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Ramatillah DL, Gan SH, Novarticia J, Araminda GN, Michael M, Elnaem M, Alawuddin R, Khan K. Side effects of CoronaVac® COVID-19 vaccination: Investigation in North Jakarta district public health center communities in Indonesia. Heliyon 2024; 10:e30087. [PMID: 38694099 PMCID: PMC11061720 DOI: 10.1016/j.heliyon.2024.e30087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
Background The decreasing prevalence of COVID-19 has highlighted the value of vaccinations. CoronaVac® vaccine was one of the most widely used vaccines in Indonesia, in other Southeast Asian countries, as well as in Latin America. However, to date the safety and side effect profiles of CoronaVac® vaccine among the Indonesian population have not been reported. Objective In this study, the CoronaVac® safety profiles were determined in a community of a public health center in North Jakarta, Indonesia. Method This is a descriptive cross-sectional questionnaire-based study on vaccine side effects as recorded in the yellow form (MESO). Patients (n = 300) who received CoronaVac® vaccinations between July and August 2021 were enrolled. SPSS was used to analyze the descriptive data. Results Most respondents were women (72.7 %) between the ages of 17 and 21 years. A significantly (p = 0.009) positive correlation was established between the vaccine side effects (namely pain at the injection site) with the female gender. Other side effects such as fatigue (p = 0.034) and headache (p < 0.001) were also correlated with disease comorbidity. Conclusion Overall, the side effects following the first and the second doses were generally mild and included fever, pain in the injection area, fatigue, headache, drowsiness, diarrhea, cough, and nausea. Regarding vaccine efficacy, CoronaVac® confers better protection following the second dose administration where the percentage of respondents affected with COVID-19 (26.7 %) decreased to only 20.3 % following the second dose.
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Affiliation(s)
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Judith Novarticia
- Faculty of Pharmacy, Universitas 17 Agustus 1945, Jakarta, Indonesia
| | | | - Michael Michael
- Faculty of Pharmacy, Universitas 17 Agustus 1945, Jakarta, Indonesia
| | - Mohammad Elnaem
- University of Ulster School of Pharmacy and Pharmaceutical Sciences, Ireland
| | - Rizki Alawuddin
- Faculty of Pharmacy, Universitas 17 Agustus 1945, Jakarta, Indonesia
| | - Kashifullah Khan
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
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2
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Han K. Reply to Cossu et al., "Switching to deltoid intramuscular injections maintains therapeutic trough concentrations of rilpivirine and cabotegravir in people with HIV". Antimicrob Agents Chemother 2024; 68:e0020424. [PMID: 38534102 DOI: 10.1128/aac.00204-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Affiliation(s)
- Kelong Han
- Clinical Pharmacology Modeling & Simulation, GSK, Collegeville, Pennsylvania, USA
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3
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Haberkorn CJ, Severance CC, Wetmore NC, West WG, Ng PC, Cendali F, Pitotti C, Schauer SG, Maddry JK, Bebarta VS, Hendry-Hofer TB. Intramuscular administration of tranexamic acid in a large swine model of hemorrhage with hyperfibrinolysis. J Trauma Acute Care Surg 2024; 96:735-741. [PMID: 37962201 DOI: 10.1097/ta.0000000000004207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Traumatic injury with subsequent hemorrhage is one of the leading causes of mortality among military personnel and civilians alike. Posttraumatic hemorrhage accounts for 40% to 50% of deaths in severe trauma patients occurring secondary to direct vessel injury or the development of trauma-induced coagulopathy (TIC). Hyperfibrinolysis plays a major role in TIC and its presence increases a patient's risk of mortality. Early therapeutic intervention with intravenous (IV) tranexamic acid (TXA) prevents development of hyperfibrinolysis and subsequent TIC leading to decreased mortality. However, obtaining IV access in an austere environment can be challenging. In this study, we evaluated the efficacy of intramuscular (IM) versus IV TXA at preventing hyperfibrinolysis in a hemorrhaged swine. METHODS Yorkshire cross swine were randomized on the day of study to receive IM or IV TXA or no treatment. Swine were sedated, intubated, and determined to be hemodynamically stable before experimentation. Controlled hemorrhaged was induced by the removal of 30% total blood volume. After hemorrhage, swine were treated with 1,000 mg of IM or IV TXA. Control animals received no treatment. Thirty minutes post-TXA treatment, fibrinolysis was induced with a 50-mg bolus of tissue plasminogen activator. Blood samples were collected to evaluate blood TXA concentrations, blood gases, blood chemistry, and fibrinolysis. RESULTS Blood TXA concentrations were significantly different between administration routes at the early time points but were equivalent by 20 minutes after injection, remaining consistently elevated for up to 3 hours postadministration. Induction of fibrinolysis resulted in 87.18 ± 4.63% lysis in control animals, compared with swine treated with IM TXA, 1.96 ± 2.66% and 1.5 ± 0.42% lysis in the IV TXA group. CONCLUSION In the large swine model of hemorrhage with hyperfibrinolysis, IM TXA is bioequivalent and equally efficacious in preventing hyperfibrinolysis as IV TXA administration.
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Affiliation(s)
- Christopher J Haberkorn
- From the Department of Emergency Medicine (C.J.H.), University of Colorado Anschutz Medical Campus; Department of Critical Care (C.J.H.), Children's Hospital Colorado; Department of Emergency Medicine (C.C.S., N.C.W., W.G.W., C.P., V.S.B., T.B.H.-H.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Emergency Medicine (P.C.N.), Brooke Army Medical Center, Ft Sam Houston, San Antonio, Texas; Department of Biochemistry and Molecular Biology (F.C.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Emergency Medicine (S.G.S.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Departments of Anesthesiology (S.G.S.) and Emergency Medicine (S.G.S.), University of Colorado Anschutz Medical Campus, Aurora, Colorado; Uniformed Services University of the Health Sciences (J.K.M.), Bethesda, Maryland; and Brooke Army Medical Center (J.K.M.), JBSA, Fort Sam Houston, Texas
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4
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Bashiardes S, Christodoulou C. Orally Administered Drugs and Their Complicated Relationship with Our Gastrointestinal Tract. Microorganisms 2024; 12:242. [PMID: 38399646 PMCID: PMC10893523 DOI: 10.3390/microorganisms12020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Orally administered compounds represent the great majority of all pharmaceutical compounds produced for human use and are the most popular among patients since they are practical and easy to self-administer. Following ingestion, orally administered drugs begin a "perilous" journey down the gastrointestinal tract and their bioavailability is modulated by numerous factors. The gastrointestinal (GI) tract anatomy can modulate drug bioavailability and accounts for interpatient drug response heterogeneity. Furthermore, host genetics is a contributor to drug bioavailability modulation. Importantly, a component of the GI tract that has been gaining notoriety with regard to drug treatment interactions is the gut microbiota, which shares a two-way interaction with pharmaceutical compounds in that they can be influenced by and are able to influence administered drugs. Overall, orally administered drugs are a patient-friendly treatment option. However, during their journey down the GI tract, there are numerous host factors that can modulate drug bioavailability in a patient-specific manner.
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Affiliation(s)
- Stavros Bashiardes
- Molecular Virology Department, Cyprus Institute of Neurology and Genetics, Iroon Avenue 6, Nicosia 2371, Cyprus;
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5
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Sabharwal KA, Simon MW. Arm or Leg? The best site for injections in pediatric patients. Front Pediatr 2023; 11:1323337. [PMID: 38188920 PMCID: PMC10769485 DOI: 10.3389/fped.2023.1323337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
| | - Michael W. Simon
- Department of Pediatrics, University of Kentucky, Lexington, KY, United States
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6
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Hasan M, Khatun A, Kogure K. Intradermal Delivery of Naked mRNA Vaccines via Iontophoresis. Pharmaceutics 2023; 15:2678. [PMID: 38140019 PMCID: PMC10747697 DOI: 10.3390/pharmaceutics15122678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Messenger RNA (mRNA) vaccines against infectious diseases and for anticancer immunotherapy have garnered considerable attention. Currently, mRNA vaccines encapsulated in lipid nanoparticles are administrated via intramuscular injection using a needle. However, such administration is associated with pain, needle phobia, and lack of patient compliance. Furthermore, side effects such as fever and anaphylaxis associated with the lipid nanoparticle components are also serious problems. Therefore, noninvasive, painless administration of mRNA vaccines that do not contain other problematic components is highly desirable. Antigen-presenting cells reside in the epidermis and dermis, making the skin an attractive vaccination site. Iontophoresis (ItP) uses weak electric current applied to the skin surface and offers a noninvasive permeation technology that enables intradermal delivery of hydrophilic and ionic substances. ItP-mediated intradermal delivery of biological macromolecules has also been studied. Herein, we review the literature on the use of ItP technology for intradermal delivery of naked mRNA vaccines which is expected to overcome the challenges associated with mRNA vaccination. In addition to the physical mechanism, we discuss novel biological mechanisms of iontophoresis, particularly ItP-mediated opening of the skin barriers and the intracellular uptake pathway, and how the combined mechanisms can allow for effective intradermal delivery of mRNA vaccines.
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Affiliation(s)
- Mahadi Hasan
- Department of Animal Disease Model, Research Center for Experimental Modeling Human Disease, Kanazawa University, Kanazawa 920-8640, Japan; (M.H.); (A.K.)
| | - Anowara Khatun
- Department of Animal Disease Model, Research Center for Experimental Modeling Human Disease, Kanazawa University, Kanazawa 920-8640, Japan; (M.H.); (A.K.)
| | - Kentaro Kogure
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8505, Japan
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7
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Patil A, Mirando AC, Liatsou I, Sgouros G, Popel AS, Pandey NB. Gel-forming therapeutic peptide exhibits sustained delivery and efficacy in a mouse model of triple-negative breast cancer. Peptides 2023; 169:171075. [PMID: 37591441 PMCID: PMC10529050 DOI: 10.1016/j.peptides.2023.171075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
Triple-negative breast cancer (TNBC) is a particularly aggressive and invasive subtype of breast cancer that represents a major cause of death of women worldwide. Here we describe the efficacy of an integrin-binding antiangiogenic peptide in a variety of delivery methods and dosing conditions. This peptide, AXT201, demonstrated consistent anti-tumor efficacy when administered intraperitoneally, subcutaneously, and intratumorally, and retained this activity even when dosing frequency was reduced to once every two weeks. Finally, in vivo imaging and biodistribution studies of AXT201 showed a long-term persistence of at least 10 days at the site of injection and a stable detectable signal in the blood over 48 h, indicating a sustained release profile. Taken together, these findings indicate AXT201 exhibits favorable pharmacokinetic properties for a 20-mer peptide.
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Affiliation(s)
- Akash Patil
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Adam C Mirando
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA; AsclepiX Therapeutics, Inc., Baltimore, MD, USA.
| | - Ioanna Liatsou
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Sgouros
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aleksander S Popel
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Niranjan B Pandey
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA; AsclepiX Therapeutics, Inc., Baltimore, MD, USA
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8
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Li B, Qi F, Zhu F, Lu Z, Wang M, Chu T, Wu S, Wei J, Song Z, Sukumar S, Zhang C, Xu J, Li S, Nie G. Nanoparticle-Based Combination Therapy Enhances Fulvestrant Efficacy and Overcomes Tumor Resistance in ER-Positive Breast Cancer. Cancer Res 2023; 83:2924-2937. [PMID: 37326467 DOI: 10.1158/0008-5472.can-22-3559] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/25/2023] [Accepted: 06/13/2023] [Indexed: 06/17/2023]
Abstract
Nanoparticles (NP) spanning diverse materials and properties have the potential to encapsulate and to protect a wide range of therapeutic cargos to increase bioavailability, to prevent undesired degradation, and to mitigate toxicity. Fulvestrant, a selective estrogen receptor degrader, is commonly used for treating patients with estrogen receptor (ER)-positive breast cancer, but its broad and continual application is limited by poor solubility, invasive muscle administration, and drug resistance. Here, we developed an active targeting motif-modified, intravenously injectable, hydrophilic NP that encapsulates fulvestrant to facilitate its delivery via the bloodstream to tumors, improving bioavailability and systemic tolerability. In addition, the NP was coloaded with abemaciclib, an inhibitor of cyclin-dependent kinases 4 and 6 (CDK4/6), to prevent the development of drug resistance associated with long-term fulvestrant treatment. Targeting peptide modifications on the NP surface assisted in the site-specific release of the drugs to ensure specific toxicity in the tumor tissues and to spare normal tissue. The NP formulation (PPFA-cRGD) exhibited efficient tumor cell killing in both in vitro organoid models and in vivo orthotopic ER-positive breast cancer models without apparent adverse effects, as verified in mouse and Bama miniature pig models. This NP-based therapeutic provides an opportunity for continual and extensive clinical application of fulvestrant, thus indicating its promise as a treatment option for patients with ER-positive breast cancer. SIGNIFICANCE A smart nanomedicine encapsulating fulvestrant to improve its half-life, bioavailability, and tumor-targeting and coloaded with CDK4/6 inhibitor abemaciclib to block resistance is a safe and effective therapy for ER-positive breast cancer.
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Affiliation(s)
- Bozhao Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
- College of Pharmaceutical Science, Jilin University, Changchun, P.R. China
| | - Feilong Qi
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
- Key Lab of Organic Optoelectronics and Molecular Engineering, Department of Chemistry, Tsinghua University, Beijing, P.R. China
| | - Fei Zhu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
| | - Zefang Lu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
| | - Meiqi Wang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Tianjiao Chu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
- College of Pharmaceutical Science, Jilin University, Changchun, P.R. China
| | - Suying Wu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
| | - Jingyan Wei
- College of Pharmaceutical Science, Jilin University, Changchun, P.R. China
| | - Zhenchuan Song
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cheng Zhang
- School of Computer Science, Key Lab of High Confidence Software Technologies, Peking University, Beijing, P.R. China
| | - Jiangfei Xu
- Key Lab of Organic Optoelectronics and Molecular Engineering, Department of Chemistry, Tsinghua University, Beijing, P.R. China
| | - Suping Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
- College of Pharmaceutical Science, Jilin University, Changchun, P.R. China
- GBA Research Innovation Institute for Nanotechnology, Guangzhou, P.R. China
| | - Guangjun Nie
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, P.R. China
- College of Pharmaceutical Science, Jilin University, Changchun, P.R. China
- GBA Research Innovation Institute for Nanotechnology, Guangzhou, P.R. China
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9
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Kowatari R, Sasaki H, Murata K, Sato K, Sagawa K, Kudo M, Minakawa M. Establishment of prediction equations for subcutaneous tissue thickness in two representative intramuscular deltoid injections. Vaccine X 2023; 14:100316. [PMID: 37275271 PMCID: PMC10239006 DOI: 10.1016/j.jvacx.2023.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
This study clarifies the predicted subcutaneous shoulder depth and investigates the safety of the conventional (three-finger breadth method) and new (axillary method) intramuscular injection methods. The anatomical features of 245 volunteers who received the COVID-19 vaccination via the conventional method were investigated at the injection site (T point) and the hypothetical injection site using the new method (A point) via ultrasonography. The body mass index (BMI) and subcutaneous thickness at the T point (men: r = 0.75; women: r = 0.45) and the A point (men: r = 0.81; women: r = 0.55) were positively correlated. The upper arm circumference and subcutaneous thickness at the T point (r = 0.51) and the A point (r = 0.58) were correlated in women. Formulas to predict subcutaneous thickness using BMI and upper arm circumference were established: predicted subcutaneous thickness at the A point = 0.62 × BMI - 7.7 mm (R2 = 0.66) in men and 0.658 × BMI - 5.5 mm (R2 = 0.31) in women. This study demonstrates safe intramuscular injection sites and their depth.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Hanae Sasaki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Kenyu Murata
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
| | - Ken Sato
- Hirosaki University Health Administration Center, Japan
| | - Koichi Sagawa
- Hirosaki University Graduate School of Science and Technology, Japan
| | - Masako Kudo
- Hirosaki University Hospital Nursing Department, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Japan
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10
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Ogston-Tuck S. Intramuscular injection: exploring the evidence on effective administration. Nurs Stand 2023; 38:71-76. [PMID: 37357532 DOI: 10.7748/ns.2023.e12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/27/2023]
Abstract
Administering medicines by intramuscular (IM) injection is a familiar, though not necessarily common, nursing procedure. To ensure effective administration of IM injections it is important that nurses are up to date with the evidence on factors such as selection of injection site, use of appropriate equipment and injection technique. This article explores the evidence on effective administration of IM injections with the aim of enhancing nurses' decision-making and technique when undertaking this procedure.
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Affiliation(s)
- Sherri Ogston-Tuck
- Institute of Health & Society, University of Worcester, Worcester, England
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11
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Salalli R, Dange JR, Dhiman S, Sharma T. Vaccines development in India: advances, regulation, and challenges. Clin Exp Vaccine Res 2023; 12:193-208. [PMID: 37599804 PMCID: PMC10435768 DOI: 10.7774/cevr.2023.12.3.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/02/2023] [Accepted: 05/05/2023] [Indexed: 08/22/2023] Open
Abstract
One of the most significant medical advancements in human history is the development of vaccines. Progress in vaccine development has always been greatly influenced by scientific human innovation. The main objective of vaccine development would be to acquire sufficient evidence of vaccine effectiveness, immunogenicity, safety, and/or quality to support requests for marketing approval. Vaccines are biological products that enhance the body's defenses against infectious diseases. From the first smallpox vaccine to the latest notable coronavirus disease 2019 nasal vaccine, India has come a long way. The development of numerous vaccines, driven by scientific innovation and advancement, combined with researcher's knowledge, has helped to reduce the global burden of disease and mortality rates. The Drugs and Cosmetics Rules of 1945 and the New Drugs and Clinical Trials Rules of 2019 specify the requirements and guidelines for CMC (chemistry, manufacturing, and controls) for all manufactured and imported vaccines, including those against coronavirus infections. This article provides an overview of the regulation pertaining to the development process, registration, and approval procedures for vaccines, particularly in India, along with their brief history.
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Affiliation(s)
- Rakshita Salalli
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Jyoti Ram Dange
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sonia Dhiman
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Teenu Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Deaney M, Terasaki D. Intramuscular, extended-release naltrexone inadvertently administered in the deltoid muscle: A case report. J Am Pharm Assoc (2003) 2023; 63:1245-1248. [PMID: 37207707 DOI: 10.1016/j.japh.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Extended-release, intramuscular (IM) naltrexone can be an effective and convenient medication option for alcohol use disorder. We sought to assess the clinical impact of an alternate, if inadvertent, administration of IM naltrexone in the deltoid muscle instead of the recommended gluteal muscle. CASE SUMMARY IM naltrexone was prescribed to a hospitalized 28-year-old man with severe alcohol use disorder as part of an inpatient clinical trial. A nurse unfamiliar with naltrexone administration mistakenly administered the drug to the deltoid instead of the gluteal muscle recommended by the manufacturer. Despite concerns that injection of the large-volume suspension to the smaller muscle would potentially contribute to increased pain and higher chance of adverse events owing to faster medication absorption, the patient experienced only mild discomfort to the deltoid region, without other adverse events on immediate physical and laboratory examinations. The patient later denied additional adverse events in the period after hospitalization, but he did not endorse any anti-craving effect of the medication, resuming drinking alcohol quickly following initial discharge. PRACTICE IMPLICATIONS This case represents a unique procedural challenge of administering a medication in the inpatient setting that is typically given in the outpatient setting. Inpatient staff members frequently rotate and may be relatively unfamiliar with IM naltrexone, so handling should be limited to personnel who have received focused training on its administration. Fortunately, in this case deltoid administration of naltrexone was well-tolerated and even deemed quite "acceptable" to the patient. Clinically, the medication was insufficiently effective, but biopsychosocial context may have made his AUD especially refractory. More research is needed to fully establish whether naltrexone given via deltoid muscle injection has comparable safety and efficacy to gluteal muscle administration.
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Bchini R, Goutte N. [Evidence-based practice and nursing: intramuscular injection in psychiatry]. Soins Psychiatr 2023; 44:21-26. [PMID: 37328226 DOI: 10.1016/j.spsy.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Intramuscular injection is a frequent technical procedure in psychiatry. In France, nurses who perform this care do not have official guidelines for good practice. The advanced practice nurse is a field actor who can promote evidence-based practice to improve the quality of care for the benefit of the patient.
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Affiliation(s)
- Rayan Bchini
- Groupement hospitalier de territoire Psy Sud Paris, Groupe hospitalier Paul-Guiraud, 54 avenue de la République, BP 20065, 94806 Villejuif cedex, France; Inserm UMR 1018 CESP UPS UVSQ, équipe Moods, Hôpital Paul-Brousse, Bâtiment 15-16, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France; Université Paris Cité 2 rue Valette, 75005 Paris, France.
| | - Nathalie Goutte
- Inserm UMR 1193, Hôpital Paul-Brousse, Groupe hospitalier Paris Sud, 12-14 avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France
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14
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Sblendorio E. Intramuscular vaccine administrations including the adoption of “Zeta-track technique” & “without aspiration slow injection technique” (ZTT & WASiT): a prospective review. FRONTIERS OF NURSING 2023. [DOI: 10.2478/fon-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Objective
To review the current literature on the practice of intramuscular injections (IMIs), focusing on immunizations.
Methods
The present study comprises 2 reviews, characterized by high-quality evidence, pertaining to the deployment of the slow injection technique without aspiration (referred to in this paper as the without-aspiration slow injection technique [WASiT]) and combined with the Zeta-track technique (ZTT). The literature review is oriented toward the analysis of 2 features associated with IMIs techniques: safety and pain, integrating new evidence on vaccinee positioning for each muscle site and general relaxation techniques in the multi-parametric analysis.
Results
The rigorous and in-depth reviews in the current study reveal the usefulness of including, among the international guidelines for via intramuscular immunizations, the adoption of WASiT only for compliant vaccinees, and in combination with all validated techniques for IMIs, and the use of ZTT limitedly if specific well-developed muscles are indicated. All the technique’s limitations are exposed.
Conclusions
Future research directions are presented by including the author’s study designs to provide indirect evidence for the validity of the rationale of the slow injection technique using scientific methods, and for the conduction of future randomized controlled trials (RCTs) focused on revisiting the adoption of ZTT in a dynamic and integrated immunizations protocol in anterolateral thigh (ALT), ventrogluteal (VG), and also in the deltoid muscle, in the specific cases analyzed.
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Affiliation(s)
- Elena Sblendorio
- a Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari , Bari , Italy
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
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Baran L, Güneş Ü, Dönmez H. Investigation of the Necessity of Aspiration During the Intramuscular Injection Administered in the Ventrogluteal Site and Its Effect on Pain: A Randomized Controlled Trial. Clin Nurs Res 2022; 32:821-829. [PMID: 36540016 DOI: 10.1177/10547738221136470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This experimental study, which was conducted to examine the necessity of aspiration procedure and its effect on pain in intramuscular (IM) injections made into the ventrogluteal site (VGS), is randomized controlled and double-blind. The patients in the study group ( n = 834) were assigned to the IM group with the aspiration period of 5 to 10 seconds (Implementation Group A-IGA), the aspiration period of 1 to 2 seconds (Control Group-CG), and no aspiration (Implementation Group B-IGB) according to stratified block randomization list. Patients’ pain levels were evaluated with the Visual Analog Scale (VAS). No bleeding was observed when aspiration periods of 1 to 2 and 5 to 10 seconds were followed during the injections administered to the VGS. The difference between the pain medians of patients in IGB and the CG were not significant ( p = .521). It can be said that there is no need to apply aspiration in IM applied into the VGS if the correct site is determined.
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16
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Exploration of Microneedle-assisted Skin Delivery of Cyanocobalamin formulated in Ultraflexible Lipid Vesicles. Eur J Pharm Biopharm 2022; 177:184-198. [PMID: 35787430 DOI: 10.1016/j.ejpb.2022.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Abstract
Vitamin B12 (cyanocobalamin) deficiency is a widespread condition because of its different aetiologies, like malabsorption syndrome or lifestyles as strict veganism that is increasing its incidence and prevalence in developed countries. It has important haematological consequences that require pharmacological treatment. Current therapy consists of oral or parenteral supplements of cyanocobalamin; however, the oral route is discarded for malabsorption syndrome patients and the parenteral route is not well accepted generally. Topical treatments have been suggested as an alternative, but the molecular weight and hydrophilicity of cyanocobalamin limits its diffusion through the skin. Lipid vesicles can allow the transdermal absorption of molecules >500 Da. The aim of this work was to use different ultraflexible lipid vesicles (transfersomes and ethosomes) to enhance cyanocobalamin transdermal delivery. Vesicles were characterized and lyophilised for long-term stability. The ability to deliver cyanocobalamin through the skin was assessed in vitro using full-thickness porcine skin in Franz diffusion cells. As expected, the best transdermal fluxes were provided by ultraflexible vesicles, in comparison to a drug solution. Moreover, the pre-treatment of the skin with a solid microneedle array boosts the amount of drug that could potentially reach the systemic circulation.
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17
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Charmode S, Sharma S, Kushwaha SS, Mehra S, Sangma SS, Mishra V. Deltoid Intramuscular Injections: A Systematic Review of Underlying Neurovascular Structures to the Muscle and Proposing a Relatively Safer Site. Cureus 2022; 14:e24172. [PMID: 35592188 PMCID: PMC9110073 DOI: 10.7759/cureus.24172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 12/02/2022] Open
Abstract
The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. The review protocol was submitted with PROSPERO (ID: 319251). PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images. The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Twelve deltoid IMI sites and techniques were identified. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); mid-deltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.
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18
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Effects of Injection Volume and Route of Administration on Dolutegravir In Situ Forming Implant Pharmacokinetics. Pharmaceutics 2022; 14:pharmaceutics14030615. [PMID: 35335991 PMCID: PMC8948873 DOI: 10.3390/pharmaceutics14030615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
Due to the versatility of the in situ forming implant (ISFI) drug delivery system, it is crucial to understand the effects of formulation parameters for clinical translation. We utilized ultrasound imaging and pharmacokinetics (PK) in mice to understand the impact of administration route, injection volume, and drug loading on ISFI formation, degradation, and drug release in mice. Placebo ISFIs injected subcutaneously (SQ) with smaller volumes (40 μL) exhibited complete degradation within 30–45 days, compared to larger volumes (80 μL), which completely degraded within 45–60 days. However, all dolutegravir (DTG)-loaded ISFIs along the range of injection volumes tested (20–80 μL) were present at 90 days post-injection, suggesting that DTG can prolong ISFI degradation. Ultrasound imaging showed that intramuscular (IM) ISFIs flattened rapidly post administration compared to SQ, which coincides with the earlier Tmax for drug-loaded IM ISFIs. All mice exhibited DTG plasma concentrations above four times the protein-adjusted 90% inhibitory concentration (PA-IC90) throughout the entire 90 days of the study. ISFI release kinetics best fit to zero order or diffusion-controlled models. When total administered dose was held constant, there was no statistical difference in drug exposure regardless of the route of administration or number of injections.
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19
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Aldossary AM, Ekweremadu CS, Offe IM, Alfassam HA, Han S, Onyali VC, Ozoude CH, Ayeni EA, Nwagwu CS, Halwani AA, Almozain NH, Tawfik EA. A Guide to Oral Vaccination: Highlighting Electrospraying as a Promising Manufacturing Technique toward a Successful Oral Vaccine Development. Saudi Pharm J 2022; 30:655-668. [PMID: 35812139 PMCID: PMC9257926 DOI: 10.1016/j.jsps.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022] Open
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20
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McCartan AJS, Curran DW, Mrsny RJ. Evaluating parameters affecting drug fate at the intramuscular injection site. J Control Release 2021; 336:322-335. [PMID: 34153375 DOI: 10.1016/j.jconrel.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/18/2022]
Abstract
Intramuscular (IM) injections are a well-established method of delivering a variety of therapeutics formulated for parenteral administration. While the wide range of commercial IM pharmaceuticals provide a wealth of pharmacokinetic (PK) information following injection, there remains an inadequate understanding of drug fate at the IM injection site that could dictate these PK outcomes. An improved understanding of injection site events could improve approaches taken by formulation scientists to identify therapeutically effective and consistent drug PK outcomes. Interplay between the typically non-physiological aspects of drug formulations and the homeostatic IM environment may provide insights into the fate of drugs at the IM injection site, leading to predictions of how a drug will behave post-injection in vivo. Immune responses occur by design after e.g. vaccine administration, however immune responses post-injection are not in the scope of this article. Taking cues from existing in vitro modelling technologies, the purpose of this article is to propose "critical parameters" of the IM environment that could be examined in hypothesis-driven studies. Outcomes of such studies might ultimately be useful in predicting and improving in vivo PK performance of IM injected drugs.
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Affiliation(s)
- Adam J S McCartan
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, Avon BA2 7AY, UK
| | - David W Curran
- CMC Analytical, GlaxoSmithKline, Collegeville, PA 19426, USA
| | - Randall J Mrsny
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, Avon BA2 7AY, UK.
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21
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Tessier N, Moawad F, Amri N, Brambilla D, Martel C. Focus on the Lymphatic Route to Optimize Drug Delivery in Cardiovascular Medicine. Pharmaceutics 2021; 13:1200. [PMID: 34452161 PMCID: PMC8398144 DOI: 10.3390/pharmaceutics13081200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022] Open
Abstract
While oral agents have been the gold standard for cardiovascular disease therapy, the new generation of treatments is switching to other administration options that offer reduced dosing frequency and more efficacy. The lymphatic network is a unidirectional and low-pressure vascular system that is responsible for the absorption of interstitial fluids, molecules, and cells from the peripheral tissue, including the skin and the intestines. Targeting the lymphatic route for drug delivery employing traditional or new technologies and drug formulations is exponentially gaining attention in the quest to avoid the hepatic first-pass effect. The present review will give an overview of the current knowledge on the involvement of the lymphatic vessels in drug delivery in the context of cardiovascular disease.
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Affiliation(s)
- Nolwenn Tessier
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; (N.T.); (N.A.)
- Montreal Heart Institute Research Center, Montreal, QC H1T 1C8, Canada
| | - Fatma Moawad
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Department of Pharmaceutics, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Nada Amri
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; (N.T.); (N.A.)
- Montreal Heart Institute Research Center, Montreal, QC H1T 1C8, Canada
| | - Davide Brambilla
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Catherine Martel
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; (N.T.); (N.A.)
- Montreal Heart Institute Research Center, Montreal, QC H1T 1C8, Canada
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22
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Lippner DS, Hildenberger DM, Rhoomes MO, Winborn JN, Dixon H, McDonough J, Rockwood GA. A novel aqueous dimethyl trisulfide formulation is effective at low doses against cyanide toxicity in non-anesthetized mice and rats. Clin Toxicol (Phila) 2021; 60:83-94. [PMID: 34219566 DOI: 10.1080/15563650.2021.1935991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cyanide (CN) is a metabolic poison that is capable of intoxicating individuals through accidental or intentional means. With high concentration exposures, death can occur in minutes. In cases of mass casualty exposures, there is a need for a rapid-acting countermeasure capable of being administered in a short period of time in a pre-hospital setting to treat victims. OBJECTIVE These studies evaluate the safety and efficacy of a novel aqueous formulation of dimethyl trisulfide (DMTS) as an intramuscular (IM) CN countermeasure using non-anesthetized rodent models. METHODS Non-anesthetized rodents (mice and rats) were exposed to hydrogen cyanide (HCN) or potassium cyanide (KCN) along with immediate IM 10% DMTS treatment or vehicle treatment. Survival and other parameters, such as the time to recovery and assessment of clinical toxic signs (e.g., gasping, loss of righting reflex, convulsions, etc.), were quantified to determine the effectiveness of 10% DMTS treatment (12.5, 25, 75 mg/kg IM) compared to vehicle control treatment. A rat KCN delayed-treatment model with a 15-minute treatment delay was also utilized to simulate a real-life exposure/treatment scenario with 10% DMTS treatment. The stability of the 10% DMTS formulation was also assessed. RESULTS A 25 mg/kg IM dose of 10% DMTS exhibits potent efficacy against subcutaneous (SC) KCN challenge in both mice and rats and inhalational HCN exposure in mice. 10% DMTS treatment also shortens the time to recovery in rats using a delayed-treatment model. CONCLUSION IM treatment with 10% DMTS improves survival and clinical outcomes in non-anesthetized rodent models of acute CN toxicity. Additionally, the use of an SC KCN delayed-treatment model in rats is advised to assess the performance of a candidate CN countermeasure in a more realistic exposure/treatment scenario.
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Affiliation(s)
- D S Lippner
- Medical Toxicology Research Division, Biochemistry and Physiology Department, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - D M Hildenberger
- Medical Toxicology Research Division, Biochemistry and Physiology Department, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - M O Rhoomes
- Medical Toxicology Research Division, Biochemistry and Physiology Department, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - J N Winborn
- Medical Toxicology Research Division, Biochemistry and Physiology Department, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - H Dixon
- Southwest Research Institute, San Antonio, TX, USA
| | - J McDonough
- Southwest Research Institute, San Antonio, TX, USA
| | - G A Rockwood
- Medical Toxicology Research Division, Biochemistry and Physiology Department, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
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23
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Ayinde O, Hayward RS, Ross JDC. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PLoS One 2021; 16:e0250883. [PMID: 33939726 PMCID: PMC8092782 DOI: 10.1371/journal.pone.0250883] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
AIM To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults. METHODS The review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported. RESULTS 29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the 'Z track technique' (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants. CONCLUSIONS Manual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.
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Affiliation(s)
- Oluseyi Ayinde
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Rachel S. Hayward
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Jonathan D. C. Ross
- Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
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24
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St Clair-Jones A, Prignano F, Goncalves J, Paul M, Sewerin P. Understanding and Minimising Injection-Site Pain Following Subcutaneous Administration of Biologics: A Narrative Review. Rheumatol Ther 2020; 7:741-757. [PMID: 33206343 PMCID: PMC7672413 DOI: 10.1007/s40744-020-00245-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023] Open
Abstract
Injection-site pain (ISP) is a subjective side effect that is commonly reported with the subcutaneous administration of biological agents, yet it may only be a concern to some. Multiple factors related to the product formulation, such as pH, volume and excipients, and/or to the injection process have the potential to contribute to ISP, while patient-related factors, such as low body weight, gender and age, can make an individual more susceptible to experiencing ISP. While total elimination of ISP remains unlikely with any subcutaneously administered agent, it can be minimised by helping the patient to develop a confident and competent injection technique via robust and effective training. Careful management of patient expectations along with open discussion regarding the potential risk of ISP may serve to minimise treatment-related anxieties and, importantly, allow the patient to remain in control of his/her treatment. Other interventions to help minimise ISP include psychological interventions, allowing biologics to reach room temperature prior to injection, using the most suitable injection device for the individual patient and selecting an alternative drug formulation, when available. Productive patient–physician communication remains important in order to support and optimise treatment experience and adherence, while also providing the opportunity for patients to discuss any ISP-related issues.
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Affiliation(s)
- Anja St Clair-Jones
- Pharmacy Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - Francesca Prignano
- Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Joao Goncalves
- iMed-Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Muriel Paul
- Department of Pharmacy, AP-HP, Henri-Mondor Hospital, Créteil, France
- University of Paris-Est Créteil, Epidemiology in Dermatology and Evaluation of Therapeutics (EpidermE), EA 7379, UPEC, Créteil, 94010, France
| | - Philipp Sewerin
- Department and Hiller Research Unit of Rheumatology, University Clinic Düsseldorf (UKD), Heinrich Heine University, Düsseldorf, Germany
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25
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Li C, Naveed M, Dar K, Liu Z, Baig MMFA, Lv R, Saeed M, Dingding C, Feng Y, Xiaohui Z. Therapeutic advances in cardiac targeted drug delivery: from theory to practice. J Drug Target 2020; 29:235-248. [PMID: 32933319 DOI: 10.1080/1061186x.2020.1818761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most commonly used administration methods in clinics and life are oral administration, intravenous injection, and other systemic administration methods. Targeted administration must be an essential long-term development direction due to the limited availability and a high incidence of systemic side effects. Cardiovascular diseases (CVD) are the leading cause of death all over the world. Targeted drug delivery (TDD) methods with the heart as the target organ have developed rapidly and are diversified. This article reviews the research progress of various TDD methods around the world with a heart as the target organ. It is mainly divided into two parts: the targeting vector represented by nanoparticles and various TDD methods such as intracoronary injection, ventricular wall injection, pericardial injection, and implantable medical device therapy and put forward some suggestions on the development of targeting. Different TDD methods described in this paper have not been widely used in clinical practice, and some have not even completed preclinical studies. Targeted drug delivery still requires long-term efforts by many researchers to realize the true meaning of the heart. HIGHLIGHTS Targeted administration can achieve a better therapeutic effect and effectively reduce the occurrence of adverse reactions. Parenteral administration or medical device implantation can be used for targeted drug delivery. Combined with new dosage forms or new technologies, better-targeted therapy can be achieved. Clinical trials have confirmed the safety and effectiveness of several administration methods.
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Affiliation(s)
- Cuican Li
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
| | - Muhammad Naveed
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China.,School of Pharmacy, Nanjing Medical University, Nanjing, P. R. China
| | - Kashif Dar
- Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, P. R. China
| | - Ziwei Liu
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
| | - Mirza Muhammad Faran Ashraf Baig
- State Key Laboratory of Analytical Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, P. R. China
| | - Rundong Lv
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
| | - Muhammad Saeed
- Faculty of Animal Production and Technology, The Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Chen Dingding
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
| | - Yu Feng
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
| | - Zhou Xiaohui
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R. China.,Department of Heart Surgery, Nanjing Shuiximen Hospital, Nanjing, P. R. China.,Department of Cardiothoracic Surgery, Zhongda Hospital affiliated with Southeast University, Nanjing, P. R. China
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26
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Philips L, Young MK, Wallace J, Dobinson HC. Clinical experience of intramuscular immunoglobulin for measles prophylaxis in children: Is it practical? J Paediatr Child Health 2020; 56:364-366. [PMID: 32043701 DOI: 10.1111/jpc.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
Measles continues to be a public health concern world-wide. Vulnerable individuals including those in which vaccinations is contraindicated, may be reliant on normal human immunoglobulin (NHIG) prophylaxis in an aim to prevent disease. This paper will summarise and discuss a tertiary paediatric hospital's clinical experience and the practicalities of administering intramuscular (IM) NHIG to paediatric patients as per the current measles prophylaxis guidelines in Australia. Following potential exposure within the emergency department, 17 paediatric patients (0-15 years) were recommended IM NHIG for prophylaxis. The dose of NHIG ranged from 0.6 to 15 mL and required multiple (2-8) injections. Two patients required sedation for staff to safely administer the injections. Staff involved with these cases reported administering multiple injections to paediatric patients to be a traumatising experience. They also expressed views that the injection of large volumes via the IM route was an impractical method of administration. Based on this experience, we recommend intravenous immunoglobulin be considered when large volumes of NHIG are recommended intramuscularly.
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Affiliation(s)
- Leanne Philips
- Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Megan K Young
- Metro North Hospital and Health Service, Metro North Public Health Unit, Brisbane, Queensland, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Janet Wallace
- Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Hazel C Dobinson
- Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia
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27
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Abstract
Abstract
Purpose
The changes in physiological functions as children grow and organ systems mature result in pharmacokinetic alterations throughout childhood. These alterations in children result in absorption, distribution, metabolism, and excretion of drugs that are different from those seen in the typical adult diseased population.
Summary
Changes in gastrointestinal motility and gastric pH in neonates and infants affect the absorption rate and bioavailability of drugs. Skin absorption rate and extent can be altered by different skin structures and perfusion in young children. Intramuscular and rectal absorption become less predictable in children due to erratic absorption site perfusion and other factors. Children’s body compositions also differ greatly from that in adults. Water-soluble drugs distribute more extensively in newborns due to larger water content than in older children and adults. Drug elimination and excretion are also affected in pediatric population due to differences in liver and renal function. Immature enzyme development and renal function result in reduced clearance of drugs in young children. There are limited pharmacokinetic data available for many drugs used in children.
Conclusion
Considering the changes in pharmacokinetics in children can help pharmacists optimize the dosing and monitoring of drugs and do the best they can to help this vulnerable population.
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28
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Şanlialp Zeyrek A, Takmak Ş, Kurban NK, Arslan S. Systematic review and meta‐analysis: Physical‐procedural interventions used to reduce pain during intramuscular injections in adults. J Adv Nurs 2019; 75:3346-3361. [DOI: 10.1111/jan.14183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Şenay Takmak
- Institute of Health Sciences Pamukkale University Denizli Turkey
| | - Nevin Kuzu Kurban
- Faculty of Health Sciences Nursing Department Pamukkale University Denizli Turkey
| | - Sümeyye Arslan
- Faculty of Health Sciences Nursing Department Pamukkale University Denizli Turkey
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29
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Davis M, Scroggins I, Bellflower B, Tucker J, Rhodes LN, Knight T. Sacred Cow University: Revealing the Evidence About Intramuscular Injections by Pediatric Nurses in a Tertiary Care Pediatric Hospital. J Pediatr Nurs 2019; 48:123-126. [PMID: 31434635 DOI: 10.1016/j.pedn.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Melissa Davis
- Le Bonheur Children's Hospital, TN, United States of America.
| | - Iva Scroggins
- Le Bonheur Children's Hospital, TN, United States of America
| | - Bobby Bellflower
- University of Tennessee Health Science Center, TN, United States of America
| | - Janet Tucker
- Le Bonheur Children's Hospital, TN, United States of America; University of Tennessee Health Science Center, TN, United States of America
| | - Leslie N Rhodes
- Le Bonheur Children's Hospital, TN, United States of America
| | - Terry Knight
- Le Bonheur Children's Hospital, TN, United States of America
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Nakajima Y, Fujii T, Mukai K, Ishida A, Kato M, Takahashi M, Tsuda M, Hashiba N, Mori N, Yamanaka A, Ozaki N, Nakatani T. Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh. Hum Vaccin Immunother 2019; 16:189-196. [PMID: 31403356 PMCID: PMC7012163 DOI: 10.1080/21645515.2019.1646576] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The anatomical safety of intramuscular injections at the deltoid and ventrogluteal sites has been investigated; however, the anatomical relationship between intramuscular injection sites in the thigh and major blood vessels and nerves remains unclear. We aimed to compare intramuscular injection sites in the rectus femoris and vastus lateralis with those at the deltoid and ventrogluteal sites and identify safe intramuscular injection sites in the thigh. Twenty-seven young adult volunteers were recruited, and the thicknesses of subcutaneous tissue and muscle as well as the number of blood vessels present were evaluated at two sites on the deltoid, ventrogluteal, and thigh using ultrasound equipment. The right thighs of 24 cadavers were used, and the thickness of muscle, number of blood vessels or nerves present, and the distance between each examined site and major blood vessels or nerves were evaluated in the rectus femoris and vastus lateralis. A major blood vessel was observed in the middle of the rectus femoris in young adults. In cadavers, the descending branch of the lateral circumflex femoral artery and muscle branch of the femoral nerves to the vastus lateralis were observed at the middle point, distal two-thirds point, and middle point between the middle and distal two-thirds points of the rectus femoris, but not at the middle of the vastus lateralis. The middle of the vastus lateralis is an appropriate site for intramuscular injections because of the low risk of vascular or nerve damage. The present results support good practices for site selection for intramuscular injections.
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Affiliation(s)
- Yukari Nakajima
- Division of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Taiga Fujii
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
| | - Kanae Mukai
- Division of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Asami Ishida
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Moeka Kato
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mao Takahashi
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mihiro Tsuda
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Nanami Hashiba
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Namiko Mori
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Ayaka Yamanaka
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriyuki Ozaki
- Department of Functional Anatomy, Graduate school of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshio Nakatani
- Division of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Homayun B, Lin X, Choi HJ. Challenges and Recent Progress in Oral Drug Delivery Systems for Biopharmaceuticals. Pharmaceutics 2019; 11:E129. [PMID: 30893852 PMCID: PMC6471246 DOI: 10.3390/pharmaceutics11030129] [Citation(s) in RCA: 365] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 01/08/2023] Open
Abstract
Routes of drug administration and the corresponding physicochemical characteristics of a given route play significant roles in therapeutic efficacy and short term/long term biological effects. Each delivery method has favorable aspects and limitations, each requiring a specific delivery vehicles design. Among various routes, oral delivery has been recognized as the most attractive method, mainly due to its potential for solid formulations with long shelf life, sustained delivery, ease of administration and intensified immune response. At the same time, a few challenges exist in oral delivery, which have been the main research focus in the field in the past few years. The present work concisely reviews different administration routes as well as the advantages and disadvantages of each method, highlighting why oral delivery is currently the most promising approach. Subsequently, the present work discusses the main obstacles for oral systems and explains the most recent solutions proposed to deal with each issue.
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Affiliation(s)
- Bahman Homayun
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada.
| | - Xueting Lin
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada.
| | - Hyo-Jick Choi
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada.
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Body Mass Index: A Reliable Predictor of Subcutaneous Fat Thickness and Needle Length for Ventral Gluteal Intramuscular Injections. Am J Ther 2019; 26:e72-e78. [DOI: 10.1097/mjt.0000000000000474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Use of Encapsulation Technology to Improve the Efficiency of an Iron Oral Supplement to Prevent Anemia in Suckling Pigs. Animals (Basel) 2018; 9:ani9010001. [PMID: 30577432 PMCID: PMC6357104 DOI: 10.3390/ani9010001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/16/2022] Open
Abstract
Simple Summary In animal nutrition, encapsulation technologies have been poorly explored, even though they may improve oral iron supplementation in suckling pigs. We hypothesized that the encapsulation of an oral supplement could enhance iron bioavailability for suckling pigs. We compared the levels of biomarkers for iron nutritional status among three groups of animals: piglets receiving oral encapsulated supplements, individuals receiving oral non-encapsulated supplements (as control group), and animals who were supplemented by parenteral route (strategy currently used in pig production systems). All treatments prevented anemia at weaning; however, only oral treatments prevented the first stage of anemia, which is iron depletion. In conclusion, piglets supplemented with encapsulated iron showed a higher concentration of serum ferritin and, therefore, had better iron reserves. Abstract The objective of this study was to develop an encapsulated iron supplement for oral ingestion and to determine its effect on the iron nutrition status of suckling pigs. Encapsulated and non-encapsulated iron supplement was prepared. Seventy-two neonatal piglets were assigned to three experimental groups: (1) parenteral group (gold standard treatment), which received one dose of parenteral iron (200 mg), 2 days of age, (2) “non-encapsulated” group (as a control group), which received 4 oral doses of unencapsulated iron supplement at 2, 7, 12 and 17 days of age, and (3) “encapsulated” group, which received 4 oral doses of encapsulated iron supplement on the same days. The encapsulated and unencapsulated iron supplements contained 65.2 and 65.0 mg/iron/dose, respectively. Parenteral treatment was not sufficient to ensure an adequate iron nutritional state in piglets at the end of the lactation period, showing iron depletion (serum ferritin: 8.4 µg/L). In contrast, oral supplementation prevented the development of iron depletion. Higher serum ferritin values were observed in the encapsulated (19.9 µg/L) compared to the unencapsulated group (17.4 µg/L) (p = 0.020). In conclusion, the use of four oral doses of an encapsulated iron supplement prevents iron deficiency anemia and its previous stages in suckling pigs.
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Analysis of gluteal subcutaneous and muscle thickness in infants and children for application to intramuscular injection, autologous fat grafting, and gluteal artery perforator flaps. Arch Plast Surg 2018; 45:550-556. [PMID: 30466235 PMCID: PMC6258979 DOI: 10.5999/aps.2017.01760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/12/2018] [Indexed: 11/08/2022] Open
Abstract
Background To achieve improvements in intramuscular injection, autologous fat grafting, and gluteal artery perforator flaps in infants and children, the relationships of computed tomography (CT)-determined gluteal muscle thickness (MT) and subcutaneous tissue thickness (SCT) with age and body mass index (BMI) were analyzed. Methods Gluteal SCT and MT at ventrogluteal (VG) and dorsogluteal (DG) sites were measured in a standardized manner in 350 patients aged 0 to 6 years who had visited a tertiary hospital and had undergone abdominopelvic CT between January 2005 and December 2016. Recorded measurements were analyzed using one-way analysis of variance and stepwise multiple regression to identify the factors that were most closely related to MT and SCT. Results Subcutaneous tissue at VG sites was thinner than at DG sites, but not significantly so in any age group. Muscles tended to be thinner at VG sites in 4 to 7-year-old, but thicker at VG sites in 1 to 3-year-old, though the differences were not significant. MT in the VG and DG regions was found to be related to age, and SCT in these regions to be related to age and BMI. Conclusions The VG and DG sites should be considered as alternatives for intramuscular injection in infants and children when the anterolateral site is problematic. In addition, considering the gluteal MT and SCT of infants and children should help produce good results in autologous fat grafting and gluteal artery perforator flap harvesting.
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Larkin TA, Elgellaie A, Ashcroft E. Comparison of the G and V methods for ventrogluteal site identification: Muscle and subcutaneous fat thicknesses and considerations for successful intramuscular injection. Int J Ment Health Nurs 2018; 27:631-641. [PMID: 28752590 DOI: 10.1111/inm.12346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/15/2017] [Indexed: 11/28/2022]
Abstract
The ventrogluteal site is increasingly recommended for long-acting antipsychotic intramuscular injections; however, it remains infrequently utilized due to nurses' lack of confidence in site identification. The more recent G (geometric) method of ventrogluteal site identification is less subjective and likely more reliable than the V method for successful intramuscular injection outcomes. Knowledge of muscle and subcutaneous fat thicknesses, and the influence of sex and anthropometry on theoretical injection outcome, is necessary to support evidence-based use of the ventrogluteal site. In the presents study, we compared the V and G methods for injection site subcutaneous fat, muscle, and total tissue thicknesses, and theoretical injection outcome (bone injury, intramuscular or subcutaneous), and determined anthropometric predictors of injection outcome. Subcutaneous fat and muscle thicknesses were measured via ultrasound, bilaterally at V and G method sites (28 males, 32 females). Muscle and total tissue were significantly thicker, and successful intramuscular injection significantly more likely, using the G versus V method (75% versus 57%). Females had significantly thicker subcutaneous fat than males at both sites. Even using the G method, 92% of males but only 59% of females, would have a successful intramuscular injection, with remaining females at risk of bone injury (16%) or subcutaneous injection (25%). The G method site is more reliable for successful intramuscular injection, with less risk of bone injury than the V method site. Appropriate needle-length selection is essential for females with a body mass index (BMI) <23 kg m-2 and weight <60 kg (to avoid bone injury), and BMI >30 kg m-2 and hip >90 cm (to avoid subcutaneous injection).
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Affiliation(s)
- Theresa A Larkin
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Asmahan Elgellaie
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elfriede Ashcroft
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Larkin TA, Ashcroft E, Hickey BA, Elgellaie A. Influence of gender, BMI and body shape on theoretical injection outcome at the ventrogluteal and dorsogluteal sites. J Clin Nurs 2017; 27:e242-e250. [DOI: 10.1111/jocn.13923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Theresa A Larkin
- School of Medicine; University of Wollongong; Wollongong NSW Australia
- Illawarra Health and Medical Research Institute; Wollongong NSW Australia
| | - Elfriede Ashcroft
- School of Medicine; University of Wollongong; Wollongong NSW Australia
| | - Blake A Hickey
- School of Medicine; University of Wollongong; Wollongong NSW Australia
| | - Asmahan Elgellaie
- School of Medicine; University of Wollongong; Wollongong NSW Australia
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Nagy CF, Leach TS, King A, Guttendorf R. Safety, Pharmacokinetics, and Immunogenicity of Obiltoxaximab After Intramuscular Administration to Healthy Humans. Clin Pharmacol Drug Dev 2017; 7:652-660. [PMID: 29125719 PMCID: PMC6668011 DOI: 10.1002/cpdd.410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/24/2017] [Indexed: 12/15/2022]
Abstract
Inhalational anthrax is a highly lethal infection caused by Bacillus anthracis and a serious bioterrorism threat. Protective antigen (PA) is a critical component required for the virulence of Bacillus anthracis. Obiltoxaximab, a high‐affinity monoclonal antibody that neutralizes PA, is approved in the United States for intravenous use for the treatment of inhalational anthrax in combination with appropriate antibacterial drugs and for prophylaxis of inhalational anthrax when alternative therapies are not available or appropriate. Here, we explored the safety, pharmacokinetics (PK), and immunogenicity of obiltoxaximab administered by intramuscular injection at doses of 4, 8, 16, 20, and 24 mg/kg in healthy humans. Systemic exposures were approximately dose proportional, maximum serum concentrations were observed after 6–9 days, and terminal half‐life ranged from 16 to 23 days. Average absolute intramuscular bioavailability was 64%. Obiltoxaximab was well tolerated, and local tolerability was acceptable up to 24 mg/kg intramuscularly, up to 6 injections per dose, and up to 5 mL per injection. No injection‐site abscesses or hypersensitivity reactions occurred; no subjects developed treatment‐emergent antitherapeutic antibodies over the study period of 71 days.
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Affiliation(s)
- Christa F Nagy
- Department of Clinical Operations, Elusys Therapeutics, Inc., Pine Brook, NJ, USA
| | | | - Alex King
- Covance Clinical Research Unit, Inc., Dallas, TX, USA
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Atay S, Yilmaz Kurt F, Akkaya G, Karatağ G, Ilhan Demir Ş, Çalidağ U. Investigation of suitability of ventrogluteal site for intramuscular injections in children aged 36 months and under. J SPEC PEDIATR NURS 2017; 22. [PMID: 28884891 DOI: 10.1111/jspn.12187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/05/2017] [Accepted: 05/29/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was performed to determine suitability of ventrogluteal (VG) site for intramuscular (IM) injections in children aged 36 months and under. DESIGN AND METHODS The present study was designed as a prospective descriptive study and performed between 2016 January and June. The study included a total of 120 children aged 36 months and under that met the study criteria. The subcutaneous tissue thickness and muscle thickness of anterolateral, deltoid, and VG sites were measured and assessed by ultrasound. RESULT A strong and powerful correlation was identified between the measurements of subcutaneous tissue and muscle thicknesses in the injection site by the age groups. The thickness of subcutaneous tissue was deltoid < anterolateral < VG by age groups. The muscle thickness of anterolateral and VG sites was significantly higher than that of deltoid site. PRACTICE IMPLICATIONS This study established that skin thickness of VG site was suitable for IM injection in children aged 36 months and under.
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Affiliation(s)
- Selma Atay
- Fundamental Nursing Department, Çanakkale Onsekiz Mart University, School of Health, Çanakkale, Turkey
| | - Fatma Yilmaz Kurt
- Pediatric Nursing Department, Çanakkale Onsekiz Mart University, School of Health, Çanakkale, Turkey
| | - Gülnur Akkaya
- Nursing Management Department, Çanakkale Onsekiz Mart University, School of Health, Çanakkale, Turkey
| | - Gülden Karatağ
- Radiology specialist, Çanakkale Goverment Hospital, Çanakkale
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Dolan SB, Patel M, Hampton LM, Burnett E, Ehlman DC, Garon J, Cloessner E, Chmielewski E, Hyde TB, Mantel C, Wallace AS. Administering Multiple Injectable Vaccines During a Single Visit-Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally. J Infect Dis 2017; 216:S152-S160. [PMID: 28838188 PMCID: PMC5853974 DOI: 10.1093/infdis/jix054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background. In 2013, the World Health Organization’s (WHO’s) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, “multiple injections”) during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques. Methods. Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children’s Fund data from 2013–2015 were used to assess multiple-injection visits included in national immunization schedules. Results. Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013–2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit. Conclusion. The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leaders, health workers, and professional societies, thus encouraging uptake of IPV as a second or third injection in an accelerated manner globally.
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Affiliation(s)
- Samantha B Dolan
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Manish Patel
- Global Immunization Division, Centers for Disease Control and Prevention.,Task Force for Global Health, Decatur, Georgia
| | - Lee M Hampton
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Eleanor Burnett
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Daniel C Ehlman
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Julie Garon
- Emory University School of Medicine, Atlanta
| | - Emily Cloessner
- Global Immunization Division, Centers for Disease Control and Prevention
| | | | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention
| | - Carsten Mantel
- Department of Immunization, Vaccines, and Biologicals, World Health Organization,Geneva, Switzerland
| | - Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention
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Sari D, Şahin M, Yaşar E, Taşkiran N, Telli S. Investigation of Turkish nurses frequency and knowledge of administration of intramuscular injections to the ventrogluteal site: Results from questionnaires. NURSE EDUCATION TODAY 2017; 56:47-51. [PMID: 28666144 DOI: 10.1016/j.nedt.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/28/2017] [Accepted: 06/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Intramuscular injection is important in the administration of parenteral medication and is a frequently-performed nursing responsibility. OBJECTIVE The objective of this study was to identify the frequency of use of the ventrogluteal site and the level of nurses' knowledge of administering an intramuscular injection to this site. DESIGN A descriptive cross-sectional study was conducted of nurses working in four hospitals (n=362). Data collection tools included a 12 item sociodemographic questionnaire and a 24 item questionnaire on knowledge of the ventrogluteal site for intramuscular injection. FINDINGS 17.1% of participants reported using the VG site frequently in intramuscular injections. On the other hand, 35.9% reported that they do not use the VG site in intramuscular injections just because they are not used to giving injections on this site. Level of knowledge of ventrogluteal site was also limited with the mean score of correct answers from 24 questions being 14.37. CONCLUSION It was found in the study that nurses' knowledge of the ventrogluteal site was limited, and they are not preferentially using the ventrogluteal site for intramuscular injections to adults even though it is recommended in recent nursing literature.
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Affiliation(s)
- Dilek Sari
- Ege University, College of Nursing, Dept. of Fundamentals of Nursing, İzmir, Turkey
| | - Melek Şahin
- 75th Year Milas Government Hospital, Muğla, Turkey
| | - Eda Yaşar
- Celal Bayar University, College of Health, Manisa, Turkey
| | - Nihal Taşkiran
- Adnan Menderes University, College of Nursing, Dept. of Fundamentals of Nursing, Aydın, Turkey.
| | - Sevil Telli
- İzmir Economy University, Health Vocational College, İzmir, Turkey
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Nakajima Y, Mukai K, Takaoka K, Hirose T, Morishita K, Yamamoto T, Yoshida Y, Urai T, Nakatani T. Establishing a new appropriate intramuscular injection site in the deltoid muscle. Hum Vaccin Immunother 2017; 13:2123-2129. [PMID: 28604191 PMCID: PMC5612213 DOI: 10.1080/21645515.2017.1334747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is becoming increasingly important for clinicians to identify a safer intramuscular (IM) injection site in the deltoid muscle because of possible complications following the vaccine administration of IM injections. We herein examined 4 original IM sites located on the perpendicular line through the mid-acromion to establish a safer IM injection site. Thirty healthy volunteers participated in this study and the distances from our 4 IM sites to some anatomical landmarks on their left arms were measured. Ultrasonography (US) was also performed to measure the thickness of the deltoid muscle and identify the posterior circumflex humeral artery (PCHA) along the course of the axillary nerve. Subcutaneous thickness was measured using 2 methods: measuring the skin thickness with caliper after pinching the skin, and with US. The results obtained revealed that the intersection between the anteroposterior axillary line (the line between the upper end of the anterior axillary line and the upper end of the posterior axillary line) and the perpendicular line from the mid-acromion was the most appropriate site for IM injections because it was distant from the axillary nerve, PCHA, and subdeltoid/subacromial brusa. At this site, depth of needle insertions was 5 mm greater than the subcutaneous thickness at a 90° angle, which was sufficient to penetrate subcutaneous tissue in both sexes. Subcutaneous thickness can be assessed with almost the same accuracy by US or measuring with calipers after pinching the skin. The results of the present study support the improved vaccine practice for safer IM injections.
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Affiliation(s)
- Yukari Nakajima
- a Graduate Course of Nursing Science, Division of Health Sciences , Graduate School of Medical Sciences, Kanazawa University , Kanazawa , Japan
| | - Kanae Mukai
- b Institute of Medical, Pharmaceutical and Health Sciences , Kanazawa University , Kanazawa , Japan
| | - Kana Takaoka
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Toshiko Hirose
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Keiko Morishita
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Takuya Yamamoto
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Yuka Yoshida
- c School of Health Sciences, College of Medical , Pharmaceutical and Health Sciences, Kanazawa University , Kanazawa , Japan
| | - Tamae Urai
- a Graduate Course of Nursing Science, Division of Health Sciences , Graduate School of Medical Sciences, Kanazawa University , Kanazawa , Japan
| | - Toshio Nakatani
- b Institute of Medical, Pharmaceutical and Health Sciences , Kanazawa University , Kanazawa , Japan
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Kim HJ, Park SK, Park SH. Upper limb nerve injuries caused by intramuscular injection or routine venipuncture. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.2.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hyun Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
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Rotator cuff tear resulting from intratendinous injection during attempted deltoid intramuscular vaccination: a report of two cases. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Effect of the Z-Track Technique on Pain and Drug Leakage in Intramuscular Injections. CLIN NURSE SPEC 2016; 30:E7-E12. [DOI: 10.1097/nur.0000000000000245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yılmaz DK, Dikmen Y, Köktürk F, Dedeoğlu Y. The effect of air-lock technique on pain at the site of intramuscular injection. Saudi Med J 2016; 37:304-8. [PMID: 26905354 PMCID: PMC4800896 DOI: 10.15537/smj.2016.3.13113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 01/23/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the effects of air-lock technique (ALT) on pain of intramuscular (IM) injection delivered to the ventrogluteal and dorsogluteal site (DS). METHODS A randomized controlled trial design was used to assess the pain intensity associated with IM injections administered using 2 different methods and injection sites. Recruitment of patients was carried out between April and August 2013 at the Department of Brain Surgery, Cekirge State Hospital, Bursa, Turkey. The sample comprised 60 patients who developed no complications at the IM site, and had no illness that could affect their perception of pain. The patients were randomly divided into 2 groups of 30 patients. Patients in the first group received injections in the ventrogluteal site (VS), while the DS was used for injections in the second group. Patients in each group received 2 injections, one using ALT and one not using the technique. After each injection, the pain felt by patients during the injection was immediately assessed using a visual analog scale. RESULTS The mean pain score after injections to the DS by the ALT was 3.30 ± 2.70, while the mean pain score after injections to the VS using the same technique was 2.53 ± 2.52. CONCLUSION Although the difference between groups was not significant, the results of the study supported the idea that injections delivered to the VS by ALT are less painful than those delivered to the DS.
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Affiliation(s)
- Dilek K Yılmaz
- Department of Nursing, School of Health, Uludag University, Görükle, Bursa, Turkey. E-mail.
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Coskun H, Kilic C, Senture C. The evaluation of dorsogluteal and ventrogluteal injection sites: a cadaver study. J Clin Nurs 2016; 25:1112-9. [PMID: 26868292 DOI: 10.1111/jocn.13171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to measure the thickness of the muscles in the dorsogluteal and the ventrogluteal injection sites and to determine which injection site is farther away from the neurovascular structures. BACKGROUND Although the dorsogluteal region is frequently used for intramuscular injections, the ventrogluteal region is suggested as a more secure injection site due to its distance to the neurovascular structures. However, there are no measurements regarding the distances of these structures. Due to this reason, the distance between these injection sites and the neurovascular structures should be measured. DESIGN This study is a descriptive study that used cadavers to measure the distance between the injection sites and the neurovascular structures. METHODS The study was conducted on 29 cadavers fixed with 10% formalin. The needle was advanced until reaching its end point. A 1·5-inch needle was used for the injections in both regions. The gluteal region was dissected. Parameters were measured with a digital vernier calliper. Data Analysis was performed using spss and the Wilcoxon Signed-Rank Test was used to examine differences among measurements from the two injection regions. Data were collected between February and May 2014. RESULTS Sum of the thickness of the muscles is greater in the dorsogluteal region. The ventrogluteal region is farther than the dorsogluteal region from neurovascular structures. For the ventrogluteal injection administered from the same side, total thickness of the muscle was 22·22 ± 5 mm, distance to the superior gluteal artery was 13·87 ± 16 mm and distance to the superior gluteal nerve was 11·82 ± 14 mm. For the dorsogluteal injection, total thickness of the muscle was 28·35 ± 7 mm, distance to the superior gluteal artery was 6·83 ± 9 mm, and distance to the superior gluteal nerve was 5·67 ± 9 mm. CONCLUSION Intramuscular injections must be based on an individual clinical assessment of each patient. RELEVANCE TO CLINICAL PRACTICE The ventrogluteal region is preferred as the first-choice injection site. A needle of recommended length should be used to reach the target muscle.
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Affiliation(s)
- Halise Coskun
- School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
| | - Cenk Kilic
- Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey
| | - Cicek Senture
- School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
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Gülnar E, Özveren H. An evaluation of the effectiveness of a planned training program for nurses on administering intramuscular injections into the ventrogluteal site. NURSE EDUCATION TODAY 2016; 36:360-363. [PMID: 26438073 DOI: 10.1016/j.nedt.2015.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/24/2015] [Accepted: 09/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Nurses commonly use the dorsogluteal area for administering intramuscular injections. Since the dorsogluteal area has the potential of leading to serious complications, the ventrogluteal area is recommended as the best alternative. OBJECTIVE This study was carried out to determine the level of knowledge nurses have about the ventrogluteal site and the effects of the training provided in this context. METHOD AND DESIGN The study was of quasi-experimental design with a single group based on a pre-test/post-test time sequence and was conducted with 81 nurses who consented to participate in the research at a University Hospital. Data in the research were collected with a questionnaire on the identifying features of the nurses and a questionnaire that contained statements about the ventrogluteal area. RESULTS The results of the study revealed that before the training, 76.5% of the nurses most commonly used the dorsogluteal area and 7.4% the ventrogluteal region. Four months after the training, however, it was found that the rate of nurses using the dorsogluteal area had fallen (48.1%) while the rate of using the ventrogluteal site rose (34.6%). It was seen that there was a significant difference between the nurses' pre-training and post-training knowledge scores and their scores four months after the training. CONCLUSION It was concluded that the training offered the nurses about the ventrogluteal area had a positive impact on their knowledge and practices and that the nurses came away from the training with raised awareness about the subject and an increased level of knowledge.
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Affiliation(s)
- Emel Gülnar
- Kırıkkale University, Faculty of Health Sciences, Nursing Department, Kırıkkale, Turkey
| | - Hüsna Özveren
- Kırıkkale University, Faculty of Health Sciences, Nursing Department, Kırıkkale, Turkey.
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Brown J, Gillespie M, Chard S. The dorso-ventro debate: in search of empirical evidence. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:1132, 1134, 1136-9. [PMID: 26653514 DOI: 10.12968/bjon.2015.24.22.1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Identification of safe injections sites is a skill practised routinely by nurses, which, as with all nursing practice, is informed by empirical evidence. Despite this, discussion as to whether the dorsogluteal site should be eradicated from nursing practice in favour of the ventrogluteal site shows no sign of abating. Review of commonly cited evidence in this debate aimed to identify the validity of excluding the dorsogluteal site in favour of the ventrogluteal site by investigating the empirical evidence, which routinely informs this decision. Empirical evidence suggests a case to exclude the dorsogluteal site for children under age 10 for fear of damaging the sciatic nerve, but not so for adults. Recommendations are made for conclusive research into the viability of the dorsogluteal site and an authoritative decision based on empirical evidence, not hearsay, with regard to its continuance or eradication from nursing practice.
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Affiliation(s)
- Joe Brown
- Lecturer in Nursing, University of the West of Scotland, Scotland
| | - Mark Gillespie
- Lecturer in Mental Health Nursing, University of the West of Scotland, Scotland
| | - Simon Chard
- Library/Research Assistant, University of the West of Scotland, Scotland
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Yapucu Güneş Ü, Ceylan B, Bayındır P. Is the ventrogluteal site suitable for intramuscular injections in children under the age of three? J Adv Nurs 2015; 72:127-34. [DOI: 10.1111/jan.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ülkü Yapucu Güneş
- Faculty of Nursing; Department of Basic Nursing; Ege University; İzmir Turkey
| | - Burcu Ceylan
- School of Nursing; Department of Basic Nursing; Ege University; İzmir Turkey
| | - Petek Bayındır
- Department of Radiology; Ege University Faculty of Medicine; İzmir Turkey
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