Valg af insulinpen nåle til voksne patienter med diabetes
Jonathan Jung Johansen. BA projekt afleveret 04.01.2024 Sygeplejerskeuddannelsen KP København. Vejleder Pernille Fastholm
Resumé
Introduktion: “4, 5 eller 6 mm?” Studier og praksiserfaringer viser, at sygeplejersker er i tvivl om, hvilken insulinnål der skal anvendes hos patienter, og valget bliver ofte truffet på baggrund af tilgængelighed frem for klinisk beslutningstagen på baggrund af videnskabelig evidens. Litteraturstudiet undersøger patientpræferencer, komfort under injektion og forekomst af smerter ved brug af forskellige insulinpen-nåle til diabetespatienter. Formålet er at undersøge, hvilken nåletype der giver mindst smerte og bedst patientoplevelse, samt at forstå patienternes holdninger til og accept af insulinbehandling.
Metode: Gennem et litteraturstudie baseret på systematisk søgning i PubMed og CINAHL, blev relevante studier udvalgt og analyseret ved brug af narrativ syntese.
Resultater: To randomiserede kontrollerede non-inferioritetsstudier blev identificeret, der hhv. undersøgte en redesignet 4-mm insulinnål og en kortere og tyndere 3,5-mm insulinnål, sammenlignet med konventionelle nåle 4-, 5- og 6-mm insulinnåle. Den redesignede 4-mm nål viste sig at have en positiv effekt på alle parametre, hvor den kortere og tyndere nål havde sammenlignelig effekt som konventionelle nåle.
Diskussion/Konklusion: Studiets viser, at fremtiden inden for nåledesign ved insulininjektioner bør fokusere på design af nålen frem for kun at reducere længden og tykkelsen af nålen. Den korte 3,5-mm nål viste sig non-inferior til en konventionel 4-mm nål, ift. patientpræferencer, smerter og introducerede yderligere risiko for komplikationer relateret til selve injektionen. Den redesignede 4-mm nål viste sig, på trods af at have samme dimensioner som en konventionel 4-mm nål, at være signifikant superior på alle undersøgte effektmål. Ydermere antages det, at de ergonomiske forbedringer ved den redesignede nål vil kunne forbedre injektionsoplevelsen for ældre medicinske patienter med diabetes.
Implikationer for praksis: Resultaterne fra dette studie kan give sygeplejersker mulighed for at nuancere og personliggøre anbefalinger til patienter, hvilket vil forbedre patientinddragelsen og kvaliteten af behandlingen. Den systematiske søgning viser også, at der på trods af et internationalt fokus på diabetes mangler forskning på området.
Kontaktoplysninger:
Jonathan Jung Johansen, sygeplejerske. Mail: Jonathan-7910@hotmail.com
Copenhagen Honours College – sygeplejerske (CHC-S)
Helle Mathar, lektor. Mail: chcsygepleje@kp.dk
Projektet er støttet af Novo Nordisk Fonden
Selection of Insulin Pen Needles for Adult Patients with Diabetes
Clinical dissertation by Jonathan Jung Johansen . Uploaded 04.01.2024 . KP University College.
Tutor Pernille Fastholm
Abstract
Introduction: “4, 5, or 6 mm?” Studies and practical experiences indicate that nurses are uncertain about which insulin needle size to use for patients, and the choice is often based on availability rather than clinical decision-making rooted in evidence-based knowledge. This litteraturestudy investigates patient preferences, comfort during injection, and the occurrence of pain using different sizes of insulin pen needles for diabetic patients as well as glycemic control. The aim is to assess which needle type causes the least pain and provides the best patient experience, as well as to understand patients’ attitudes towards and acceptance of insulin treatment.
Method: Through a literature study based on systematic searches in PubMed and CINAHL, relevant studies were selected and analyzed using narrative synthesis.
Results: Two randomized controlled non-inferiority studies were identified, one examining a redesigned 4-mm insulin needle and the other a shorter and thinner 3.5-mm insulin needle, compared with conventional needles of 4-, 5-, and 6-mm. The redesigned 4-mm needle was found to have a positive effect on all outcomes, where the shorter and thinner needle had a comparable effect to conventional needles.
Discussion/Conclusion: The findings of the study suggest that the future of needle design for insulin injections should focus on the design of the needle rather than merely reducing its length and thickness. The short 3.5-mm needle proved to be non-inferior to a conventional 4-mm needle regarding patient preferences, pain, and introduced additional risk for complications related to the injection itself. The redesigned 4-mm needle, despite having the same dimensions as a conventional 4-mm needle, was significantly superior on all studied outcomes. Moreover, it is assumed that the ergonomic improvements of the redesigned needle could enhance the injection experience for older medical patients with diabetes.
Relevance to clinical practice: The results of this study can enable nurses to nuance and personalize recommendations to patients, which will improve patient involvement and the quality of treatment. The systematic search also shows that despite a global focus on diabetes, there is a lack of research in the area.
Contact information:
Jonathan Jung Johansen , RN. Mail: Jonathan-7910@hotmail.com
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