Subcutaneous Injection
When injected into the adipose (fatty) tissue beneath the skin, a drug moves into the bloodstream more rapidly than if given by mouth. Subcutaneous injection allows slower, more sustained drug administration than IM injection; it also causes minimal tissue trauma and carries little risk of striking large blood vessels and nerves.
Absorbed mainly through the capillaries, drugs recommended for subcutaneous injection include nonirritating aqueous solutions and suspensions contained in 0.5 to 2 mL of fluid. Heparin and insulin, for example, are usually administered subcutaneously. (Some diabetic patients may benefit from an insulin infusion pump.)
Drugs and solutions for subcutaneous injection are injected through a relatively short needle. The most common subcutaneous injection sites are the outer aspect of the upper arm, anterior thigh, loose tissue of the lower abdomen, upper hips, buttocks, and upper back. (See Locating subcutaneous injection sites.) Injection is contraindicated in sites that are inflamed, edematous, scarred, or covered by a mole, birthmark, or other lesion. It may also be contraindicated in patients with impaired coagulation mechanisms.
Equipment
Prescribed medication ▪ patient’s medication administration record ▪ 25G to 27G 5/8″ to ½″ needle ▪ gloves ▪ 1- to 3-mL syringe ▪ alcohol pads ▪ filter needle ▪ Optional: antiseptic cleaning agent, insulin syringe. (See Types of insulin infusion pumps, page 682.)
Preparation of Equipment
Verify the order on the patient’s medication record by checking it against the doctor’s order.1 Also note whether the patient has any allergies, especially before the first dose.
Avoid distractions and interruptions when preparing and administering medication to prevent medication errors.2
Inspect the medication to make sure it isn’t abnormally discolored or cloudy and doesn’t contain precipitates (unless the manufacturer’s instructions allow it).1
Perform hand hygiene.3,4,5 Choose equipment appropriate to the prescribed medication and injection site.
Check the medication label against the patient’s medication record. Read the label again as you draw up the medication for injection.
For Single-Dose Ampules
Wrap an alcohol pad around the ampule’s neck and snap off the top, directing the force away from your body. Attach a filter needle to the syringe and withdraw the medication, keeping the needle’s bevel tip below the level of the solution. Tap the syringe to clear air from it. Cover the needle with the needle sheath.
Before discarding the ampule, check the medication label against the patient’s medication record.1
Discard the filter needle and the ampule. Attach the appropriate needle to the syringe.
For Single-Dose or Multidose Vials
Reconstitute powdered drugs according to instructions. Make sure all crystals have dissolved in the solution. Warm the vial by rolling it between your palms to help the drug dissolve faster.
Clean the vial’s rubber stopper with an alcohol pad. Pull the syringe plunger back until the volume of air in the syringe equals the volume of drug to be withdrawn from the vial.
Without inverting the vial, insert the needle into the vial. Inject the air, invert the vial, and keep the needle’s bevel tip below the level of the solution as you withdraw the prescribed amount of medication. Cover the needle with the needle sheath. Tap the syringe to clear any air from it.
Check the medication label against the patient’s medication record before discarding the single-dose vial or returning the multidose vial to the shelf.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.6
If your facility uses a bar code scanning system, scan your identification badge, the patient’s identification bracelet, and the medication’s bar code, or follow the procedure for your facility’s bar code system.
Explain the procedure to the patient and provide privacy.
Select an appropriate injection site. Rotate sites according to a schedule for repeated injections, using different areas of the body unless contraindicated. (Heparin, for example, should be injected only in the abdomen if possible.)
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