Effect of a reused insulin needle remaining in a patient's body

Abstract

Diabetes is one of the most common chronic diseases at present, and insulin pen injection therapy plays an important role in the treatment of diabetes. However, the majority of patients might reuse disposable insulin pen needles for various reasons, which leads to related complications. As far as we know, this article is the first to describe a patient whose needle remained in the right upper limb while reusing a disposable insulin injection needle for subcutaneous insulin injection with the non‐dominant hand. The patient went to the doctor 1 week later. The needle moved from the lateral area of the proximal upper arm (the injection site) to the posterolateral area of the distal upper arm. The needle was then successfully removed by surgery. The reuse of disposable insulin pen needles might lead to serious complications. It is suggested to strengthen the education of people living with diabetes to help them use insulin pen needles safely.

A needle remaining in the patient's body is a theoretically possible, but rare, complication, and no case has been reported in the literature so far. In this article, we first present a case of a reused disposable insulin pen needle remaining in the patient's body, and the needle was successfully removed by surgery.

INTRODUCTION

Diabetes is one of the most common chronic diseases threatening human health ¹ . Insulin injection is the most important treatment method for people living with diabetes ² . The insulin pen is the most commonly used, because it is safe, simple to use, portable, efficient and painless ³ . Although the insulin pen is equipped with a disposable injection needle, the reuse of a disposable needle is incredibly common in practice. Needle reuse might increase acupuncture pain, lipohypertrophy around the injection site and decrease insulin efficacy ⁴ .

According to previous studies focused on disposable insulin pen needle reuse, it is theoretically possible that the needle might remain in the body. However, its complication is rarely mentioned in the great majority of studies. No case has been reported in the literature so far ⁴ . As far as we know, we are the first to present a case of a needle remaining in the patient's body while injecting with a reused disposable insulin pen needle for the fourth time using the non‐dominant hand, and the needle was removed surgically.

CASE REPORT

The patient was a 72‐year‐old man with an 11‐year history of type 2 diabetes. A needle became accidentally detached and remained in the patient's body when he used the disposable insulin pen needle (31‐G 6 mm, Easydrip®; SteriLance Medical, Suzhou, China). It was the fourth time he used the needle, and he used his left (non‐dominant) hand to inject insulin while lying in bed in the dark at home at night. After a week, during his outpatient visit, the patient claimed that the needle was too expensive and the replacement was complicated. One day before the outpatient visit, the patient underwent an X‐ray examination in another hospital, showing that the needle had moved from the lateral area of the proximal right upper arm to the posterolateral area of the distal right upper arm. The X‐ray examination carried out for his right elbow joint in The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China, showed that a small strip of high‐density shadow could be seen in the soft tissue behind the distal right humerus, which was considered a foreign body of the needle (Figure 1).

Figure 1.

Anteroposterior and lateral X‐ray of the patient's right elbow joint showed a small strip of high‐density shadow on the posterolateral area of the distal right humerus. The small image on the upper right is a local magnification, and the white arrowhead points to the insulin pen needle.

The patient was admitted to the hospital, and the C‐arm‐guided foreign body removal operation was successfully carried out under brachial plexus anesthesia on the second day of hospitalization. By using the C‐arm fluoroscopy and Kirschner wires (K‐wires), the needle was successfully found on the lateral side of the distal triceps tendon, and no obvious abnormalities were observed in the surrounding tissues. It was considered that the needle moved through the space between the subcutaneous fat and the fascia layer. The patient was discharged on the second day after the operation and followed up in the outpatient setting subsequently.

DISCUSSION

Insulin injection is an important daily treatment for diabetes patients, and the patients benefit a great deal from the use of insulin pens ¹ , ² . The combination of an insulin pen and a disposable injection needle enables patients to obtain painless, simple‐to‐operate, safe and effective insulin injection therapy. However, due to a variety of factors, including financial constraints and the complexity of needle replacement, most patients will reuse disposable injection needles in practice ⁴ . The disposable injection needle is thin and sharp, and is coated with a lubricating silica gel layer, which can reduce acupuncture friction and reduce injection pain. Reuse might lead to bending and deformation of the needle tip, which will not only increase injection pain, but also cause lipohypertrophy and induration of subcutaneous tissues, even affecting the accuracy of insulin injection ⁵ . The risk of an insulin injection needle remaining in a patient's body has been mentioned in previous literature, but there is no empirical case. In the present article, a patient with an insulin injection needle remaining in their body is reported for the first time, and the needle is successfully removed surgically.

The reuse of the needle and injection with the non‐dominant hand are thought to be the primary causes of needle detachment and retention. The reused needle became blunt, the tip bent and the silica gel layer fell off, resulting in increased friction between the needle and the skin. Meanwhile, the needle was not correctly inserted vertically when the non‐dominant hand was used for injection. Thus, the needle detached and remained in the patient's body for the aforementioned reasons. Furthermore, muscle contraction and gravity made the needle travel in the subcutaneous fat layer, moving from the lateral area of the proximal upper arm to the posterolateral area of the distal upper arm. According to the literature, insulin pump needle detachment and retention in the body were closely observed without surgery, which achieved a barely acceptable outcome ⁶ , ⁷ . In the present case, the patient insisted on having the remaining needle removed, and because the needle was located in the subcutaneous fat layer of the elbow, which had no important blood vessels, nerves or muscles, open surgery was ultimately chosen.

People living with diabetes are unaware of the potential harm caused by the reuse of disposable needles as a result of a lack of out‐of‐hospital education and re‐education on the use of insulin pens ⁸ . Indeed, several studies showed that there was no clear scientific evidence against the reuse of needles for subcutaneous insulin injection ⁹ , but with the present case for evidence, people living with diabetes will be on alert for complications caused by the reuse of needles. Furthermore, studies have shown that effective health education can effectively improve the use of insulin pens in people living with diabetes, ensuring the efficacy of insulin injections ⁴ , ¹⁰ .

In conclusion, it is extremely urgent to strengthen the education on insulin injection therapy for people living with diabetes to correctly use disposable injection needles and avoid needle detachment during injection therapy.

DISCLOSURE

The authors declare no conflict of interest.

Approval of the research protocol: N/A.

Informed consent: The patient gave written informed consent.

Approval date of registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.