Research Article
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Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography

Year 2021, Volume: 9 Issue: 2, 1 - 9, 31.08.2021
https://doi.org/10.24998/maeusabed.971037

Abstract

The most commonly used areas in the lower extremity in subcutaneous injection applications are anterior and lateral surface of the thigh. The calf region, which is an alternative to these areas, is located in the lateral region of the gastrocnemius muscle. The aim of the study is to retrospectively evaluate of suitability of thigh and calf site subcutaneous adipose tissue thickness for subcutaneous injection through computed tomography sections. The sample of this descriptive study consisted of 140 adult patients over the age of 18 who underwent Contrast-Enhanced Lower Extremite Computed Tomography Angiography between March 2020 and March 2021. Subcutaneous tissue thicknesses of the anterior thigh, lateral thigh, and calf injection site of the subjects were measured by a specialist radiologist using computed tomography sections. As a result of the study, a comparison of subcutaneous tissue thickness in the thigh and calf was achieved according to gender and body mass index. The mean subcutaneous tissue thickness of the patients was 13.64 ± 6.85 mm on the anterior thigh, 8.82 ± 7.21 mm on the lateral side of the thigh, and 6.15 ± 3.12 mm in the calf area. It was found that there was a significant difference between subcutaneous tissue thicknesses according to their gender and body mass index. Subcutaneous tissue thickness on the anterior thigh was thicker than the lateral thigh and the calf injection site. Subcutaneous tissue thickness in females was greater than in males. Subcutaneous tissue thickness in the calf region was thicker than 4 mm in 77.1%, 8 mm in 19.3% and 12 mm in 12.3%.

References

  • Akkus, O., Oguz, A., Uzunlulu, M., Kizilgul, M., 2012. Evaluation of skin and subcutaneous adipose tissue thickness for optimal insulin injection. Journal of Diabetes & Metabolism 3(8), 1-5.
  • Akyer, Ş. P., Adigüzel, E., Sabir, N., Akdoğan, I., Yilmaz, B., Yonguç, G. N., 2014. Comparison of ultrasonography and skinfold measurements of subcutaneous fat thickness in the evaluation of body composition. Anatomy 8(1), 1-8.
  • Bergenstal, R.M., Strock, E.S., Peremislov, D., Gibney, M.A., Parvu, V., Hirsch, L.J., 2015. Safety and efficacy of insulin therapy delivered via a 4 mm pen needle in obese patients with diabetes. Mayo Clinic Proceedings 90(3), 329–338.
  • Berman, A.T., Snyder, C., Frandsen, G., Kozier, Erb's., 2016. Fundamentals of Nursing, UK: Global Edition. Pearson Education p.791-796.
  • Dalkıran, Ş., 2014. Subkutan insulin enjeksiyonu uygulamasında deri kalınlığı, subkutan yağ dokusu ve iğne boyu seçiminin metabolik kontrol üzerine etkisi. Akdeniz Üniversitesi Sağlık Bilimleri Enstitüsü İç Hastalıkları Anabilim Dalı, Yayınlanmamış Yüksek Lisans Tezi.
  • Diggle, D. 2014. Are you FIT for purpose? The importance of getting injection technique right. J Diabetes Nurs. 18, 50.
  • Fraiz, G.M., Gallo, L.H., Rabito, E.I., Gomes, A.R.S., Schieferdecker, M.E.M. (2020). Relationship between muscle thickness and calf circumference in healthy older women. Archives of Gerontology and Geriatrics, 86, 103942.
  • Gibney, M.A., Arce, C.H., Byron, K.J., Hirsch, L.J., 2010. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Current Medical Research and Opinion 26(6), 1519-1530.
  • Guo, X., Wang, W., 2017. Challenges and recent advances in the subcutaneous delivery of insulin. Expert Opinion on Drug Delivery 14(6), 727-734.
  • Hirsch, L., Byron, K., Gibney, M., 2014. Intramuscular risk at insulin injection sites–measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes Technology & Therapeutics 16, 867–73.
  • Hirsch, L.J., Strauss, K.W., 2019. The injection technique factor: what you don’t know or teach can make a difference. Clinical Diabetes 37(3), 227-233.
  • Misnikova, I.V., Gubkina, V.A., Lakeeva, T.S., Dreval, A.V., 2017. A randomized controlled trial to assess the impact of proper insulin injection technique training on glycemic control. Diabetes Therapy 8(6), 1309-1318.
  • Perez-Chirinos Buxade, C., Solà-Perez, T., Castizo-Olier, J., Carrasco-Marginet, M., Roy, A., Marfell-Jones, M., Irurtia, A., 2018. Assessing subcutaneous adipose tissue by simple and portable field instruments: Skinfolds versus Amode ultrasound measurements. PLoS ONE 13(11), 1-13. e0205226.
  • Potter, P.A., Perry, A.G., Stockert, P.A., Hall, A.M., 2017. Fundamentals of Nursing. In. Medication Administration, 9th ed. St Louis: Elsevier Inc; p.647-49.
  • Pozzuoli, G.M., Laudato, M., Barone, M., Crisci, F., Pozzuoli, B., 2018. Errors in insulin treatment management and risk of lipohypertrophy. Acta Diabetologica, 55(1), 67-73.
  • Spollett, G., Edelman, S.V., Mehner, P., Walter, C., Penfornis, A., 2016. Improvement of insulin injection technique: examination of current issues and recommendations. Diabetes Educator 42, 379–94. Torun, S., Mutluay, Ş.D., 2017. Applicability of calf subcutaneous tissue to subcutaneous injection in young adults. Applied Nursing Research 34, 66-69.
  • Tubiana Rufi, N., 2009 Short needles reduces the risk of intramuscular injections in children with type 1 diabeets. Diabeets Care 22, 1621-1625.
  • Turan, N., Aydın, G.Ö., Kaya, N., 2019. Subkütan Enjeksiyon Uygulamasında Güncel Yaklaşımlar. Sağlık Bilimleri ve Meslekleri Dergisi 6(2), 406-411.
  • Wagner, D.R., Cain, D.L., Clark, N.W., 2016. Validity and reliability of a-mode ultrasound for body composition assessment of NCAA division I athletes. PLoS One 11, 1–12.
  • Zijlstra, E., Jahnke, J., Fischer, A., Kapitza, C., Forst, T., 2018. Impact of injection speed, volume, and site on pain sensation. Journal of Diabetes Science and Technology 12(1), 163-168.

Uyluk ve Baldır Bölgesindeki Deri Altı Yağ Dokusunun Subkutan Enjeksiyona Uygunluğunun Bilgisayarlı Tomografi ile Değerlendirilmesi

Year 2021, Volume: 9 Issue: 2, 1 - 9, 31.08.2021
https://doi.org/10.24998/maeusabed.971037

Abstract

Subkutan enjeksiyon uygulamalarında alt extremitede en fazla kullanılan bölgeler uyluk ön ve yan yüzüdür. Literatürde geçen ve pratikte kullanılan bu bölgelere alternatif olan baldır bölgesi gastroknemius kasının yan bölgesinde yer almaktadır. Araştırmanın amacı, bireylerde uyluk ve baldır bölgesi deri altı yağ dokusu kalınlığının subkutan enjeksiyona uygunluğunun bilgisayarlı tomografi kesitleri üzerinden ölçülerek retrospektif değerlendirilmesidir. Tanımlayıcı tipte olan araştırmanın örneklemini Mart 2020 – Mart 2021 tarihleri arasında Kontrastlı Alt Extremite Bilgisayarlı Tomografi Anjiografi çekilen 18 yaş üzeri 140 yetişkin birey oluşturdu. Bireylerin uyluk ön yüz, uyluk yan yüz ve baldır bölgesindeki subkutan doku kalınlıkları bir uzman radyolog tarafından bilgisayarlı tomografi kesitleri üzerinden ölçüldü. Araştırma sonucunda cinsiyet ve beden kitle indeksine göre uyluk ve baldır bölgesindeki subkutan doku kalınlığının karşılaştırılması sağlandı.
Bireylerin subkutan doku kalınlığı ortalamaları uyluk ön yüzde 13,64±6,85 uyluk yan yüzde 8,82±7,21 ve baldır bölgesinde 6,15±3,12 mm olarak bulundu. Bireylerin cinsiyet ve beden kitle indeksine göre subkutan doku kalınlıkları arasında anlamlı fark olduğu saptandı. Uyluğun ön yüzündeki subkutan doku kalınlığı uyluğun yan yüzü ve baldır bölgesine göre daha kalındı. Kadın bireylerde tüm enjeksiyon bölgesindeki subkutan doku kalınlığı erkeklerden daha fazlaydı. Baldır bölgesinde subkutan doku kalınlıkları bireylerin %77,1’inde 4 mm’den, %19,3’ünde 8 mm’den ve %12,3’ünde 12 mm’den daha kalındı.

References

  • Akkus, O., Oguz, A., Uzunlulu, M., Kizilgul, M., 2012. Evaluation of skin and subcutaneous adipose tissue thickness for optimal insulin injection. Journal of Diabetes & Metabolism 3(8), 1-5.
  • Akyer, Ş. P., Adigüzel, E., Sabir, N., Akdoğan, I., Yilmaz, B., Yonguç, G. N., 2014. Comparison of ultrasonography and skinfold measurements of subcutaneous fat thickness in the evaluation of body composition. Anatomy 8(1), 1-8.
  • Bergenstal, R.M., Strock, E.S., Peremislov, D., Gibney, M.A., Parvu, V., Hirsch, L.J., 2015. Safety and efficacy of insulin therapy delivered via a 4 mm pen needle in obese patients with diabetes. Mayo Clinic Proceedings 90(3), 329–338.
  • Berman, A.T., Snyder, C., Frandsen, G., Kozier, Erb's., 2016. Fundamentals of Nursing, UK: Global Edition. Pearson Education p.791-796.
  • Dalkıran, Ş., 2014. Subkutan insulin enjeksiyonu uygulamasında deri kalınlığı, subkutan yağ dokusu ve iğne boyu seçiminin metabolik kontrol üzerine etkisi. Akdeniz Üniversitesi Sağlık Bilimleri Enstitüsü İç Hastalıkları Anabilim Dalı, Yayınlanmamış Yüksek Lisans Tezi.
  • Diggle, D. 2014. Are you FIT for purpose? The importance of getting injection technique right. J Diabetes Nurs. 18, 50.
  • Fraiz, G.M., Gallo, L.H., Rabito, E.I., Gomes, A.R.S., Schieferdecker, M.E.M. (2020). Relationship between muscle thickness and calf circumference in healthy older women. Archives of Gerontology and Geriatrics, 86, 103942.
  • Gibney, M.A., Arce, C.H., Byron, K.J., Hirsch, L.J., 2010. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Current Medical Research and Opinion 26(6), 1519-1530.
  • Guo, X., Wang, W., 2017. Challenges and recent advances in the subcutaneous delivery of insulin. Expert Opinion on Drug Delivery 14(6), 727-734.
  • Hirsch, L., Byron, K., Gibney, M., 2014. Intramuscular risk at insulin injection sites–measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes Technology & Therapeutics 16, 867–73.
  • Hirsch, L.J., Strauss, K.W., 2019. The injection technique factor: what you don’t know or teach can make a difference. Clinical Diabetes 37(3), 227-233.
  • Misnikova, I.V., Gubkina, V.A., Lakeeva, T.S., Dreval, A.V., 2017. A randomized controlled trial to assess the impact of proper insulin injection technique training on glycemic control. Diabetes Therapy 8(6), 1309-1318.
  • Perez-Chirinos Buxade, C., Solà-Perez, T., Castizo-Olier, J., Carrasco-Marginet, M., Roy, A., Marfell-Jones, M., Irurtia, A., 2018. Assessing subcutaneous adipose tissue by simple and portable field instruments: Skinfolds versus Amode ultrasound measurements. PLoS ONE 13(11), 1-13. e0205226.
  • Potter, P.A., Perry, A.G., Stockert, P.A., Hall, A.M., 2017. Fundamentals of Nursing. In. Medication Administration, 9th ed. St Louis: Elsevier Inc; p.647-49.
  • Pozzuoli, G.M., Laudato, M., Barone, M., Crisci, F., Pozzuoli, B., 2018. Errors in insulin treatment management and risk of lipohypertrophy. Acta Diabetologica, 55(1), 67-73.
  • Spollett, G., Edelman, S.V., Mehner, P., Walter, C., Penfornis, A., 2016. Improvement of insulin injection technique: examination of current issues and recommendations. Diabetes Educator 42, 379–94. Torun, S., Mutluay, Ş.D., 2017. Applicability of calf subcutaneous tissue to subcutaneous injection in young adults. Applied Nursing Research 34, 66-69.
  • Tubiana Rufi, N., 2009 Short needles reduces the risk of intramuscular injections in children with type 1 diabeets. Diabeets Care 22, 1621-1625.
  • Turan, N., Aydın, G.Ö., Kaya, N., 2019. Subkütan Enjeksiyon Uygulamasında Güncel Yaklaşımlar. Sağlık Bilimleri ve Meslekleri Dergisi 6(2), 406-411.
  • Wagner, D.R., Cain, D.L., Clark, N.W., 2016. Validity and reliability of a-mode ultrasound for body composition assessment of NCAA division I athletes. PLoS One 11, 1–12.
  • Zijlstra, E., Jahnke, J., Fischer, A., Kapitza, C., Forst, T., 2018. Impact of injection speed, volume, and site on pain sensation. Journal of Diabetes Science and Technology 12(1), 163-168.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Eren İSMAİLOĞLU 0000-0001-9998-6081

Elif GÜNAY İSMAİLOĞLU 0000-0002-9152-3469

Publication Date August 31, 2021
Submission Date July 13, 2021
Published in Issue Year 2021 Volume: 9 Issue: 2

Cite

APA İSMAİLOĞLU, E., & GÜNAY İSMAİLOĞLU, E. (2021). Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 9(2), 1-9. https://doi.org/10.24998/maeusabed.971037
AMA İSMAİLOĞLU E, GÜNAY İSMAİLOĞLU E. Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. August 2021;9(2):1-9. doi:10.24998/maeusabed.971037
Chicago İSMAİLOĞLU, Eren, and Elif GÜNAY İSMAİLOĞLU. “Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography”. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9, no. 2 (August 2021): 1-9. https://doi.org/10.24998/maeusabed.971037.
EndNote İSMAİLOĞLU E, GÜNAY İSMAİLOĞLU E (August 1, 2021) Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9 2 1–9.
IEEE E. İSMAİLOĞLU and E. GÜNAY İSMAİLOĞLU, “Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography”, Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, vol. 9, no. 2, pp. 1–9, 2021, doi: 10.24998/maeusabed.971037.
ISNAD İSMAİLOĞLU, Eren - GÜNAY İSMAİLOĞLU, Elif. “Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography”. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9/2 (August 2021), 1-9. https://doi.org/10.24998/maeusabed.971037.
JAMA İSMAİLOĞLU E, GÜNAY İSMAİLOĞLU E. Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;9:1–9.
MLA İSMAİLOĞLU, Eren and Elif GÜNAY İSMAİLOĞLU. “Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography”. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, vol. 9, no. 2, 2021, pp. 1-9, doi:10.24998/maeusabed.971037.
Vancouver İSMAİLOĞLU E, GÜNAY İSMAİLOĞLU E. Evaluation of Subcutaneous Adipose Tissue in the Thigh and Calf Region for Subcutaneous Injection by Computed Tomography. Mehmet Akif Ersoy Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;9(2):1-9.