Subcutaneous Injections

• Subcutaneous (SC) injections


  • Administered into the adipose tissue layer just below the epidermis and dermis
  • Tissue has few blood vessels, so drugs administered by this route have a slow, sustained rate of absorption
  • Sites for SC injections include the outer aspect of the upper arm, the abdomen, anterior aspects of the thighs, upper back, and upper ventral gluteal area
• Administering an SC injection

  1. Use a 25 to 30 gauge, 3/8 in. to 5/8 in. needle

  2. Subcutaneous injections are usually given at a 45- to 90-degree angle

  3. No more than 1 ml of medication is given subcutaneously, as larger amounts may cause discomfort to the patient and may not be absorbed appropriately
• Pinching the skin during administration

  • Advised for thinner patients in order to lift the adipose tissue up and away from the underlying muscle and tissue
  • Elevating or pinching the skin has been found to increase the risk of injury, as the needle may pierce the opposite side of the skin fold and enter the skin of the health care worker
• Abdomen


  • Best location for an SC injection if a patient has little peripheral SC tissue
  • If patient is obese, use a needle that is long enough to insert through the tissue at the base of the skin fold

  
• Medication administration steps


  1. Check accuracy and completeness of each medication administration record (MAR) with prescriber's medication order

  2. Review pertinent information related to medication: action, purpose, normal dose, route, side effects, adverse reactions, time of onset, peak of action and nursing implications

  3. Assess patient's medical and medication history and history of allergies

  4. Check date of expiration for medication

  5. Assess patient symptoms or condition for which medication has been prescribed

  6. Prepare the materials needed

  7. Obtain the appropriate medication. Read the MAR and prepare medications for one client at a time. Select the proper medication from the unit stock/ patient's medication drawer

  8. Compare the label of the medication against the order on the patient's MAR/ CMAR. Check the expiration date and perform calculations. Return expired medications to the pharmacy

  9. Bring medications to patient's bedside and keep in sight at all times

  10. Wash hands

  11. Identify the patient using two identifiers

  12. Explain the procedure and purpose to the patient and family

  13. Provide privacy

  14. Re-check again the medication against the MAR at the patient's bedside

  15. Select the injection site

  16. Help patient to comfortable position

  17. Cleanse the skin using a firm circular motion starting at the center and widening the circle outward. Allow the area to dry thoroughly

  18. Hold cotton between third and fourth fingers of non-dominant hand

  19. Uncap the needle with by pulling it straight off

  20. Grasp and bunch the area surrounding the injection site

  21. Hold the syringe as dart, palm down between thumb and forefinger of dominant hand

  22. Insert the needle quickly at 45 to 90 degree angle while firmly grasping the site

  23. After the needle is inserted, release the tissue. Immediately move your non dominant hand to steady the lower end of the syringe. Slide your dominant hand to the end of the plunger. Avoid moving the syringe

  24. Inject medication slowly and steady

  25. Withdraw the needle quickly. Using the dry cotton, apply gentle pressure to the site after the needle is withdrawn. Do not massage

  26. Assist patient to comfortable position

  27. Discard uncapped needle or needle enclosed in safety shield and attached syringe into puncture-proof and leak-proof receptacle

  28. Remove gloves and perform hand hygiene. Care for equipment

  29. Document the administration of medication

  30. Return to room and ask if patient feels any acute pain, burning, numbness, or tingling at injection site

  31. Conduct appropriate follow up such as desired effect, any adverse effects and clinical signs of side effects

  32. Observe patient's response to medication at times that correlate with onset, peak, and duration of medication

  33. Ask patient to explain purpose and effects of medication to evaluate patient's understanding of information given
• Rationale of: Check accuracy and completeness of each medication administration record (MAR) with prescriber's medication order


  To ensure safety
• Rationale of: Review pertinent information related to medication: action, purpose, normal dose, route,

  side effects, adverse reactions, time of onset, peak of action and nursing implications.

  To ensure accuracy and safety
• Rationale of: Assess patient’s medical and medication history and history of allergies. Know his or her

  normal response to an allergy.

  To ensure safety
• Rationale of: Review pertinent information related to medication: action, purpose, normal dose, route,

  side effects, adverse reactions, time of onset, peak of action and nursing implications.

  To ensure accuracy & safety
• Rationale of: Assess patient’s medical and medication

  history and history of allergies. Know his or her normal response to an allergy.

  To establish a baseline
• Rationale of: Check date of expiration for medication.

  To ensure drug efficacy
• Rationale of: Assess patient symptoms or condition for which medication has been prescribed.


  To ensure safety of the client
• Rationale of: Prepare the materials needed.

  -Prescribed medication

  -Syringe (e.g 3-ml syringe)

  -Sterile needle (25 gauge needle or

  smaller, 3/8 or 5/8 inches long)

  -Alcohol swab

  -Dry cotton ball

  -Clean gloves

  -Medication Administration Record

  To save time and effort; to make them readily available and accessible
• Rationale of: Obtain the appropriate medication. Read the MAR and prepare medications for one client at a time. Select the proper medication from the unit stock/ patient’s medication drawer

  For accuracy & to avoid drug administration & preparation errors
• Rationale of: Compare the label of the medication against the order on the patient’s MAR/ CMAR. Check the

  expiration date and perform calculations. Return expired medications to the pharmacy 


  To ensure safety and accuracy to avid any drug administration error
• Rationale of: Bring medications to patient’s bedside and keep in sight at all times.

  For accessibility; to ensure safety & drug integrity
• Rationale of: Wash hands

  To mechanically remove microorganisms
• Rationale of: Identify the patient using two identifiers (i.e name and birth date or name and account number.) Compare identifiers with information on the patient’s medical record.


  To ensure patient identity; for accuracy, to avoid any medication error
• Rationale of: Explain the procedure and purpose to the patient and family 


  To keep patient/family informed
• Rationale of: Provide privacy.


  To keep patient comfortable & cooperative
• Rationale of: Re-check again the medication against the MAR at the patient’s bedside.

  For accuracy
• Rationale of: Select the injection site: Common sites for subcutaneous injections are outer aspect of upper arms and anterior aspect of thighs. 


  To locate the better site for injection
• Rationale of: Help patient to comfortable position: Have patient relax arm, leg, or abdomen,

  depending on site chosen for injection. Drape as needed, to expose only site area to be used.

  To ensure patient welfare is in place; to help calm the patient; to keep patient privacy
• Rationale of: Cleanse the skin using a firm circular motion starting at the center and widening the circle outward. Allow the area to dry

  thoroughly.

  To remove microrganisms on the target site & surrounding area
• Rationale of: Hold cotton between third and fourth

  To keep it accessible for use
• Rationale of: Uncap the needle with by pulling it straight

  To avoid any accident like needle pricks
• Rationale of: Grasp and bunch the area surrounding the injection site. 


  To have a better aim on the site of injection
• Rationale of: Hold the syringe as dart, palm down between thumb and forefinger of dominant hand. 


  To keep fingers & hands steady
• Rationale of: Insert the needle quickly at 45 to 90 degree

  angle while firmly grasping the site.

  For a person with little subcutaneous

  tissues, it is best to insert the needle at a 45 degree angle while grasping the site.


  To facilitate drug entry in the targeted area
• Rationale of: For obese patient pinch skin at site and inject at 90 degree angle below tissue fold. 


  To facilitate drug entry in the targeted area
• Rationale of: After the needle is inserted, release the tissue. Immediately move your non dominant hand to steady the lower end of the syringe. Slide your

  dominant hand to the end of the plunger. Avoid moving the syringe.

  To ensure proper technique
• Rationale of: Inject medication slowly and steady.


  To facilitate drug entry & comfort to the patient
• Rationale of: Withdraw the needle quickly. Using the dry cotton, apply gentle pressure to the site after the needle is withdrawn. Do not

  massage. 


  To avoid irritating the site & leakage of the drugs (when massaged)
• Rationale of: Assist patient to comfortable position.

  To keep patient relaxed
• Rationale of: Discard uncapped needle or needle enclosed in safety shield and attached syringe into puncture-proof and leak-proof

  receptacle.

  To ensure safety as it reduces risks of infection (ie.needle prick) & spread of microorganism
• Rationale of: Remove gloves and perform hand hygiene. Care for equipment. 


  To remove microorganisms and prevent contamination
• Rationale of: Document the administration of medication. 


  To ensure proof of medication administration is in place
• Rationale of: Return to room and ask if patient feels any acute pain, burning, numbness, or tingling at injection site. 


  To check for drug reaction on the patient
• Rationale of: Conduct appropriate follow up such as desired

  effect (e.g., relief of pain, sedation, lowered blood sugar,

  a prothrombin time within pre-established limits), any

  adverse effects (e.g., nausea, vomiting, skin rash) and

  clinical signs of side effects.


  To check for the drug effect
• Rationale of: Observe patient’s response to medication at times that correlate with onset, peak, and duration of medication. 


  To check for the drug efficacy & client’s welfare