Department of Anatomy, Faculty of Medicine, University of Ruhuna, Sri Lanka.
Lady Ridgeway Hospital Colombo, Sri Lanka, Sri Lanka.
Arch Pediatr. 2020 Jul;27(5):244-249. doi: 10.1016/j.arcped.2020.05.008. Epub 2020 May 24.
Insulin therapy is essential for type 1 diabetes. While a reasonable glycemic control prevents complications, inadvertent intramuscular (IM) insulin injection results in hypoglycemia and fluctuations of blood glucose levels.
To assess the subcutaneous thickness (SCt) at the potential insulin injection sites, in order to determine the suitable needle length.
Diabetic and non-diabetic children (n=125; aged 2-14 years) attending a tertiary care hospital were examined, after excluding those who had skin abnormality at the injection site, were hospitalized for>3 days, or had any other chronic illnesses. Dermal thickness (Dt) and SCt at the potential insulin injection sites were measured with ultrasonography.
The mean age of the patients was 8 years and 57% were boys; mean Dt was 2.1±0.4 mm, SCt was 7.45.6±3.7 mm, and maximum SCt was 29.8 mm in the anterior abdominal wall. SCt increased with age and by raising a skin fold (sf). There was no difference (P>0.05) in Dt between genders, and limbs showed thinner Dt values than the abdomen. SCt changed with the injection site: it was the lowest in the thigh and the highest in the abdomen. SCt was thicker in females, with or without sf (P<0.001). For all sites, IM risk was high for 15-mm needles: it was highest in the thighs (98%) and reduced to 86% with sf. IM risk was low for 5-mm needles: it was highest in the thigh (38%), and reduced to 12% with sf. Compared with girls (up to 42%), IM risk was higher for boys (up to 54%), even for 5-mm needles with a sf.
Using a short needle is recommended for children, particularly for boys. Regardless of the needle length, the raised sf technique is associated with reduced IM risk.
胰岛素治疗对于 1 型糖尿病至关重要。虽然合理的血糖控制可以预防并发症，但意外的肌内（IM）胰岛素注射会导致低血糖和血糖水平波动。
评估潜在胰岛素注射部位的皮下厚度（SCt），以确定合适的针头长度。
在排除注射部位皮肤异常、住院时间超过 3 天或患有其他慢性疾病的儿童后，对 125 名（年龄 2-14 岁）糖尿病和非糖尿病儿童进行检查。使用超声测量潜在胰岛素注射部位的真皮厚度（Dt）和 SCt。
患者的平均年龄为 8 岁，其中 57%为男孩；平均 Dt 为 2.1±0.4mm，SCt 为 7.45.6±3.7mm，在前腹壁最大 SCt 为 29.8mm。SCt 随年龄增长和提起皮肤褶皱（sf）而增加。性别之间的 Dt 无差异（P>0.05），且四肢的 Dt 值比腹部薄。SCt 随注射部位变化：大腿处最薄，腹部处最高。有或没有 sf 时，女性的 SCt 较厚（P<0.001）。对于所有部位，15mm 针头的 IM 风险很高：大腿处最高（98%），sf 时降低至 86%。5mm 针头的 IM 风险较低：大腿处最高（38%），sf 时降低至 12%。与女孩（高达 42%）相比，男孩（高达 54%）的 IM 风险更高，即使使用 sf 时也使用 5mm 针头。
建议儿童使用短针头，尤其是男孩。无论针头长度如何，提起 sf 技术均可降低 IM 风险。
