update/Enbrel & new needles

[Guest guest]

I just talked to a RN at Enliven yesterday and she told me that the new needles for dispensing Enbrel will be 27 gauge. These are the new "smallest" needles that they mentioned in their letter. They are the smallest needles to be used for dispensing enbrel - not the smallest needles in general. Insulin syringes, for example, are smaller - 28 to 30 gauge needles. Can anyone please tell me if their doctors specifically recommended them to use insulin syringes for dispensing their enbrel and how long ago did they do that? I used insulin syringes on my son for quite a while and noticed no ill effects - however my doctor would not prescribe them now and also, our pharmacist also stated that enbrel should not be dispensed from such a small syringe. In addition, the drug isn't even being packaged with that small of a syringe. If it could be dispensed in that manner, I can't think of a reason why the company wouldn't package it with the smaller size needle if they thought it was safe. I heard many people on the list say they use insulin syringes for enbrel. I am concerned for two reasons - (1) am I getting the wrong info from my doctor and Pharmacy? or (2) are there people mistakenly using insulin syringes for enbrel and unnecessarily risking the drugs' effectiveness? Also, I don't mean to seem like a "Miss Know-it-all", but I was also really surprised when a number of people said that they habitually bend their needles when drawing out enbrel from the vial. I mean this kindly and sincerely - are you sure that you are properly inserting the needle into the vial? I have been dispensing the drug for 2 years now and never bent a needle. I had a really great RN teach me how to do it and she stated that if you experience tension while inserting it - don't force it or you will bend it - take it out and reinsert it, making sure that it is facing exactly straight down and not tilted at any angle. Also, make sure it is in the center and not hitting the side at all. I have often experienced the "tension" when putting the needle in and I stopped and realized that I was ever so slightly tilting the needle at an angle and it wouldn't enter the vial properly. Maybe this info will be helpful to you. Take care! Robin & (4, poly)

[Guest guest]

Hi Robbin,

goes to Cincinatti Childrens Hospital for a 3yr Enbrel study and sees the notorious Dr.Lovell.A 27 gauge needle is perfect, it is also in the insert that comes with the Enbrel kit.Mtx can also be given in a 27 gauge needle and is a much thicker drug.For Enbrel it's either a 27 gauge or the bigger 29 gauge that comes with it.Cincy even circled the literature for me.I have no trouble inserting the bigger 29 gauge needle with the dilutent into the vial,its when I stick the tiny 27 gauge needle in to draw it up that I have trouble.I took Georginas advice and get 2 syringes for each shot.One to draw it up and then take the new syringe pull the needle off and put it on the one with the Enbrel in it.Last Monday I didn't have any trouble drawing it up so I left things alone.I went to push it in and it wouldn't budge.Yet again I had to stab my baby to get it in,which is why we went to doubling up to begin with.The stopper on the Enbrel is differant then MTX.I think it's so all of the drug can be pulled out.MTX does not have the rubber on the sides so the drug gets stuck in the vial.Enbrel has just a small space to insert the needle and all the drug goes to the stopper.If you have no trouble that is great! I hate the Enbrel vials but for 25cents a syringe for us it's no big deal.Before Georginas advice it was tough though,stabbing with a dull needle.

hugs

Becki and 5systemic

[Guest guest]

Hi e, It is very interesting how doctors and pharmacies and nurses differ in their medical views. You would think that it would be easy to determine the truth - but it isn't. I am more confused now than ever. I am going to try to find out the study that was cited by my doctor which suggested that the medication should not be given through insulin needles because it some how might cause a breakdown of some important aspect of the medication when forced through the small opening (pushed quickly). I am not an RN so I am not able to tell you or remember the exact medical terminology that my doctor told me. However, I will say, that my doctor is very well known by his participation in and authorship of some of the most famous and important enbrel studies in children. I really do trust his expertise. He has no reason for lying. Why would he want want to cause my son more pain by forcing him to use a larger needle? Also our pharmacist said essentially the same thing. It doesn't make sense. I have a question for you. Since you are a nurse, I would really like to understand why you say that enbrel is packaged with huge needles for IM injections but that insulin needles are for subcut. injections - which is what enbrel requires. I haven't heard of this. Why would enliven package a needle for IM injections with enbrel when their drug is intended to be injected subcutaneously? I don't get it. I can't imagine why they would do that. I always heard that their needle was to give subcut. injections. I am not trying to start a fight - I don't even use the needle that they package with the enbrel - except to mix the medicine. I am just really trying to make sense of this whole thing. Another question. - Isn't there a difference between gauge and length of the needle? The length of a needle will determine if it can deliver a subcutaneous injection right - not the gauge? Gauge simply has to do with the width of the opening, right? Or am I wrong? I am not an expert on needles. Can needles be purchased with varying gauges and lengths or are there standards - like 27 gauge needles only come in a fixed length etc.? As for insulin syringes. I used them for 1 whole year while dispensing enbrel for my son. So I am familiar with them and I know how to insert them properly into the enbrel vial - again, I have never bent one needle - never had a problem. I stand by what the RN told me - and I also agree with what you have said as well - your views are not in conflict with one another. She told me NOT to force the needle if I felt tension because it was a sign that it was not being inserted properly and it WOULD bend the needle. This of course would cause problems inserting the needle into the patient and cause more pain for the patient as you stated. The key here was that she wanted me to notice the signs of improper insertion of the needle so that I could AVOID bending the needle. I guess that I should NOT have said "take it out and reinsert it". When really happens is that the needle never actually goes through the vial - I notice the tension. Stop and straighten the needle to the proper angle and continue to insert it into the vial. I don't push the needle hard enough to cause a bend in it. I stop before any bending can occur. I quite honestly find that the medical field has so many conflicting opinions on medical matters such as this that it is disturbing. I mean, you are a medical professional and so you can take comfort in what you do for your child not only because of what other professionals tell you but also because of the knowledge you have gained throughout the years doing your job. You know what info you feel comfortable dismissing and which info you choose to follow. For me, I don't have the same professional background as you and I feel really confused. I am an auditor and so I need to investigate everything and find out what the truth is - and this situation is no different. Thanks for reading this long email and thank you in advance for any response you have. Robin and (4, poly)

[Guest guest]

Hi Georgina,

You are right.Thank you for correcting me.Thats what I get for e-mailing half asleep.I just pulled out the literature and its a 25gauge or 27gauge.Enbrel comes with the bigger 25 gauge.

Hugs

Becki and 5systemic

[Guest guest]

Hi Becki,

Hold on, before I start getting confused The higher the gauge number,

the smaller the needle. I think. Which is why smaller or more sensitive

people may tolerate injections with higher gauge needles better. The

size 21 gauge needle that Josh used to have to use caused him

considerable discomfort. Now he's using not 27 or 29 gauge (like I

thought previously) but actually size 31 gauge needle tips ... and he

doesn't hardly feel a thing!

Aloha,

Georgina

Arthurnator@... wrote:

> Hi Robbin,

> goes to Cincinatti Childrens Hospital for a 3yr Enbrel study and

> sees the notorious Dr.Lovell.A 27 gauge needle is perfect, it is also in

> the insert that comes with the Enbrel kit.Mtx can also be given in a 27

> gauge needle and is a much thicker drug.For Enbrel it's either a 27

> gauge or the bigger 29 gauge that comes with it.Cincy even circled the

> literature for me.I have no trouble inserting the bigger 29 gauge needle

> with the dilutent into the vial,its when I stick the tiny 27 gauge

> needle in to draw it up that I have trouble.I took Georginas advice and

> get 2 syringes for each shot.One to draw it up and then take the new

> syringe pull the needle off and put it on the one with the Enbrel in

> it.Last Monday I didn't have any trouble drawing it up so I left things

> alone.I went to push it in and it wouldn't budge.Yet again I had to stab

> my baby to get it in,which is why we went to doubling up to begin

> with.The stopper on the Enbrel is differant then MTX.I think it's so all

> of the drug can be pulled out.MTX does not have the rubber on the sides

> so the drug gets stuck in the vial.Enbrel has just a small space to

> insert the needle and all the drug goes to the stopper.If you have no

> trouble that is great! I hate the Enbrel vials but for 25cents a syringe

> for us it's no big deal.Before Georginas advice it was tough

> though,stabbing with a dull needle.

> hugs

> Becki and 5systemic