Give a Subcutaneous Injection

A subcutaneous injection is an injection administered into the fatty area just under the skin (as opposed to an intravenous injection, which is administered directly into the bloodstream). Because they give a slower, more gradual release than intravenous injections, subcutaneous injections are frequently used as a way to administer both vaccines and medications (for instance, type I diabetics often use this type of injection to administer insulin.). Prescriptions for medications requiring subcutaneous injections are usually accompanied by detailed instructions on the correct way to give the injection. The instructions in this article are intended to be used only as a guideline - contact a medical professional before you give any injections at home. Read on below the jump for detailed instructions.

Steps

Preparing for a Subcutaneous Injection

1. Gather your supplies. Performing a subcutaneous injection properly requires more than just a needle, syringe, and medicine. Before proceeding, make sure you have the following:
   • A sterile dose of your medication or vaccine (usually in a small, labeled vial)
   • A suitable syringe with a sterile needle tip. Depending on the size of your patient and the amount of medication to be administered, you may choose to use one of the following configurations or another safe, sterile means of injection:
     • A 0.5, 1, or 2 cc syringe with a 27-gauge needle
     • A 3 cc luer lock syringe (for large doses)
     • A pre-filled, disposable syringe
   • A container for Dispose of Discarded Needles and Sharp Objects Safely
   • A sterile gauze pad (usually 2 x 2 inch)
   • A sterile adhesive bandage (note - make sure the patient is not allergic to the adhesive, as can lead to irritation near the wound)
   • A clean towel
2. Ensure you have the correct medication and dosage. Most subcutaneously-injected medications are clear and come in similarly-sized containers. Thus, it's easy to get them mixed up. Double-check the medication's label to ensure you have the right medication and dosage before proceeding.
   • Note - some medication vials contain only a single dose, while some contain enough medication for multiple doses. Ensure you have enough medication to administer the recommended dose before continuing.
3. Prepare a clean, ordered work area. When performing a subcutaneous injection, the less you have to come in to contact with un-sterilized materials, the better. Having all your tools laid out ahead of time in a clean, easily-accessible work area makes the process of injection quicker, easier, and more sanitary. Lay your towel on a clean surface within easy reach of your intended work site. Lay your tools on the towel.
   • Arrange your supplies on the towel in the order you will need them. Note: You can make a small tear in the edge of your alcohol wipe packages (one that doesn't puncture the inner pocket containing the alcohol wipe) to make them easier to quickly open when you need them.
4. Choose an injection site. Subcutaneous injections are meant to be given into the layer of fat below the skin. Certain areas of the body allow this fatty layer to be accessed more easily than others. Your medication may come with instructions about which specific injection site to use - check with your local health care professional or the medication's manufacturer if you are uncertain of where to administer your medication. Below is a common list of sites for subcutaneous injections:
   • The fatty part of the tricep on the side and back of the arm between the elbow and shoulder
   • The fatty part of the leg on the outside front portion of the thigh between the hips/groin and knee
   • The fatty part of the frontal abdomen below the ribs, above the hips, and not directly adjacent to the belly button
   • Note: It's important to rotate injection sites, as repeated injections into the same location can cause scarring and hardening of the fatty tissue, making future injections more difficult and interfering with absorption of the medication.
5. Wipe the injection site. Using a fresh, sterile alcohol wipe, clean the injection site by gently wiping in a spiral motion from the center outward, being careful not to go back over already clean areas. Allow the site to air dry.
   • Before wiping, if necessary, expose the area of the body where the injection will be given by moving any clothing, jewelry, etc. away. This will not only make it easier to give the injection without obstruction, but also reduce the risk of infection from un-sterilized clothing coming into contact with the injection wound before it's bandaged.
   • If, at this point, you discover the skin at the injection site you've chosen is irritated, bruised, discolored, or distressed in any other way, pick a different site.
6. Wash your hands with soap and water. Because subcutaneous injections pierce the skin, it's important for the person administering the injection to wash his or her hands. Washing kills any bacteria present on the hands, which, if accidentally transferred to the small wound caused by injection, can cause infection. After washing, dry thoroughly.
   • Be sure to wash methodically, ensuring all the surfaces of your hands receive soap and water. Studies have shown that the vast majority of adults don't wash their hands well enough to kill all bacteria.

Drawing a Dose of Medication

1. Remove the tamper resistance tab from the vial of medication. Set this on the towel. If this tab has already been removed, as in the case of multidose vials, wipe the vial's rubber diaphragm with a clean alcohol wipe.
   • Note - if you are using a pre-filled syringe, skip this step.
2. Grab your syringe. Hold the syringe firmly in your dominant hand. Hold it like a pencil, with its (still capped) needle pointed up.
   • Though, at this point, you shouldn't have removed the syringe's cap, handle it carefully regardless.
3. Remove the needle's cap. Grasp the cap over the needle with the thumb and forefinger of your other hand and pull the cap off the needle. Take care, from this point forward, not to allow the needle to touch anything except your patient's skin when s/he receives the injection. Lay the discarded cap on your towel.
   • You are now holding a small but extremely sharp needle - handle it with caution, never carelessly gesturing or making sudden movements with it.
   • Note - if you are using a pre-filled syringe, skip to the next section.
4. Pull the plunger back on the syringe. Keeping the needle pointed up and away from you, use your non-dominant hand to pull the syringe's plunger, filling the syringe with air to the desired dosage.
5. Grab the medication vial. Carefully use your non-dominant hand to grab the vial of medication. Hold it upside down. Take extra care not to touch the vial's rubber diaphragm, which must stay sterile.
6. Insert the needle into the rubber stopper. At this point, your syringe should still contain air.
7. Depress the plunger injecting the air into the medication vial. The air should rise through the liquid medicine to the highest point of the vial. This serves two purposes - first, it empties your syringe, ensuring that no air bubbles will be administered along with the medicine. Second, it makes it easier to draw the medication into the syringe by increasing the air pressure in the vial.
8. Draw medication into your syringe. Making sure the needle tip is submerged in the liquid medicine and not the air pocket within the vial, pull back on the plunger slowly and gently until you have reached your desired dosage.
   • You may need to tap the sides of your syringe to force air bubbles to the top, then expel the air bubbles by gently pressing the plunger, forcing the air bubbles back into the medication vial.
9. Repeat the previous step as needed. Repeat the process of drawing medication into your syringe and expelling air bubbles until you have the desired dose in your syringe with no air bubbles.
   • It's very important for there to be no air bubbles in the syringe when the medication is administered. Forcing an air bubble under the skin can cause a serious medical condition known as an embolism, which, though rare, can be fatal if the air bubble blocks blood flow to the heart, brain, or lungs.
10. Remove the vial from your syringe. Place the vial back on your towel. Do not set your syringe down at this point, as doing so can contaminate your needle which can lead to infection.

Giving a Subcutaneous Injection

1. Ready the syringe in your dominant hand. Hold the syringe in your hand as though you are holding a pencil or a dart. Make sure you can easily reach the syringe's plunger.
2. Gently "pinch" the injection site. Using your non-dominant hand, gather about {{safesubst:#invoke:convert|convert}} of skin between your thumb and index finger creating a slight mound of skin, taking care not to bruise or damage the surrounding area. By bunching up the skin, you create a thicker area of fat for you to inject into, ensuring the entire dose is administered into the fat and not into the underlying muscle.
   • When gathering your skin, do not gather any muscle tissue. You should be able to feel the different between the soft upper fat layer and firmer, lower muscle tissue. Subcutaneous medications are not intended for injection into muscle and, if administered into muscle, may result in bleeding into the muscle tissue. This is especially true if the medication has blood thinning properties.
3. Insert the syringe into the skin. With a slight snapping motion of your wrist, plunge the needle all the way into the skin. Usually, the needle should be inserted into the skin at 90 degrees (straight up and down, relative to the skin) to ensure that the medication is injected into the fatty tissue. However, for exceptionally thin or muscular people with little subcutaneous fat, you may need to insert the needle at a 45 degree angle (diagonally) to avoid injecting into muscle tissue.
   • Act quickly and firmly, but without jamming or stabbing the needle into the patient with excessive force. Hesitation may cause the needle to bounce off the skin or pierce the skin slowly, causing increased pain.
4. Release the skin. Ease your grip on the patient's skin, allowing it to fall back to its natural position. Keep the needle submerged in the skin.
   
   
5. Depress the plunger with steady, even pressure. Push down on the plunger without applying extra pressure onto the patient until all of the medication has been injected. Use one controlled, steady motion.
6. Gently press a piece of gauze or a cotton ball next to the needle at the injection site. This sterile material will soak up any bleeding that occurs after the needle is removed. The pressure you apply to the skin through the gauze or cotton will also prevent the needle from pulling on the skin as it's removed, which can be painful.
7. Remove the needle from the skin in one smooth motion. Either gently hold the gauze or cotton ball in place over the wound or instruct the patient to do so. Do not rub or massage the injection site, as can cause bruising or bleeding under the skin.
   • At this point, you may secure the gauze or cotton to the patient's wound with a small adhesive bandage. However, because bleeding is likely to be minimal, you may also allow the patient to simply hold the gauze or cotton in place for a minute or two until bleeding stops. If using a bandage, make sure the patient isn't allergic to the adhesive.
8. Safety dispose of your needle and syringe. Carefully place your needle and syringe in a proper puncture-resistant sharps container. It's very important to ensure the needles aren't thrown out with the "normal" trash, as used needles can spread potentially deadly blood-borne illnesses.
9. Put all of your supplies away. You have successfully completed your subcutaneous injection.

Video

Template:Video:Give a Subcutaneous Injection

Tips

• Give your child a choice of the age-appropriate parts of the ritual, for example, holding the cap for you after you pull it off the syringe, and when "they are grown up enough", letting them pull it off. It is calming to take an active part and learn to take care of themselves.
• An ice cube may be used to slightly numb the intended injection site.
• To prevent bruising or small lumps of scar tissue from developing at the injection site, press steadily on the injection site with the gauze or cotton for at least 30 seconds after removing the needle. This is a wonderful trick for anyone who has to have daily injections. Within the range of steady "firm pressure", let your child tell you if they want more or less pressure.
• Placing a piece of cotton or gauze at the injection site before removing the needle will prevent the skin from pulling and decrease the pain from the injection.
• For children, or anyone needing a painless injection, use Emla, a topical anesthesia held in place with a Tegaderm patch for a half an hour before the injection.
• Also, rotate injection sites among legs, arms and middle (left and right, front and back, upper and lower) so that you don't get an injection in the same part of your body more often than once every two weeks. Simply follow the same order of 14 sites, and the spacing is automatic! Kids love predictability. Or, if they do better choosing the location themselves, make a list and cross them off.
• If you have access to the internet look up your medication on the manufacturers web site.
• Try drawing up a bit on the syringe to check for blood while the syringe is in before you put in the medication, if blood comes up into the syringe then take the needle out and if possible redraw your dose. This will prevent from injecting into blood vessels.

Warnings

• When using an ice cube to alleviate the pain of the injection, do not leave the ice cube in place too long as it can freeze cells damaging the tissues and decrease the absorption of the medication.
• Read the label of your medication carefully to ensure you have the correct medication and strength.
• Do not discard needles or syringes in regular trash, use only puncture resistant sharps disposal containers.
• Do not attempt to give any injections without proper instruction from your healthcare provider.

Things You'll Need

• Multi-dose medication vial and properly calibrated syringe or pre-filled medication syringe
• Alcohol wipes
• Small clean towel
• A small gauze square or clean cotton ball
• Puncture proof sharps disposal container (if not using a syringe with needle safety device)
• A sterile bandage

Sources and Citations

• http://products.sanofi-aventis.us/lovenox/lovenox.html
• http://diabetes.about.com/od/equipmentandbreakthroughs/ht/injectinsulin.htm?
• http://www.cc.nih.gov/ccc/patient_education/pepubs/subq.pdf

See also

• Give an Intradermal Injection
• Give a Glucagon Shot
• Give a Heparin Shot
• Get an Injection Without It Hurting
• Give an Intramuscular Injection
• Overcome the Fear of Injections
• Administer a Flu Shot
• Get a Shot
• Properly Place a TB Skin Test
• Cope With Having Injections

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What links here

• Give an Intramuscular Injection
• Manage a Painful Injection
• Properly Place a TB Skin Test