Details about subcutaneous injection. We know about subcutaneous injection but do we know about the right information? Maybe you know, I here try to upgrade your current knowledge about the topic. Here, we discuss about the indications, contraindications, precautions, procedure, nursing care plan of subcutaneous injection, complications and many more. Feel free to learn.
Thanks
2. INTRODUCTION
The administration of subcutaneous injection is an important part of
drug administration and a common nursing intervention in clinical
practice. Among the different drug injection methods, subcutaneous
injection is the one which is applied to the fatty layer of
subcutaneous tissue just beneath the skin. As subcutaneous tissue
has few blood vessels, the injected drug is diffused very slowly at a
sustained rate of absorption. Therefore, it is highly effective in
administering vaccines, growth hormones and insulin, which require
continuous delivery at a low dose rate. It is often part of nurse’s role
to administer medicine and educate the patient in injection
technique. A skilled injection technique can make the patients
experience less painful and avoid unnecessary complications.
Giving a subcutaneous injection safely is considered to be a routine
nursing activity. However, it requires knowledge of anatomy and
physiology, psychology, communication skills and practical
expertise.
3.
4. DEFINITION
Subcutaneous injection is administered into the
fatty layer of skin directly below the dermis and
epidermis. Subcutaneous injections are highly
effective in administering vaccines such as
measles, mumps, rubella and medications such
as insulin, morphine, di-acetyl morphine and
goserelin.
5.
6. TYPES OF SYRINGE FOR SUBCUTANEOUS INJECTION
Two types of syringe :
I. Insulin syringe:
This holds maximum of 1 ml of medicine . The syringe
has markings from 10 to 100.The marking at 100 is
the same as 1 ml
7. II.TUBERCULIN SYRINGE :
This syringe holds up to 1ml of medicine . It has a
needle that is slightly longer than an insulin syringe .
The syringe is marked every 0.1 ml.
8. NEEDLE SIZE WITH SITE AND VOLUME
ACCORDING TO AGE OF PATIENTS
Patient’s age Injection Site Needle size Volume of drugs
Infants
(Birth-1 year)
• Fatty area of
the thigh
• 3/8 inches
• 31 G
0.1 ml
Toddlers
(1-3 years)
• Fatty area of
the thigh or
outer aspect of
upper arm
• 3/8 inches
• 29-31 G
0.5 ml
Children
(3-11 years)
• Fatty area of
the thigh or
outer aspect of
upper arm
• 5/8 inches
• 28-31 G
1 ml
Adolescents /
adults(11years-
olders)
• Abdomen(abou
t 2 inches away
from the navel)
or upper
buttock
• 5/8 inches
• 28-31 G
0.5-1 ml
9. SITES OF SUBCUTANEOUS INJECTION:
Abdomen: At or under the level of the belly button, about
2 inches away from the navel.
Arm: Back or side of the upper arm.
Thigh: Front of the thigh.
Buttock: Imagine a line that runs across the back just above
the crack between the buttocks . An injection may be given
below the waist and above this line
10.
11.
12. INDICATIONS OF SUBCUTANEOUS INJECTION
Severe dysphagia/swallowing difficulties
Mouth, throat and esophageal lesions
Intestinal obstruction
Profound weakness
Poor absorption of oral drugs
Unacceptable number of oral medications
Unconscious patient
13. ADVANTAGES OF SUBCUTANEOUS INJECTION
1. Safe and easy route.
2. Slow and sustained absorption.
3. Self medication is possible.
4. Prolonged duration of action.
5. Foul smelling & irritating drugs can be given.
14. DISADVANTAGES OF SUBCUTANEOUS INJECTION
1. Painful
2. Skin pigmentation
3. Hypersensitivity reaction may occur.
4. Large volume of drug can not be given.
5. Discoloration of skin may occur.
6. Irritation , infection , tissue necrosis to the
site of injection may occur.
15. COMPLICATIONS:
Severe pain
Redness
Swelling or bruising
Skin irritation
Thrombus formation
Pulmonary embolism
Allergic reaction
Restlessness
Tenderness
May be experience soreness or bleeding
16. PRECAUTION FOR SUBCUTANEOUS INJECTION
Subcutaneous injection are inserted at 45 to 90 degree
angles , depending on amount of subcutaneous tissue
present and length of needle.
i. Do not aspirate . It is not necessary to aspirate
because the epidermis and dermis is relatively
without vessels.
ii. Review lab values and assessment data prior to
injection. (e.g –insulin)
iii. Avoid sites that are bruised, tender, hard or
swollen.
iv. Be careful when preparing and administering high
alert medications.
17. ESSENTIAL STEPS FOR ADMINISTERING
SUBCUTANEOUS INJECTION
Cheek for administration rights . These are :
Right drug/Medication
Right client/Patient
Right Route
Right Dose
Right Time
Right Assessment
Right Approach
18. Continue..
Right Education
Right Prescription
Right Nurse Clinician
Right Principle of Care
Right Evaluation
Right Documentation
19. EQUIPMENT NEEDED FOR SUBCUTANEOUS
INJECTION
Syringe appropriate for the medication being
given.
Needle (3/8 or 5/8 inch)
Alcohol pad
Medication ampoule or vial
Disposable gloves
Kidney tray
One sterile gauze or cotton piece
One tray
20. PROCEDURE
Wash hands to minimize risk of infection to the patient.
Don gloves
Check the patient’s identification.
Position patient either sitting or lying down
Check the drug , formulation, indication, route, volume and side
effects.
Assess the skin and the patient’s condition.
Prepare the patient:
Clean the area with the an alcohol pad in a spiral motion, clean
outward 3 inches.
Assist the client into a comfortable position:
Relax the arm, leg, or abdomen.
Distract client by talking about an interesting subject or explaining
what we are doing step by step
21. CONTINUE..
Injection Administration procedure:
Consider rotation of injection sites and assess
those that are repeatedly used for injection
Hold the syringe between thumb and
forefinger of dominant hand like a dart
Pinch skin with non dominant hand
Inject needle quickly and firmly (like a dart) at
a 45 degree to 90 degree
Ensure the fold of skin is injected into and
released only when the needle is removed .
24. CONTINUE..
Wait at least 10 seconds before withdrawing the needle.
Do not massage or rub the site afterwards unless otherwise
indicated.
Re-assess for therapeutic effects and/or any side effects.
Assist the client to a comfortable position.
Discard the uncapped needle and syringe in a disposable
needle receptacle.
Remove gloves ; wash hands.
Document accurately and appropriately.
25. NURSING CARE PLAN
Nursing
diagnosis
Goal Nursing intervention Evaluation
1.Fear and
anxiety due to
administration of
subcutaneous
injection
To reduce fear
and anxiety
• Explain the
procedure to the
patient about
subcutaneous
injection
• Provide emotional
and psychological
support
• Allow the time for
questions and
answers
Gradually
minimize fear
and anxiety
26. Nursing
diagnosis
Goal Nursing intervention Evaluation
2.Risk for
developing
complication
To prevent
complication
• Maintain aseptic
technique during
procedure
• Use of disposable
needle and syringe
• Use the needle of
appropriate size and
length according to
age
• Maintain rotation of
injection site
Gradually reduce
the complication
28. SUMMARY
The subcutaneous injection technique requires skill,
knowledge and a good understanding of the indications for the
injection. Although the subcutaneous route is relatively pain-
free , over injection can lead to these sites being more painful.
Poor injection technique can lead to adverse outcomes for the
patient: site pain and bruising can occur from local tissue
trauma. Rotation of sites is therefore recommended to avoid
irritation, scarring of tissue and pain.
29. REFERENCE
Dr. Md. Mokbul Hossain MBBS;M phil (pharmacology), A
handbook of easy pharmacology
Hunter J (2008) Subcutaneous injection technique.
Nursing Standard.22,21,41-44.
In Jamieson EM, Whyte LA, McCall JM (Eds) Clinical Nursing
Practices. Fifth Edition. Churchill Livingstone Elsevier, Edinburgh,
5-9.
Sherri Ogston -Tuck
Senior lecturer, adult nursing, Institute of Health and Society,
University of Worcester, Worcester.
Correspondence to : S.ogston-tuck@worc.ac.uk
http://en.wikipedia.org/wiki/subcutaneous injection
www.healthline.com/health/SC injection
