Explanatory Variables as Evidence for Precision in Intramuscular Long-Acting Injections of Patients with Schizophrenia

Masuda, Shigeaki; Sakamaki, Sakiko; Yasuhara, Yuko; Zhao, Yueren; Takase, Kensaku; Kai, Yoshihiro; Tanioka, Tetsuya; Locsin, Rozzano C.

doi:10.4236/ojpsych.2016.61015

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…As such, the current IM injection method has its limitations, featuring a multitude of problems in terms of ensuring medical safety and establishing a proven IM injection technique. The authors' research team has experience in the use of ultrasound diagnostic devices to conduct analysis of drug luminance changes post-IM injection [17], the relationship between injection site reactions and treatment efficacy according to IM injection needle penetration depth [11], and research involving appropriate and safe needle penetration length in IM injections [15] [18] [19] [20]. Data were obtained from 136 patients undergoing treatment with LAI and 83 healthy subjects by ultrasonogra-T. Tanioka et al phy at four psychiatric hospitals and one psychiatric clinic in Japan.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Tanioka¹,

Takase²,

Yasuhara³

et al. 2018

Health

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Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new confirmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Tanioka¹,

Takase²,

Yasuhara³

et al. 2018

Health

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“…In previous studies using ultrasonography, the "distance from the epidermis to the under-fascia" and "distance from the epidermis to the iliac bone" of the buttocks at the dorsogluteal and ventrogluteal sites in healthy Japanese volunteer subjects 8) and patients with schizophrenia were measured 9,10) in order to evaluate the optimal IM injection needle length 11) and the optimal gluteal muscular injection needle should be 40-50mm in length. The IM administrated LAIs showed high-echogenicity masses with acoustic shadowing 12,13) .…”

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confidence: 99%

Evaluations of echogenicity in gluteal muscle in patients with schizophrenia treated with second generation long-acting injectable antipsychotics: risperidone or aripiprazole

et al. 2018

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Second generation long-acting injectable antipsychotics (SG-LAIs) injected muscle region show high-echogenicity with acoustic shadowing on B-mode scan. This study aimed to distinguish two specific types of SG-LAIs at the gluteal muscle. Forty-seven patients [risperidone (RLAI): 28 patients, aripiprazole (ALAI): 19 patients] were examined using grayscale histogram analysis of echo-intensities. Pre-and immediately after (post)-injected SG-LAI region of interest (ROI) was placed on the same sites of gluteal muscle, and the grayscale histograms were recorded. Pre-and post-injected echogenicity values were analyzed using paired t-test, and Pearson's moment correlation coefficient. Mixed effects model regression analysis was performed on variations in average echogenicity from age and medication type. Statistical significance was at 5%. There was no significant correlation between age and average echogenicity of ROI pre-intramuscular (IM) injection (r = 0.26, p = 0.078). In both RLAI and ALAI, the mean echogenicity post-IM injection was significantly higher than pre-IM injection (p < 0.001). With increasing age, the values of echogenicity of post-injection was decreased significantly (p = 0.002). The increasing values of the echo-intensities post-injections of RLAI showed significantly higher than ALAI (p = 0.002). It was considered that administered type of LAI could be identified because each LAI exhibits specific echographically findings, it also will be able to applied clinically.

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“…In past research studies, concerning the injection method of LAI using ultrasonic examination [12] [13], it was determined that there were individual differences in the distance from the epidermis to the under-fascia (DEUF) of gluteus maximus muscle or gluteus medius muscle for each patient. Concerning the injection insertion depth in the case of IM injection, particularly in the case of LAI, a shallow insertion depth sometimes occurs and the needle does not penetrate the muscle fascia and as a result the medication is delivered into the subcutaneous tissue, or it happens that some of the medication leaks into the subcutaneous tissue.…”

Section: Introductionmentioning

confidence: 99%

Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

Zhao¹,

Tanioka²,

Yasuhara³

et al. 2017

OJPsych

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In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients' psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks; comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site 375 Open Journal of Psychiatry adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.

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Explanatory Variables as Evidence for Precision in Intramuscular Long-Acting Injections of Patients with Schizophrenia

Cited by 3 publications

References 4 publications

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Evaluations of echogenicity in gluteal muscle in patients with schizophrenia treated with second generation long-acting injectable antipsychotics: risperidone or aripiprazole

Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

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