Subcutaneous Injection

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Subcutaneous Injection

Definition

A subcutaneous injection is a method of drug administration. Up to 2 ml of a drug solution can be injected directly beneath the skin. The drug becomes effective within 20 minutes.

Purpose

Subcutaneous injection is the method used to administer drugs when a small amount of fluid is to be injected, the patient is unable to take the drug orally, or the drug is destroyed by intestinal secretions.

Precautions

If the drug to be administered is harmful to superficial tissues, it should be administered intramuscularly or intravenously. It is useful to remember the following when administering any medication: the right patient, the right medicine, the right route, the right dose, the right site, and the right time.

Description

With the subcutaneous route, a small thin needle is inserted beneath the skin and the drug injected slowly. The drug moves from the small blood vessels into the bloodstream. Subcutaneous injections are usually given in the abdomen, upper arm, or the upper leg.

Preparation

The hands should be washed, and gloves may be worn during the procedure. A syringe and needle should be prepared. If a sterile, multiple-dose vial is used, the rubber-capped bottle should be rubbed with an antiseptic swab. The needle is then inserted through the center of the cap and some air from the syringe inserted to equalize the pressure in the container. Slightly more of the required amount of drug is then removed. Holding the syringe vertically at eye level, the syringe piston is pushed carefully to the exact measurement line.

If a small individual vial containing the correct amount of drug is used, the outside should be wiped with an antiseptic swab and held in the swab while the top is removed. The needle is then inserted into the vial, taking care that the tip of the needle does not scratch against the sides of the vial, thereby becoming blunt.

A syringe and needle containing the drug should be placed on a tray with sterile cotton swabs, cleaning disinfectant, and adhesive tape. If the patient is unfamiliar with the procedure, the nurse should explain what he or she is about to do and that the patient is to receive medication prescribed for them. The dose on the patient's prescription sheet should be checked prior to administration.

A screen should be drawn around the patient to avoid any personal embarassment. The injection site is then rubbed vigorously with a swab and disinfectant to cleanse the area and increase the blood supply. A small piece of skin and subcutaneous tissue is pinched between the thumb and forefinger, and the needle inserted quickly at a 45-degree angle. Certain drugs such as heparin are given at a 90-degree angle rather than at 45 degrees. It is important to ensure that the needle is not in a vein. Therefore the syringe should be aspirated a little by pulling back on the piston. If blood is present, the needle should be re-injected, and the piston withdrawn slightly once more. The skin is then released and the syringe piston pushed down steadily and slowly.

A sterile cotton swab should be pressed over the injection site as the needle is quickly withdrawn, and the swab is taped to the skin for a few minutes, if required.

Aftercare

Monitor the patient's reaction and provide reassurance if required. Dispose of all waste products carefully, and place the syringe and needle in a puncture-resistant receptacle. Wash the hands. For patients requiring frequent injections, the site is changed each time.

Complications

If the circulation is depleted, absorption of the drug administered may be slow. Certain drugs such as anticoagulants have specific side effects that the patient may experience. Injected drugs can also interact with other medications that the patient is taking. Check for any adverse reactions if the drug is being administered for the first time.

Results

The proper method of subcutaneous injection results in the safe administration of the drug with no complications for the health care provider or patient.

Health care team roles

The health care team should record any side effects or negative reactions to the injected drug and notify the medical staff as appropriate. If the medication is to be prescribed regularly for a specific disease, the patient can be directed to a self-help group where members have the same medical condition.