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The prick versus the time

Hi everyone- this isn't a ground breaking question, but it is something that can cause discomfort everyday, multiple times- injections!  Does anyone know of any research indicating whether or not an animal reacts more to a 25G needle with a longer injection time versus a larger needle (22G, sometimes 20G if it is large dose of a thicker drug SQ, such as Pen. G on a 60lb lab), but a shorter injection time?  Our hospital seems split down the middle, with doctors and techs on both side. 

I personally am for the larger fresh needle.  I feel less squirming is involved, because it is quicker.  Tom cat skin, wrinkled skin, or larger dogs injections seem to go intradermal with the shorter 25G needles.  Kittens and puppies are small, but personally they seem to act up more for the restraint, even when giving them a treat to distract them, then they do with the needle poke.  I also feel I have to use more force to poke with a 25G needle, especially with larger pets.  I am ok using 25G with less resistant IV or quick blood draws for a glucose sample, but for IM injections, even the smallest amount, sometimes I have problems with the pressure used to adminster the drug, and loose the syringe (we only have luer locks on 3cc and above.)   

My 25G needle loving coworkers say I just have to work on technique, and in their opinions, the animals do not seem to notice the prick at all when done right.  They do use a 22G with more than 1cc with thicker or IM injections. 

Comments

( 5 comments — Leave a comment )
veracosa
May. 28th, 2011 07:48 pm (UTC)
Here's my take:
Subcutaneous fluids? Bigger needle, faster injection. You're going to be a few minutes anyway. I usually used 18 ga unless the patient was a tiny neonate.

Watery liquid injectables like vaccines, giving less than 2 cc, use a 25 ga. needle. If it is a larger volume I'll use a 22 ga.

Thick substances, like percorten or corticotropin gel, use the larger needle, period; you'll be there all day if you don't.

I don't think there should be a hard and fast rule; I think it is good to use common sense. *shrug*
macula_densa
May. 28th, 2011 07:56 pm (UTC)
Interesting question. I know of no research on this topic, but you'll definitely find people in both camps. Up until fairly recently I was more for using larger gauge needles on everyone because it is faster, but I have found particularly on small puppies they tend not to react nearly as much to the 25 gauge needle prick, so even though the injection is slower they are overall more comfortable and less traumatized (and they struggle less). So, I think perhaps I'm becoming a convert for 25 gauge needles in small puppies. On the other hand I haven't noticed the same disparity in cats, so I continue with the 22 gauge on them.

I'm primarily referring to SQ injections here (mostly vaccines). It entirely depends on what you're injecting IM and how much; if it's larger volumes (i.e. 1 cc) I use 22 gauge, and if it's a small volume 25 is usually just fine. I think it is all a matter of preference and what works for you; it's not as though there is a 'right' or 'wrong' answer to this.
karmahappens
May. 28th, 2011 10:11 pm (UTC)
I've worked at three different practices now (1 general practice and 2 referral/specialty centers), and everyone at those practices seemed to favor using a larger needle for "big" (SQ fluids) or "thick" injections. Otherwise (vaccines, etc.) mediating the needle size to the patient size.
belle7067
May. 29th, 2011 02:38 am (UTC)
We typically use 22g on most things - IM injections, vaccines, other SC injections unless it is extremely thick. I use 18g for sub-q fluids as a rule, unless it is a neonate or the owner specifically requests a smaller size. One teeny puppies and kittens I am more likely to use a 25g for everything - even though it takes longer, the smaller size typically elicits less of a reaction. Although if it's a kitten who is going to have a fit about being poked anyways, it doesn't seem to matter. Blood draws I almost always use 22g, only use 25g on kittens or when I need a few drops for an FELV/FIV.

I think that it's so variable - depending on what you're injecting, what route it's going, and most importantly what kind of patient you're working on. Some pets will react no matter what size needle you use, and we've got dogs who wouldn't care if you poked a 18g needle in their eyeballs as long as they are getting treats. Again, so much is down to common sense and personal judgement in the specific situation.
dianimal
May. 30th, 2011 01:31 am (UTC)
I figured I would get a bunch of "common sense" responses. Some people can get so passionate about the subject, I thought it would be beneficial to ask just in case there was a "right answer" somewhere out there.

Thanks to those that gave imput. Happy Memorial Day everyone!
( 5 comments — Leave a comment )