Subcutaneous injection

Please note this information is for educational purposes only and procedures should not conducted based on this information. OSCEstop and authors take no responsibility for errors or for the use of any content.

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)

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 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)
• With the thumb and index finger of your non-dominant hand, gently 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 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 – if using these needles, they 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

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