given before.
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veronica

557 Posts

Posted:  28-Mar-2017 06:23 Log in to like this post
I am puzzled how a blue needle can be justified to give I'm injection in adults. Unless the person is extremely thin?? I use a green needle, never occurred to me that blue would be long enough. This is my personal opinion.
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