Table of Contents
Subcutaneous injections are administered in to the subcutaneous adipose tissue below the dermis. This allows a slow and more sustained rate of absorption. Many drugs can be given by this route, including insulin and heparin.
Introduction
- Wash hands; Introduce self; Patient’s name, DOB and wrist band; Explain procedure and obtain consent
- Allergy check: check for allergies with patient and on drug chart
- Prescription check: check the prescription drug and dose, and confirm the name and DOB are correct (check with patient and their wristband)
- Look up drug in Injectable Medicines book to determine volume of sterile water/saline required to reconstitute drug (if it is in powder form)
Preparation
- Wash handsÂ
- Clean tray
- Gather equipment around tray (think through what you need in order)
Equipment list
- Gloves (+ extra pair and apron if you need to draw up drug)
- Drug – CHECK DATE, DOSE, PRESCRIPTION AND ALLERGIES
- + if drug is in liquid form: blunt fill 18G drawing-up needle and syringe for drawing-up
- + if drug is in powder form: blunt fill 18G drawing-up needle, syringe and vial of sterile water/saline for reconstituting drug and drawing-up – CHECK DATE
- Alcohol 70%/chlorhexidine 2% skin-cleansing wipe – optional
- Orange 16mm 25G needle for injection
- Sterile gauze
- Tape
- Wash hands
- Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
- If the drug is in powder form:
- Wash hands, put on apron and extra pair of gloves
- Snap top off sterile water/saline vial
- Put drawing-up needle on syringe, hold sterile water/saline vial upside-down and draw up required amount for reconstitution (plus a bit extra)
- Expel air and some water to leave the exact amount needed for reconstitution
- Flick top off drug vialÂ
- Insert needle and inject the sterile water/saline. Twist the vial back and forth on end of needle until drug powder is fully dissolved.
- Draw up drug solution while the vial is upside-down
- Remove and dispose of drawing-up needle in sharps bin and replace with injection needle (leave sheath on)
- Expel air from syringe and place back into syringe packet in tray
- Discard waste; then discard gloves and apron; wash handsÂ
- If the drug is in liquid form:
- Wash hands, put on apron and extra pair of gloves
- Put drawing-up needle on syringe and fill with approximately the same volume of air as in the drug vial if drug vial contains a vacuum
- Flick/snap top off drug vial
- Insert the needle into the vial, and inject the air into the airspace if drug vial contains a vacuum
- Draw up drug solution while the vial is upside-down
- Remove and dispose of drawing-up needle in sharps bin and replace with injection needle (leave sheath on)
- Expel air from syringe and place back into syringe packet in tray
- Discard waste; then discard gloves and apron; wash handsÂ
- Walk to patient (with tray and sharps bin)
Procedure
Exposure
- Wash hands
- Expose injection site (upper outer arms, upper outer thighs or central abdomen avoiding area around umbilicus)
- Support the limb with pillows if necessary
Injection
- Wash hands
- Put on gloves
- Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds) – optional
- With the thumb and index finger of your non-dominant hand, pinch a 5cm fold of skin at the injection site
- Holding the syringe (like a dart) between the thumb, index and middle fingers of your dominant hand, insert the needle into the subcutaneous tissue at 45Ëš, then release the pinch
- Using your dominant hand to securely hold the syringe in place (against the patient), use your non-dominant hand to:
- Pull back on the top of the syringe (to confirm you are not in a blood vessel) – optional
- Slowly, inject the drug
- Gently but briskly remove the needle and immediately dispose of it (with syringe) in the sharps bin
- Wipe the injection site and press over it firmly with gauze, before applying tape
NB: some purpose-made subcutaneous injection needles are very short (≤8mm), e.g. insulin or LMWH needles – these should be inserted at 90Ëš.
To complete
- Thank patient and restore clothing
- Discard waste and clean tray; then discard gloves; wash hands
- Sign on the drug chart that the drug has been administered