# Possible Pen Needle Confusion Prompts FDA Safety Alert



## Northerner (Sep 28, 2018)

Reports of patients using standard pen needles to inject insulin without removing the inner needle cover have prompted the US Food and Drug Administration (FDA) to issue a safety communication on proper use of pen needles.

Posted September 27 on the agency's website, the safety notice reminds healthcare providers, patients, and caregivers about the correct use of pen needles and potential risks if the standard pen needle's inner needle cover is not removed before injection.

Pen needles are used to inject different types of medicine with pen injectors. Standard pen needles often have an outer cover and a removable inner needle cover. Both the outer cover and inner needle cover must be removed before an injection.

https://www.medscape.com/viewarticle/902654

I'd never heard of these safety needles before, so I can appreciate a little bit of confusion if you've been used to them and then get given the standard ones 

"One patient was hospitalized and died because of prolonged hyperglycemia, according to the FDA." - I would have thought you would have realised something wasn't working before it got to such a stage


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## mikeyB (Sep 28, 2018)

You can’t legislate for stupidity. One for the Darwin awards, methinks.


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## Lanny (Sep 28, 2018)

Northerner said:


> Reports of patients using standard pen needles to inject insulin without removing the inner needle cover have prompted the US Food and Drug Administration (FDA) to issue a safety communication on proper use of pen needles.
> 
> Posted September 27 on the agency's website, the safety notice reminds healthcare providers, patients, and caregivers about the correct use of pen needles and potential risks if the standard pen needle's inner needle cover is not removed before injection.
> 
> ...



Safety needles are used in hospital as it’s pressure operated & has no exposed needle. They hurt a lot more though because of the pressure. They were used on me during my stay in hospital in May 2017. It confused me at first as I couldn’t see a needle. Just push it up against the skin & keep pressing to release the needle.

Hospital staff can get stabbed by needles very easily & risk who knows what! Especially those getting admitted in emergencies & are very dehydrated, as I was & the poor A&E doctor got stabbed by my IV needle because all my veins had shrivelled up & it took 10+ plus attempts all up & down both arms!

So, safety needles for insulin delivery in hospitals cut that risk!


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## Northerner (Sep 28, 2018)

Lanny said:


> So, safety needles for insulin delivery in hospitals cut that risk!


Thanks for the explanation @Lanny  When I was in hospital they used syringes with ordinary needles on me


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## silentsquirrel (Sep 28, 2018)

I don't think the safety needles are what they are talking about, just standard needles with 2 covers, both needing to be removed.  I use Novotwist for Novorapid, and BD Micro-fine Ultra for Lantus (the Novotwist which I prefer does not fit the Lantus pen).  My surgery changed everyone onto cheap Omnican needles with no inner cover some months ago, and I hated these.  Apart from disliking no inner cover, I found they were occasionally painful, and causing far more lumps and bruises.  Managed to persuade my GP to change me back on this basis.
It beggars belief that people could think they could inject with the inner cover in place!


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## Ljc (Sep 28, 2018)

I’ve heard but never seen these safety needles .  I agree with @silentsquirrel its the standard pen needles with the inner and outer cover they are talking about.
Fancy trying to inject with the inner cover on .


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## Bruce Stephens (Sep 28, 2018)

Ljc said:


> I’ve heard but never seen these safety needles . I agree with @silentsquirrel its the standard pen needles with the inner and outer cover they are talking about.
> Fancy trying to inject with the inner cover on



Seems hard to believe. The ones I use (BD Micro-fine, I think) are really pretty obvious: they're grey plastic, about 3mm in diameter, and obviously removable. There must be some others that are more confusable that they're worried about.


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## Northerner (Sep 28, 2018)

Ljc said:


> I’ve heard but never seen these safety needles . I agree with @silentsquirrel its the standard pen needles with the inner and outer cover they are talking about.


Yes, that's so, but they also explain about the 'safety' needles and how they are different - perhaps some people in the US are used to using them. I haven't tried to 'inject' a dose with the inner cover on, but I would imagine that either the insulin won't come out, leaving the pen permanently full, or it will dribble out all over the injection site, which I would have thought both to be obvious. Reminds me of the Lament of the Lonely Lancet... 


One of the forum’s members related the unusual tale of trying to inject her small daughter, but no insulin was being delivered. She changed the insulin – no luck, changed the pen, no luck – then realised it was because the needle had no hole! Clearly a lancet who had been frightened by the folk tales of other lancets who told him that lancets rarely get changed – not at all like the official ‘single-use’ line he had been taught – and perhaps that’s how he ended up in a needle box…

Congratulations lancets all! You’ve all achieved a pass,
And now it’s time for you to leave the Lancing Duties class!
So follow me, you’ll be assigned to boxes at the gate – 
Just keep in line and you’ll be fine, don’t push, not long to wait!

‘I’m scared, I’m not sure I should go, for though I passed the course,
And though I’d only do it once – could I draw blood by force?’
‘Just once? You’re joking! You’ll find out it’s six times every day,
And every day for several weeks before you’re thrown away!’

‘Are you sure? How awful! I think I may hang back
And lurk here in the shadows – they won’t miss one in a pack…
I’ll mingle with the needles, for surely they’re used less
And don’t conclude their useful life a blunt and bloodied mess!’

‘Oh my! I’ve been selected after months within this box,
In the darkness of this drawer with the underpants and socks!
It’s up to me to do my best and pierce this person’s skin
And deliver up a dialled dose of clean fresh insulin!’

Oh no! But wait! But it’s too late, I didn’t think this through!
I have no hole! It can’t get out! Whatever shall I do?
If only I’d stuck to my task, I’d surely have succeeded – 
A lancet’s not a needle, for a needle’s hole is needed!


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## silentsquirrel (Sep 28, 2018)

Must admit I posted without reading the article!


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## Ljc (Sep 28, 2018)

Unless the doses were so small I guess the insulin would dribbleout too


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## Lanny (Sep 28, 2018)

My sister in law hates needles & tried the safety ones but, went back to using the normal ones because they hurt a lot more. They are also a lot more expensive! So, maybe people using the safety ones are being forced to use the normal ones instead.

The amount of pressure used means I can’t actually feel the needle going in. So, the first time it was used on me I questioned whether I’d gotten the insulin dose.

There is an outer cap & there’s no sign of a needle at all. The nurse explained & was pushing it into her finger a few times to show me there’s no needle to harm staff. You have to push into the skin very hard, with a lot of pressure for a sustained amount of time to get the needle to engage & what I felt is the pressure rather than the needle.

I was thinking if people have gotten used to the safety needles they just assume the needle will engage by pushing hard enough! On reading this thread, I tried pushing the novofine needles, I have, with the inner cap on with the amount of pressure I know is required from using the safety needles & it feels about the same!

I have sometimes, when first on insulin, forgotten to take off the inner cap & pushed the insulin through & it doesn’t dribble out & only realised it when I didn’t feel the needle.

I CAN see how people have gotten confused!

It must have happened in suffient numbers of people for it to be flagged up!


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## mikeyB (Sep 28, 2018)

Are these folk not doing air shots?


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## Northerner (Sep 28, 2018)

mikeyB said:


> Are these folk not doing air shots?


Have you seen the price of insulin in the US?


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