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Prefilling and storage considerations for insulin, flu clinics

Last week’s post [1] on prefilling and storing syringes drew a number of comments [2] from the home health crowd, expressing concern that insulin is often drawn up and stored for patients in that setting. Others wondered what the best-practice is during flu clinics where several syringes at a time are filled to speed the process.

First the flu clinic question. The CDC’s National Center for Immunization and Respiratory Diseases strongly discourages the practice of prefilling influenza vaccines in large quantities [3], although a limited amount of vaccine may be predrawn under certain circumstances (see guidelines under “Influenza Clinics and Prefilling Syringes”).

What typically happens at these flu clinics is a group of people will be drawing up and labeling the vaccine at one table and it is delivered by trained volunteers to the proper tables for giving the vaccine. Once, drawn up it must be used during that clinic, so as they get closer to the end they will quit drawing up the vaccines until they need them. This procedure is done in a closed monitored setting with trained personnel.

Insulin, on the other hand, is more unique. Many people have gone to the insulin pens so the risk of contamination and wrong dose is lessened.

If you are not using insulin pens the first step would be to check the manufacturer’s recommendations. Some syringe manufacturers discourage prefilling and storage of any medication, including insulin. Additionally, there are many different types of insulin and pre-mixtures, all of which may have different requirements.

For example, a commentary written by Martin M. Grajower, MD, from the department of medicine/endocrinology at Albert Einstein College of Medicine, in Riverdale, NY, published in the September 2003 issue of “Diabetes Care,” [4] indicated that Lantus (made by Aventis Pharmaceuticals) should not be prefilled because it can interact with the plastic in the syringe and begin breaking down.

Additionally BD has this recommendation [5] for their syringes: “BD does not recommend that any of our syringes be prefilled more than a few minutes in advance of the injection. There are no conclusive studies to determine the safety or risks associated with this practice.”

According to “Diabetes Education & Management in Home Care,” regular and NPH insulin can be prefilled for up to 30 days; although it’s recommended to use the insulin within seven days, says Lu Post, RN, MN, COS-C, president of Home Care Institute, LLC and contributor to OASIS-Central [6], a Beacon Health resource (a division of HCPro) for home healthcare professionals. Mixed insulin however, needs to be used immediately because longer-acting insulin can cause faster-acting insulin to work more slowly, especially with the presence of zinc protamine.

Simply put, as with most recommendations, check with both the syringe manufacturer and the insulin manufacturer to be sure you are operating under appropriate best-practices.