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Cyanocobalamin clears faster and requires more frequent dosing, so it has largely fallen out of routine use here

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Needle sizes most commonly used at the RCH include: 25g x 25mm ORANGE 23g x 25mm BLUE 21g x 38mm GREEN Equipment Appropriate size needle for administration Drawing up needle and syringe (if medication not pre-filled) Sharps container Alcohol impregnated swab (if area visibly soiled) Cotton ball Band-Aid (check for allergies) Personal Protective Equipment (PPE) for hazardous medications or infectious patients The procedure Prepare patient and obtain consent Perform the five moments of hand hygiene Prepare equipment as per Aseptic Technique Complete the six rights of medication administration Don PPE if required (particularly for hazardous medications) Draw up or prime medication as per Paediatric Injectable Guidelines Position patient in a safe and comfortable position Procedure Management Guideline Consider the use of comfort techniques such as distraction, buzzy bee, ice or a countdown Landmark injection site (see above) Clean site with an alcohol swab (if required) Stretch the skin flat (Z-tracking if applicable) Inject the needle to the hub at a 90-degree angle Do not aspirate or drawback as this can increase pain and discomfort in children Inject the medication at a slow and steady pace Remove the needle and apply a cotton ball Place the needle in a sharps container Apply Band-Aid Remove PPE (if required) Perform the five moments of hand hygiene Special considerations Monitor for immediate adverse reactions, e.g., fever, rash, vomiting, shortness of breath

ESR involves the enzymatic degradation of collagen-rich fibrous septae which play a key role in the pathophysiology of cellulite