Definition
A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis.
Articles
- Medication card.
- Sterile syringes and needles.
- The prescribed medication in ampoules or vials.
- Alcohol swabs.
- Clean gloves.
- Kidney tray.
Procedure
| NURSING ACTION | RATIONALE | |
| 1. | Before procedure Assemble equipment and check physician’s order. | Avoids medication error from occurring. |
| 2. | Identify patient carefully. | Ensures that right procedure is done on right patient. |
| 3. | Explain procedure to patient, the drug that is to be administered, site, and how he has to cooperate. | Encourages cooperation and allays anxiety. |
| 4. | During procedure Wash hands. | Reduces spread of microorganisms. |
| 5. | Withdraw medication from an ampoule/vial as prescribed. | |
| 6. | Assemble all equipment including loaded medication in syringe near the patient’s bedside. | |
| 7. | Pull curtains. | Provides privacy. |
| 8. | Help patient assume position depending on site selected. Outer aspect of upper arm – arm relaxed and at the side of the body. Anterior thigh– sitting or lying down with muscles relaxed. Abdomen – patient in semi-recumbent position. | Ensures free access to injection site. |
| 9. | Assess the area. Check for lumps, nodules, tenderness, hardness, swelling, scarring, itching, burning sensation and localized inflammation in the area. | Good visualization helps in establishing the correct location of site and avoids damage to tissues. Nodules and lumps indicate that there is inadequate absorption at previous injection site. |
| 10. | Don gloves. | Reduces spread of microorganisms. |
| 11. | Clean the area around injection site with an alcohol swab. Use firm circular motion, while moving while moving outward (5cm diameter). Allow the site to dry. Keep alcohol swab in the tray for reuse, when withdrawing needle. | Friction helps to clean the skin. |
| 12. | Remove needle cap with non-dominant hand, pulling straight off. | Lessens risk of an accidental needle prick. |
| 13. | Grasp and pinch the area surrounding the injection site spread in at site. | Provides for easy and less painful entry into subcutaneous tissue. |
| 14. | Hold the syringe in dominant hand between thumb and forefinger. Inject needle quickly at an angle of 45°- 90°, depending on amount of tissue, turgor of tissue, and length of needle. For thin people, an angle of 45° is preferred. When using an insulin syringe with a 26G needle, an angle of 90° can be used in normal and obese people. | Subcutaneous tissue is abundant in well nourished, well hydrated people and sparse in emaciated dehydrated or very thin people. |
| 15. | After insertion, release the tissue and immediately move your non dominant hand to steady lower end of syringe. Slide your dominant hand to top of the barrel. | Injecting solution into compressed tissue results in pressure against nerve fibers and creates discomfort. The non dominant hand secures the needle and allows for smooth aspiration. |
| 16. | Aspirate if recommended, by pulling back gently on the plunger to determine whether needle is in a blood vessel. If blood appears, withdraw needle and discard. Prepare medication again. Do not aspirate for heparin/insulin. | Discomfort and serious reactions may occur if a drug intended for subcutaneous administration enters into the bloodstream. Heparin is an anticoagulant and can cause bruising on aspiration. Insulin needle is very small and hence aspiration will not give relevant information regarding placement of needle. |
| 17. | Inject medication slowly if no blood appears. | Rapid injection of the medication creates pressure in the tissues and results in discomfort. |
| 18. | Withdraw needle quickly at the same angle as it was inserted, while applying counter traction around the injection site with non-dominant hand. | Slow withdrawal of the needle pulls tissue and causes discomfort. Applying counter traction around the injection site helps in preventing pulling of tissues when needle is withdrawn. Removing needle at the same angle minimizes trauma to tissues and discomfort to the patient. |
| 19. | Massage the area gently with alcohol swab. Do not massage a heparin/insulin injection site. | Massaging helps to distribute the medication and hastens its absorption. Massaging a heparin site can lead to bruising. |
| 20. | Do not recap needle. Discard syringe and needle in appropriate receptacles. | Proper disposal prevents accidental needle stick injury. |
| 21. | After procedure Assist patients to a comfortable position. | |
| 22. | Wash hands after removing gloves. | |
| 23. | Document medication administration with date, time, dosage, route, site and nurse’s signature. | |
| 24. | Evaluate response of the patient to medication. |
REFERENCES
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