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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, October 29, 2012

Shorter Needles Or No Needles – Flu Shot Choices

By Rod Moser, PA, PhD

Needle

WebMD’s Ear, Nose, and Throat Community Board has a very lively, ongoing discussion with scores of people who have residual arm pain as a result of getting a (flu) vaccination. It is my assumption that most have experienced some peripheral nerve injury from the needle and poor injection technique….not the vaccine. The flu vaccine is supposed to be given intramuscular, but this is the same area where a network of nerves travels down our arms to our fingertips. Those longer needles plunge blindly into this abyss – a shot in the dark.  A shorter needle would seem to be safer.

It is amazing how many people admit to having “needle phobia”. I have seen big ‘ol, strapping high school football players cry like babies when I tell them that the need a “shot” or a simple blood test. Just yesterday, one of my favorite, long-time patients needed a blood test for his cholesterol. He adamantly refused because he “hates needles”.

More recently, I have been using some little white lies when it comes to injections. When I get a refusal or a child or teenager puts their foot down when I inform them that an injection is needed, I tell them the following:

“The good news is that we ran out of the normal needles that we use for shots. All we have are the tiny newborn needles – the ones we use for babies. We are not supposed to use them for older kids, but if you promise not to say anything I can use them for your injection today….or, you can wait until tomorrow when the bigger needles come in.”

So far, 100% have agreed to get the shots with the baby needles. Of course, there are no such things as “special baby needles”.  I fibbed. Incidentally, they reported less pain or none at all.

I do several different surgical procedures in my practice that require that I anesthetize the area with lidocaine. Of course, this requires a needle. As soon as I start filling up the syringe, I can see the sweat beading up on some of those patients, because I use a huge needle to draw up the solution. I then change the needle to a little tiny one, but I still have to talk them through the procedure carefully. I allow the patient to drive, so to speak. They let me know on a one to five scale how much discomfort they are having and I can adjust the injection accordingly.

People getting flu vaccines typically have a choice, since flu vaccine comes in two forms. One is the live intranasal vaccine that is a mist sprayed painlessly in the nose. The other requires a needle from one inch to 1.5 inches long. The FDA has now approved use of a much shorter needle for this season’s flu vaccine – one that is 90% shorter; about 1/10 of an inch long.  So far, this has only been approved for adult patients over 18; not children. The shorter needle has been used successfully in Europe, Australia, and Canada for a few years.

It would be wonderful if all vaccines could be delivered without the use of any needles. Pharmaceutical companies have been scrambling to get an inexpensive and effective needless delivery system. When a company finally develops a delivery system for vaccines that is 100% painless, risk-free, inexpensive, and efficacious, the world will be knocking down the door to get it.

In the mid-1970s, I worked with a physician who used a special air gun to give certain hormonal medications to patients requiring a daily injection. Similar to the military version used for mass immunizations, this needleless method required a large canister of compressed air that shot the vaccine directly through the skin. The area would still bleed a bit, just like a needle, and it still hurt. Patients stated that it was not as painful as getting a needle every day, so 90% preferred the air gun method.

Until edible vaccines are perfected (they are working on them) or more intranasal ones are offered, needles will continue to be used as a delivery system. That’s my story and I am sticking to it (so to speak).

Photo: Design pics

Posted by: Rod Moser, PA, PhD at 1:00 am

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