18.5: Введення підшкірних ліків

Last updated

Oct 27, 2022
Save as PDF
- 18.4: Введення внутрішньошкірних препаратів
- 18.6: Введення внутрішньом'язових препаратів

Ernstmeyer & Christman (Eds.)
Chippewa Valley Technical College via OpenRN

$\newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} }$

$\newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}}$

$\newcommand{\id}{\mathrm{id}}$

$\newcommand{\Span}{\mathrm{span}}$

$\newcommand{\kernel}{\mathrm{null}\,}$

$\newcommand{\range}{\mathrm{range}\,}$

$\newcommand{\RealPart}{\mathrm{Re}}$

$\newcommand{\ImaginaryPart}{\mathrm{Im}}$

$\newcommand{\Argument}{\mathrm{Arg}}$

$\newcommand{\norm}[1]{\| #1 \|}$

$\newcommand{\inner}[2]{\langle #1, #2 \rangle}$

$\newcommand{\Span}{\mathrm{span}}$

$\newcommand{\id}{\mathrm{id}}$

$\newcommand{\Span}{\mathrm{span}}$

$\newcommand{\kernel}{\mathrm{null}\,}$

$\newcommand{\range}{\mathrm{range}\,}$

$\newcommand{\RealPart}{\mathrm{Re}}$

$\newcommand{\ImaginaryPart}{\mathrm{Im}}$

$\newcommand{\Argument}{\mathrm{Arg}}$

$\newcommand{\norm}[1]{\| #1 \|}$

$\newcommand{\inner}[2]{\langle #1, #2 \rangle}$

$\newcommand{\Span}{\mathrm{span}}$

Підшкірні ін'єкції вводяться в шар жирової тканини під назвою «підшкірний» нижче дерми. Дивіться зображення підшкірного шару (гіподерми) на малюнку $\PageIndex{1}$ . ^{^[1]} Ліки, що вводяться в підшкірний шар, всмоктуються з повільною і стійкою швидкістю.

Ілюстрація, що показує підшкірний шар шкіри, з етикетками — Малюнок $\PageIndex{1}$ : Підшкірний шар шкіри

анатомічні сайти

Місця для підшкірних ін'єкцій включають зовнішній бічний аспект верхньої частини руки, живота (знизу реберного краю до клубового гребеня і більше двох дюймів від пупка), передня верхня частина стегон, верхня частина спини, і верхня черевна сіднична область. ^{^[2]} Див. Рис. $\PageIndex{2}$ ^{^[3]} для ілюстрації часто використовуваних підшкірних місць ін'єкцій. Ці області мають великі площі поверхні, які дозволяють обертати підшкірні ін'єкції в межах одного місця, коли це застосовно.

Ілюстрація показ підшкірних ін'єкцій сайтів — Малюнок $\PageIndex{2}$ : Загальні підшкірні місця ін'єкцій

Перед введенням медикаменту слід оглянути ділянку шкіри. Уникайте ділянок шкіри, які є синцями, відкритими, шрамами або над кістковими виступами. Медичні стани, які погіршують приплив крові до області тканин, протипоказані використання підшкірних ін'єкцій в цій області. Наприклад, якщо у пацієнта є інфекція на ділянці шкіри під назвою «целюліт», то підшкірні ін'єкції не слід робити в цій області.

Опис процедури

Медсестри підбирають відповідний розмір голки для підшкірної ін'єкції залежно від розміру пацієнта. Підшкірні голки варіюються в калібрі від 25-31 і довжиною від ½ дюйма до дюйма. Перед введенням ін'єкції визначте кількість присутньої підшкірної клітковини і використовуйте цю інформацію для вибору довжини голки. Для підшкірної ін'єкції використовується кут 45 або 90 градусів. Кут 90 градусів використовується для дорослих пацієнтів нормального розміру або пацієнтів з ожирінням, а кут 45 градусів використовується для пацієнтів, які тонкі або мають менше жирової тканини в місці ін'єкції. Обсяг розчину в підшкірній ін'єкції повинен бути не більше 1 мл для дорослих і 0,5 мл для дітей. Більші кількості можуть не всмоктуватися належним чином і можуть спричинити посилення дискомфорту для пацієнта. ^{^[4]}

При введенні підшкірної ін'єкції оцініть пацієнта на наявність будь-яких протипоказань для прийому медикаменту. Нанесіть нестерильні рукавички після виконання гігієни рук, щоб зменшити ризик потрапляння крові. Розташуйте пацієнта в зручному положенні і виберіть відповідне місце для ін'єкції. Очистіть ділянку спиртовим тампоном або антисептичним тампоном протягом 30 секунд твердими круговими рухами, а потім дайте ділянці висохнути. Дозволяючи шкірі висохнути, запобігає введенню спирту в тканини, що може бути дратівливим і дискомфортним. Зніміть ковпачок голки недомінуючою рукою, потягнувши її прямо, щоб уникнути травмування голкою. Візьміть і затисніть область, обрану в якості місця ін'єкції. ^{^[5]} Див. Рис. $\PageIndex{3}$ ^{^[6]} зображення медсестри, яка захоплює спину плеча пацієнта недомінуючою рукою при підготовці підшкірної ін'єкції в анатомічному місці, якому вказано «X».

Фото, показуючи руку захоплення і защемлення верхньої трицепс на пацієнта — Малюнок $\PageIndex{3}$ : Області захоплення та защемлення

Тримайте шприц в домінуючій руці між великим і вказівним пальцями, як дротик. Вставте голку швидко під кутом від 45 до 90 градусів, залежно від розміру пацієнта та кількості жирової тканини. Після того, як голка буде на місці, звільніть тканину недомінуючою рукою. Домінуючою рукою вводите ліки зі швидкістю 10 секунд на мл. Уникайте переміщення шприца. ^{^[7]} Див. Рис. $\PageIndex{4}$ ^{^[8]} для зображення підшкірної ін'єкції.

Фото показує крупним планом підшкірної ін'єкції — Малюнок $\PageIndex{4}$ : Підшкірна ін'єкція

При введенні гепарину або при використанні інсулінової ручки продовжуйте затискати шкіру під час ін'єкції і звільніть шкірну складку безпосередньо перед вилученням голки.

Вийміть голку швидко під тим же кутом, під яким вона була введена. Використовуючи стерильну марлю, нанесіть легке натискання на місце після вилучення голки. Чи не масажуйте ділянку. Масаж після ін'єкції гепарину може сприяти утворенню гематоми. Не повторюйте голку, щоб уникнути проколу себе. Нанесіть захисний щиток і утилізуйте шприц/голку в контейнер для гострих сортів. Див. Малюнок $\PageIndex{5}$ ^{^[9]} for an image of a needle after the safety shield has been applied. Remove gloves and perform hand hygiene.^{^[10]}

Photo showing closeup of a needle with safety shield applied — Figure $\PageIndex{5}$ : Needle with Safety Shield Applied

Examples of common medications administered via subcutaneous injection include insulin and heparin. Special considerations for each of these medications are discussed below.

Insulin Injections

Insulin is considered a high-alert medication requiring special care to prevent medication errors. Care must be taken to ensure the correct type and amount of insulin are administered at the correct time. It is highly recommended to have insulin dosages double-checked by another nurse before administration because of the potential for life-threatening adverse effects that can occur due to medication errors. Some agencies require this second safety check.

Only insulin syringes should be used to administer insulin injection. Insulin syringes are supplied in 30-, 50-, or 100-unit measurements, so read the barrel increments (calibration) carefully. Insulin is always ordered and administered in unit dosage. Insulin dosage may be based on the patient’s pre-meal blood sugar reading and a sliding scale protocol that indicates the number of units administered based on the blood sugar reading.^{^[11]}^{,^[12]}

There are rapid-, short-, intermediate-, and long-acting insulins. For each type of insulin, it is important to know the onset, peak, and duration of the insulin so that it can be timed appropriately with the patient’s food intake. It is essential to time the administration of insulin with food intake to avoid hypoglycemia. When administering insulin before a meal, always ensure the patient is not nauseated and is able to eat. Short- or rapid-acting insulin may be administered up to 15-30 minutes before meals. Intermediate insulin is typically administered twice daily, at breakfast and dinner, and long-acting insulin is typically administered in the evening.^{^[13]}^{,^[14]}

When administering cloudy insulin preparations such as NPH insulin (Humulin-N), gently roll the vial between the palms of your hands to resuspend the medication before withdrawing it from the vial.^{^[15]}^{,^[16]}See Figure $\PageIndex{6}$ ^{^[17]} for an image of insulin NPH that is cloudy in color.

Photo showing closeup of a vial of N P H insulin and a capped syringe — Figure $\PageIndex{6}$ : NPH Insulin

Preparing Insulin in a Syringe

When withdrawing insulin from a vial, check the insulin vial to make sure it is the right kind of insulin and that there are no clumps or particles in it. Also, make sure the insulin is not past its expiration date. Pull air into the syringe to match the amount of insulin you plan to remove. Hold the syringe like a pencil and insert the needle into the rubber stopper on the top of the vial. Push the plunger down until all of the air is in the bottle. This helps to keep the right amount of pressure in the bottle and makes it easier to draw up the insulin. With the needle still in the vial, turn the bottle and syringe upside down (vial above syringe). Pull the plunger to fill the syringe to the desired amount. Check the syringe for air bubbles. If you see any large bubbles, push the plunger until the air is purged out of the syringe. Pull the plunger back down to the desired dose. Remove the needle from the bottle. Be careful to not let the needle touch anything until you are ready to inject.^{^[18]}

Mixing Two Types of Insulin

If a patient is ordered two types of insulin, some insulins may be mixed together in one syringe. For example, insulin NPH (Novolin-N) can be mixed with insulin regular (Humulin-R), insulin aspart (Novolog), or insulin lispro (Humalog). However, some types of insulin cannot be mixed with other insulin, such as insulin glargine (Lantus) or insulin detemir (Levemir).^{^[19]}^{,^[20]}

When mixing insulin, gather your insulin supplies. Check the insulin vials to make sure they are the right kinds of insulin, there are no clumps or particles in them, and the expiration dates have not passed. Gently mix intermediate or premixed insulin by turning the vial on its side and rolling it between the palms of your hands. Prepare the insulin vials by injecting air into the intermediate insulin vial. Remove the cap from the needle. With the vial of insulin below the syringe, inject an amount of air equal to the dose of intermediate insulin that you will be taking. Do not draw out the insulin into the syringe yet. Remove the needle from the vial. Inject air into the rapid-acting insulin vial equal to the rapid-acting insulin dose. With the needle still in the vial, turn the vial upside down (vial above the syringe) and pull the plunger to fill the syringe with the desired dose. Check the syringe for air bubbles. If you see any large bubbles, push the plunger until the air is purged out of the syringe. Pull the plunger back down to the desired dose. Remove the needle from the vial and recheck your dose. Insert the needle into the vial of cloudy insulin. Turn the vial upside down (vial above syringe) and pull the plunger to draw the dose of intermediate-acting insulin. Because the short-acting insulin is already in the syringe, pull the plunger to the total number of units you need. Do not inject any of the insulin back into the vial because the syringe now contains a mixture of intermediate- and rapid-acting insulin. Remove the needle from the vial and be careful to not let the needle touch anything until you are ready to inject.^{^[21]}

When mixing insulin, it is important to always draw up the short-acting insulin first to prevent it from being contaminated with the long-acting insulin. See Figure $\PageIndex{7}$ ^{^[22]} for an illustration of the order to follow when mixing insulin.

Illustration showing steps in mixing insulin — Figure $\PageIndex{7}$ : Mixing Insulin

One anatomic region should be selected for a patient’s insulin injections to maintain consistent absorption, and then sites should be rotated within that region. The abdomen absorbs insulin the fastest, followed by the arms, thighs, and buttocks. It is no longer necessary to rotate anatomic regions, as was once done, because newer insulins have a lower risk for causing hypertrophy of the skin.^{^[23]}^{,^[24]}

Insulin Pens

Insulin pens are a newer technology designed to be used multiple times for a single person, using a new needle for each injection. See Figure $\PageIndex{8}$ ^{^[25]} for an image of an insulin pen. Insulin pens must never be used for more than one person. Regurgitation of blood into the insulin cartridge can occur after injection, creating a risk of blood-borne pathogen transmission if the pen is used for more than one person, even when the needle is changed.^{^[26]} Prefilled insulin pens consist of a prefilled cartridge of insulin to which a special, single-use needle is attached. When using an insulin pen for subcutaneous insulin administration, a few additional steps must be taken according to manufacturer guidelines. The needle should be primed with two units of insulin, and then the dosage should be dialed in the dose window. The pen should be held with the hand using four fingers so that the thumb can be used to fully depress the plunger button. The pen should be left in place for ten seconds after the insulin is injected to aid in absorption.^{^[27]}

Insulin pens are often prescribed for home use because of their ease of use. Patients and family members must be educated on how to correctly use an insulin pen before discharge. To evaluate a patient’s knowledge of how to correctly administer insulin, ask them to “return demonstrate” the procedure to you.^{^[28]}^{,^[29]}

Photo showing closeup of insulin pen, with labels — Figure $\PageIndex{8}$ : Insulin Pen A) tip, B) medication chamber, C) plunger, D) dose window, E) dose selection dial, F) plunger button

Special Considerations for Insulin

Insulin vials are stored in the refrigerator until they are opened. When removed, it should be labelled with an open date and expiration date according to agency policy. When a vial is in use, it should be at room temperature. Do not inject cold insulin because this can cause discomfort.
Patients who take insulin should monitor their blood sugar (glucose) levels as prescribed by their health care provider.
Vials of insulin should be inspected prior to use. Any change in appearance may indicate a change in potency. Check the expiration date and do not use it if it has expired.
All health care workers should be aware of the signs and symptoms of hypoglycemia. Signs and symptoms of hypoglycemia include fruity breath, restlessness, agitation, confusion, slurring of words, clammy skin, inability to concentrate or follow commands, hunger, and nausea. Follow agency policy regarding hypoglycemic reactions.^{^[30]}

Note

For more information about injecting insulin, read the following American Association of Diabetes Educators PDF:
Insulin Injection Know-How

For additional details about different types of insulin, hypoglycemia, and safety considerations when administering insulin, visit the “Antidiabetics” section of the “Endocrine” chapter in Open RN Nursing Pharmacology.

Video Review of Mixing Insulin^{^[31]}

Heparin Injections

Heparin is an anticoagulant medication used to treat or prevent blood clots. It comes in various strengths and can be administered subcutaneously or intravenously. Heparin is also considered a high-alert medication because of the potential life-threatening harm that can result from a medication error. See Figure $\PageIndex{9}$ ^{^[32]} for an image of a prefilled syringe of enoxaparin (Lovenox), a low-molecular weight heparin, that is typically dispensed in prefilled syringes. Review specific guidelines regarding heparin administration in Table $\PageIndex{1}$ .^{^[33]}

Photo showing a syringe filled with low molecular weight heparin — Figure $\PageIndex{9}$ : Low-Molecular Weight Heparin

Note

For more information about heparin, visit the “Blood Coagulation Modifiers” section of the “Cardiovascular and Renal System” chapter in Open RN Nursing Pharmacology.

Table $\PageIndex{1}$ : Specific Guidelines for Administering Heparin^{^[34]}
Guidelines	Additional Information
Remember that heparin is considered a high-alert medication.	Heparin is available in vials and prefilled syringes in a variety of concentrations. Because of the dangerous adverse effects of the medication, it is considered a high-alert medication. Always follow agency policy regarding the preparation and administration of heparin.
Rotate heparin injection sites.	It is important to rotate heparin sites to avoid bruising in one location. Heparin is absorbed best in the abdominal area, at least 2 inches (5 cm.) away from the umbilicus.
Know the risks associated with heparin.	There are many risks associated with the administration of heparin, including bleeding, hematuria, hematemesis, bleeding gums, and melena. Monitor, document, and report these side effects when a patient is receiving heparin.
Review lab values.	Review lab values (PTT and aPTT) before and after heparin administration. If injecting low-molecular weight heparin (enoxaparin), review platelet count because heparin can cause thrombocytopenia.
Follow administration standards for prepackaged heparin and enoxaparin syringes.	Many agencies use prepackaged heparin and enoxaparin syringes. Always follow the standards for safe medication administration when using prefilled syringes.
Assess patient conditions prior to administration.	Some medical conditions increase the patient’s risk for hemorrhage (severe bleeding), such as recent childbirth, severe kidney and liver disease, cerebral or aortic aneurysm, and cerebral vascular accidents (CVA).
Assess other medications and diet.	Over-the-counter (OTC) herbal medications, such as garlic, ginger, and horse chestnut, may interact with heparin. Additional medications that may interact or cause increased risk of bleeding include aspirin, NSAIDs, cephalosporins, antithyroid agents, thrombolytics, and probenecids. Foods like green leafy vegetables can alter the therapeutic effect of heparin.

Device Technology

A jet injector is a medical device used for vaccinations and other subcutaneous injections that uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a hypodermic needle. An example of a flu vaccine approved for administration to adults aged 18-64 is AFLURIA © Quadrivalent. The most common injection-site adverse reactions of the jet injector flu vaccine up to seven days post-vaccination were tenderness, swelling, pain, redness, itching, and bruising.^{^[35]} Insulin can also be successfully administered via a jet injector, with research demonstrating improved glucose control because the insulin is spread out over a larger area of tissue and enters the bloodstream faster than when administered by an insulin pen or needle. Patients have indicated preference for insulin delivered by the jet injector compared to the insulin pen or syringe because it is needle-free with less tissue injury and pain as compared to the needle injection.^{^[36]} See Figure $\PageIndex{10}$ ^{^[37]} for an image comparing insulin delivery devices.

Photo showing various insulin devices — Figure $\PageIndex{10}$ : Insulin Delivery Devices

Another type of new technology used to continuously deliver subcutaneous insulin is the insulin pump. Pumps are a computerized device attached to the body, either with tubing or attached to the skin. They are programmed to release small doses of insulin (continuously or as a surge bolus dose) close to mealtime to control the rise in blood sugar after a meal. They work by closely mimicking the body’s normal release of insulin. Insulin doses are delivered through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place.^{^[38]} See Figure $\PageIndex{11}$ ^{^[39]} for an image of an insulin pump infusion set attached to a patient.

Photo of in insulin pump placed on an abdomen — Figure $\PageIndex{11}$ : Insulin Pump

“HumanSkinDiagram.jpg” by Daniel de Souza Telles is licensed under CC BY-SA 3.0↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
“Subcutaneous-injection-sites-274x300.png” by British Columbia Institute of Technology is licensed under CC BY 4.0. Access for free at https://opentextbc.ca/clinicalskills/chapter/6-7-intradermal-subcutaneous-and-intramuscular-injections/. ↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
“Upper Posterior Arm” by Meredith Pomietlo for Chippewa Valley Technical College is licensed under CC BY 4.0↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
“Book-pictures-2015-650.jpg” by British Columbia Institute of Technology is licensed under CC BY 4.0. Access for free at https://opentextbc.ca/clinicalskills/chapter/6-7-intradermal-subcutaneous-and-intramuscular-injections/. ↵
“Sept-22-2015-040.jpg” by British Columbia Institute of Technology is licensed under CC BY 4.0. Access for free at https://opentextbc.ca/clinicalskills/chapter/6-7-intradermal-subcutaneous-and-intramuscular-injections/↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
“insulin-syringe” by biologycorner is licensed under CC BY-NC 2.0↵
American Association of Diabetes Educators. (n.d.). Insulin injection know-how. https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
American Association of Diabetes Educators. (n.d.). Insulin injection know-how. https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf↵
“Mixing Insulin” by Meredith Pomietlo for Chippewa Valley Technical College is licensed under CC BY 4.0↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
“Insulin_pen_(labeled).jpg” by User:Wesalius is licensed under CC BY 4.0↵
Centers for Disease Control and Prevention. (2012, January 4). CDC clinical reminder: Insulin pens must never be used for more than one person. https://www.cdc.gov/injectionsafety/clinical-reminders/insulin-pens.html↵
American Association of Diabetes Educators. (n.d.). Insulin injection know-how. https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
American Diabetes Association. (n.d.). Insulin basics. https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics↵
RegisteredNurseRN. (2016, July 15). How to mix insulin NPH and regular insulin nursing | Mixing insulin clear to cloudy. [Video]. YouTube. All rights reserved. Video used with permission. https://youtu.be/O_kXOnrYYRA. ↵
“syringe-103060_1920.jpg” by Stux from Pixabay is licensed under CC0 . ↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
This work is a derivative of Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology and is licensed under CC BY 4.0↵
Centers for Disease Control and Prevention. (2020, August 20). Flu vaccination by jet injector. https://www.cdc.gov/flu/prevent/jet-injector.htm↵
Guo, L., Xiao, X., Sun, X., & Qi, C. (2017). Comparison of jet injector and insulin pen in controlling plasma glucose and insulin concentrations in type 2 diabetic patients. Medicine, 96(1), e5482. doi.org/10.1097/MD.0000000000005482↵
“Insulin_Delivery_Devices.png” by BruceBlaus is licensed under CC BY-SA 4.0↵
American Diabetes Association. (n.d.). Device technology. https://www.diabetes.org/diabetes/device-technology↵
"insulin pump day 1" by Erin Stevenson O’Connor is licensed under CC BY-SA 2.0↵

анатомічні сайти

Опис процедури

Insulin Injections

Preparing Insulin in a Syringe

Mixing Two Types of Insulin

Insulin Pens

Special Considerations for Insulin

Note

Video Review of Mixing Insulin[31]

Heparin Injections

Note

Device Technology

Video Review of Mixing Insulin^{^[31]}