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SUBCUTANEOUS INJECTION
Subcutaneous injection is the route of administration that is most commonly chosen for injection because it provides a greater comfort level. Alternate sites in order to prevent absorption problems, the risk of infection, or soreness, which may occur if one site is used repeatedly.
Supplies:
- Alcohol swabs.
- Needle and syringe for subcutaneous injection.
- Band-aid strip.
- Gauze pads.
- Medication.
- Sharp's container.
THE PROCEDURE
Note: These are a general guidelines for giving an injection using a standard needle-syringe injection unit. Be sure to consult with your health care provider about the medication you are using and follow any product-specific instructions that may be required for your particular situation.
STEP 1
Wash your hands with soap and water.
STEP 2
Wipe the top of the medication vial for injection with an alcohol swab.
STEP 3
Remove the needle guard (cover) from the needle and syringe, saving the needle guard. Be sure you are using a proper syringe for subcutaneous injections. Pull back on the syringe plunger to draw up an amount of air equal to the amount of medication that will be used for the injection.
STEP 4
Holding the vial of medication in an upright position (such as sitting it on a table top), slowly insert the needle into the rubber stopper on top of the vial while holding the syringe barrel carefully. Do not bend needle. Then push the plunger to discharge all the air into the vial. This prevents vacuum.
STEP 5
With the needle in the vial, turn the vial upside down and hold both the vial and the syringe together in one hand. The tip of the needle should be in the solution. Hold the vial between the thumb and forefinger, supporting the syringe with other hand, pull the plunger back in a slow, continuous motion until you have drawn into the syringe the amount of medication to be given. Be sure the needle stays in the fluid in vial. Do not touch inside of plunger.
STEP 6
Check for clear air bubbles inside of syringe. Small bubbles are not harmful but take up space in syringe. With bubbles present, correct amount of medication may not be prepared. If air bubbles have formed in the syringe, dislodge them by gently tapping the syringe with your free hand while continuing to hold the syringe and vial in the inverted position. Bubbles should rise to the top of the syringe, and then you can push them back into the vial by moving the plunger and slowly pull the medication into the syringe again, stopping at the correct dose. Repeat this procedure until there are no large air bubbles in the syringe. Always double check to make sure you have the correct amount of medication in the syringe. If necessary, draw more solution into the syringe.
STEP 7
Remove the needle from the vial by pulling it straight out. VERY CAREFULLY replace the needle guard without touching the needle. If the medication needs to be refrigerated, place in the refrigerator.
STEP 8
Prepare the injection site by cleaning the area with an alcohol swab. To do this start at the center, apply pressure, and cleanse in a circular motion working outward. Do NOT retrace your steps. (If this is a wound repair using sutures, wash the wound thoroughly with sterile saline solution and gently dab dry with sterile gauze pads (4X4s) before injecting with anesthetic medication. Do not use alcohol for cleansing sensitive episiotomy or tears in the perineal area of the body.)
STEP 9
Wait a few seconds until the alcohol has dried. This reduces the sting. Remove the needle guard from the needle and syringe filled with medication. Hold the syringe as you would a pencil.
STEP 10
With your free hand, gently pinch up the skin at the injection site. Holding the syringe at a right angle to the site, insert the needle using a quick smooth motion. Going slowly will cause more pain. A 45 degree angle may be used for children or thin adults.
STEP 11
When the needle is in place, slowly pull back on the plunger to see if any blood flows into the syringe. If some blood does enter the syringe (a rare occurrence), remove the needle and discard the syringe and medication, and prepare another injection. According to Mosby: Nursing Interventions and Clinical Skills Skill 40.3, Routine aspiration is no longer recommended. If no blood enters the syringe, let go of the skin and slowly inject the medication by gently pushing the plunger until the syringe is empty.
STEP 12
Put alcohol swab over needle gently, and pull needle out quickly at the same angle it was inserted. Check for medication leakage at site. Apply pressure to the injection site with a dry, sterile gauze pad. You may note a drop of blood, but there is no cause for concern. If desired, apply a bandage. Without replacing the needle guard on the needle, dispose of the needle into a sharps container.
INTRAMUSCULAR (IM) INJECTIONS
Follow the same instructions above except these injections are usually given in the large muscle of the buttock. To locate the correct area, divide the buttock into four areas. The injection should be given in the upper, outer portion of the buttock.
The needle should go into the skin on a 90 degree angle, should go into the skin the entire 1-1/2 inches (the entire length of the needle). A consistent even motion should be used when an injection is administered. The person who is getting the injection should lay face down on the bed or lean over the bed.
When the needle is in the muscle, steady the syringe with hand and pull back on the plunger to look for possible blood in the syringe (this would indicate that the needle is in not in the correct area). Should this occur, simply remove the needle and find a new injection site. You may still use the same medication, but attach a new needle to the syringe. If after pulling back on the plunger no blood was noted, medication remains clear, slowly push on the plunger to administer the entire medication in the syringe.
Pull the needle out straight and quickly. Some blood may appear at the surface of the skin. Place a band-aid at the injection site. Dispose of all needles in a safe manner using a sharps container. Gently massage the area.
INJECTION LINKS
Injections - Insulin
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