Subcutaneous injection

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 hands 
• Clean tray
• Gather equipment around tray (think through what you need in order)

• 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 vial 
  • 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 hands 
• 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 hands 
• 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 45˚, 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 90˚.

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

Try an OSCE station

1. Subcutaneous injection
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