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.

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:
o A 0.5, 1, or 2 cc syringe with a 27-gauge needle
o A 3 cc luer lock syringe (for large doses)
o A pre-filled, disposable syringe
 A container for safely disposing of your syringe.
 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:[1]

 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.[3]

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 1 1⁄2 to 2 inches (3.8 to 5.1 cm) 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.[4] 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.