# Subcutaneous Injection

# Overview

This module describes how to inject medication into the space between the skin and the muscle tissue.

# Indications

1. Administering subcutaneous medication such as heparin,

   insulin
   insulin

   Treatment of diabetic ketoacidoses (DKA) requires IV administration.

   or vaccines

# Contraindications

1. Damaged, infected, swollen, thickened, or scarred skin at the injection site

2. More than 2ml of medication in one site

3. Some medications may have their own specific contraindications

# Patient Information & Consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I need to give you medication through an injection under your skin.”

### What can my patient expect?

“This will sting for a moment.”

### What is my patient’s role?

“Keep still while I give the injection. Let me know if you have any allergies or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it.”

# Preparation

### Documentation

1. Prescription chart or vaccine card as required

### Equipment

1. Non-sterile gloves

   only if indicated
   only if indicated

   Gloves are only necessary when there is a risk of exposure to body fluids or infection, such as for patients with broken skin or where contact precautions are indicated.

2. Alcohol-based hand rub

3. Sharps container
   Sharps container

   If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.

4. One blunt fill needle for aspiration and one 25-27 G needle for injection.

5. Syringe
   Syringe

   Medication is sometimes provided in pre-filled syringes e.g. heparin or insulin penset.

   (1-3 ml size)

6. Medication or vaccine

7. Alcohol swab

8. Cotton wool ball

# Site & Positioning

# Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene. Do not routinely glove unless indicated.

2. Check patient identity, allergies, consent, and that you have the correct, unexpired medication, sometimes referred to as the

   5 Rs
   5 Rs

   Right patient
   Right drug
   Right dose
   Right site
   Right timing

   of medication administration.

3. Draw up the medication with the aspiration needle. Attach the injection needle to the syringe.

4. Select the injection site and expose. Avoid recently used sites.

5. Do not clean the site unless it is visibly dirty or if the patient may be immunocompromised.

6. Pinch the skin up.

7. Insert the needle, bevel up, at a 45° angle into the pinched fold in a dart-like action. Stay in the fatty subcutaneous tissue layer.

8. Do not pull back the plunger. Inject slowly over 10-30 seconds.

9. Wait 10 more seconds, then withdraw. Do not massage the site. Apply gentle pressure with a cotton ball.

10. Dispose of medical waste safely.

11. Record medication administration and the site used. Monitor for drug reactions.

# Troubleshooting

Medication is leaking out after injection.

Next time, make sure you’re using the smallest needle available. Inject more slowly, deeper if possible, and wait a little longer before withdrawing the needle. Don’t inject more than 2 ml of medication in one site.

# Risks

1. Bleeding, bruising, and pain at the site

2. Lipohypertrophy: a persistent painless lump at the site

3. Infection or irritation at the site, including abscess formation

4. Drug-related complications, e.g. hypoglycaemia after administering insulin

5. Sharps injury to healthcare personnel

6. Vasovagal response (fainting)

# References

1. Shepherd E. Injection technique 2: administering drugs via the subcutaneous route. Nursing Times [online]. 2010;(114) 9: 55-57.

2. WHO Best Practices for Injections and Related Procedures Toolkit. World Health Organization: Geneva; 2010.

3. Rushing J. How to administer a subcutaneous injection. Nursing [online]. 2004;(34)6: 32.

4. Joubert A. Administration of injections. In: Mulder M, Joubert A, Olivier N, eds. Practical Guide for General Nursing Sciences. 2nd ed. Pearson; 2020.