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11/13/24, 7\:27 PM Guide | Subcutaneous (SC) injection

Subcutaneous (SC) injection

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Gather equipment

Gather the appropriate equipment\:
Non-sterile gloves
Apron
Equipment tray
Syringe (the smallest syringe that will accommodate the medication volume)
Injecting needle (26–30 gauge)\: a standard length is 13-16mm.
¹
Drawing-up needle (also known as a blunt
when drawing up medications from ampoules.
Gauze or cotton swab
Sharps container
The medication to be administered
The patient’s prescription

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
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Brie
t h i s w i l l i n v o l v e a n i n j e c t i o n u n d e r t h e s k i n . Y o u m a y b r i e
d o e s i n v o l v e s o m e r i s k s w h i c h i n c l u d e b l e e d i n g , b r u i s i n g , a p e r s i s t e n t l u m p a t t h e i n j e c t i o n s i t e a n d a s m a l l c h a n c e o f i n f e c t i o n
o r s e r i o u s a l l e r g i c r e a c t i o n .
"
Check the patient's understanding of the medication being administered and explain the indication for the treatment.
Gain consent to proceed with the subcutaneous injection.
Check if the patient has any allergies.
Ask if the patient has a preferred injection site. If the patient is receiving regular subcutaneous injections, ensure that the
injection sites are rotated.
Adequately expose the planned injection site for the procedure.
Position the patient so that they are sitting comfortably.
Ask the patient if they have any pain before continuing with the clinical procedure.

Final checks

Before proceeding, check the seven rights of medication administration.
1. Right person\: ask the patient to con
prescription. You should use at least two identi
2. Right drug\: check the labelled drug against the prescription and ensure the medication hasn't expired.
3. Right dose\: check the drug dose against the prescription to ensure it is correct.
4. Right time\: con
dose if relevant.
5. Right route\: check that the planned route is appropriate for the medication you are administering.
6. Right to refuse\: ensure that valid consent has been gained prior to medication administration.
7. Right documentation of the prescription and allergies\: ensure that the prescription is valid and check the patient isn't
allergic to the medication you are going to administer.
Once all of the above have been con

Performing the subcutaneous injection

1. Wash your hands and don some gloves (if not already done).
2. Draw-up the appropriate medication into the syringe using a drawing-up needle.
3. Remove the drawing-up needle and immediately dispose of it into a sharps bin, then attach the needle to be used for
performing the injection.
4. Choose an appropriate site for the injection\: ¹
Abdomen\: avoid injecting within a 2-inch radius around the umbilicus (this is the preferred site if administering low molecular
weight heparin).
Upper outer aspect of the arm
Outer aspect of the upper thigh
Upper buttock
Do NOT use a site that is scarred, in
If multiple injections need to be administered, use di
administered, rotate injection sites.
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5. Position the patient to provide optimal access to your chosen site.
6. Cleaning the site\:
WHO does not recommend the routine use of alcohol-based cleansing wipes prior to administration of subcutaneous
medication as this can predispose an individual to develop hardened skin at the injection site.
² ³
,
If the skin is visibly soiled it should be cleaned with soap and water.
Routine cleaning is not usually required prior to subcutaneous injection.
In older patients and those who are immunocompromised, skin preparation using an alcohol-impregnated swab (70%
isopropyl alcohol) may be recommended.
4
7. Pinch a 5cm fold of skin between the thumb and index
depth of the subcutaneous tissue available).
8. Warn the patient of a sharp scratch.
9. Pierce the skin at a 45-90°
the bevel facing upwards.
angle, aiming to remain in the subcutaneous tissue layer. Insert the needle quickly and
10. Inject the contents of the syringe whilst holding the barrel
injections, as there are no major blood vessels in the subcutaneous tissue and the risk of inadvertent intravenous administration
is minimal. 5
You should, however, always follow your local guidelines.
11. Remove the needle and immediately dispose of it into a sharps container.
12. Apply gentle pressure over the injection site with a cotton swab or gauze and avoid rubbing the site.
13. Replace the gauze with a plaster.
14. Dispose of your equipment into an appropriate clinical waste bin.
Don apron

To complete the procedure...

Explain to the patient that the procedure is now complete.
Thank the patient for their time.
Discuss post-injection care\:
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Warn the patient that it is normal for the injection site to be sore for one or two days. Advise that if they experience
worsening pain after 48 hours they should seek medical review.
Reiterate the potential complications of subcutaneous injections including haematoma formation, persistent nodules, local
irritation and rarely anaphylaxis.
Dispose of PPE appropriately and wash your hands.
Document the details of the procedure and the medication administered.

Reviewer

Graham Bone
Senior Clinical Lecturer in Medical Education

References

1. BD. Subcutaneous Injection Guidelines for Needle Length and Gauge Selection. Published in 2012. Retrieved from\: [LINK].
2. World Health Organisation - WHO Best Practices for Injections and Related Procedures Toolkit. Retrieved from\: [LINK].
3. Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. Yvan Hutin et al. 2003.
Retrieved from\: [LINK].
4. Dougherty L, Lister S (2015) The Royal Marsden Manual of Clinical Nursing Procedures. Oxford\: Wiley-Blackwell.
5. Public Health England (2013) Immunisation Procedures\: The Green Book, Chapter 4. Retrieved from\: [LINK].
Source\: geekymedics.com
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