Q:

1/20/2014
It was recently brought to my attention that one of our clinics is using a protocol for allergy injections that I am not familiar with. The nurse is instructed by an ENT Instruction Sheet to draw up the correct dose of medicine from the vial and then "wipe off the needle with a dry cotton ball" prior to injection. The instructions state that doing this will lessen the chance of a local reaction. Touching the needle with anything totally goes against my training as an RN! Is this common practice among allergy shot givers?

A:

Thank you for your inquiry.

We have answered a very similar question previously on our website. I have copied below the question and our response to that question.

In addition, since the time of that posting, I have encountered a PDF document which speaks to proper injection technique. The title of that PDF document, and a link to it, is also copied below for your convenience. Also copied below is a direct statement taken from the PDF document.

Thank you again for your inquiry and we hope this response is helpful to you.

Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections
"Avoid recapping of needles and other hand manipulations of needles."

Previous inquiry posted on our "Ask the Expert" website:
Wiping needle with an alcohol wipe before administering an allergy injection
Question:
11/14/2011
I am preparing to start allergy shots. However, the allergist that I am going to instructs his non-licensed staff to "wipe the needle off with alcohol wipe, wipe the vial of serum off, withdraw the vaccine, wipe the needle off again with alcohol and then give the injection". Is this approved practice to give allergy shots by your association? As an RN, I was trained to NEVER touch the sterile needle before the injection was given.

Answer:
A very similar question was submitted to our website, and the answer was posted on 4/1/2008.

"Wiping the Needle" and "Rinsing the Syringe" to Diminish Local Reactions during Immunotherapy

Question:
In response to local shot reactions, I know nurses and allergy physicians who will recommend "wiping the needle" between withdrawing from the allergen vial and injecting the patient. Is there any information or tradition supporting this practice? I didn't turn up anything with a literature search. I would also have some concern about the possibility of clean needle sticks and about breakdown of clean technique. Some patients are believers and specifically request a needle wipe.

Similarly, is there any information supporting admixing ("rinsing the syringe") small amounts of diphenhydramine or corticosteroids with the allergen injection in order to help reactions?

Answer:
I must profess ignorance in that I have never previously heard of either of the two practices ("wiping the needle" or "rinsing the syringe"). My literature search, as yours, was not productive in this regard. Thus, my opinion would be, based upon these observations, that there is no evidence in the literature to support either practice. In addition, I share the concerns expressed in your letter regarding "wiping needles."

In summary, I can find no evidence to support either of the practices that you mentioned, and would be worried about the practice of "wiping the needle" prior to the injection. I really cannot offer any specific advice as to how you should approach the "believers" who specifically request a "needle wipe." Until there is evidence, however, to support either of these techniques, I am afraid there can be no definitive answer as to whether the practices would be helpful.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology