How to safely give a subcutaneous injection?

It is best to leave this task to a healthcare specialist, so before you read on, always keep in mind that the patient will always be safer in the hands of a practitioner when it comes to a subcutaneous injection. However there might come a time when both caregivers and the patients they care for need to be proficient in administering others and themselves injections. The first step towards safely giving an injection is to learn about the types of injections there are, and the differences between them. Injection methods employed in humans include intradermal, subcutaneous, intramuscular, intravenous, intraosseous, intraperitoneal, intrathecal, epidural, intracardiac, intraarticular, intracavernous, and intravitreal. Today we will focus on subcutaneous injections. A subcutaneous injection is given into the fatty tissue layer right underneath the skin, where there is little blood flow, which makes it ideal to administer medications required to be absorbed slowly, usually over a period of 24 hours, such as insulin, morphine, diacetylmorphine and goserelin.  Subcutaneous injection sites include the exterior area of the upper arm, right above and below the waist, the upper area of the buttock, and the front of the thigh. Burned, hardened, inflamed, swollen, or otherwise damaged skin is not apt to receive a subcutaneous injection.
Next up, you need to wash your hands meticulously before gathering and handling all the necessary equipment. This equipment consists of the medication (either a multidose vial of liquid or a vial with powder that needs reconstitution), a syringe, needles, medication log, syringe disposal container, sterile, 2’’x2’’ gauze pads, and alcohol pads. The size of the syringe depends on the dose and the size of the person receiving the injection. Examples of syringes include 0.5 cc,1.0 cc, or 2 cc with 27­gauge needle (5/8 of an inch long); 3­cc luer lock syringe (used when solution is more than 1 cc); 25­gauge needle (5/8 of an inch long) or 27­gauge needle (5/8 of an inch long); and 0.3 mL insulin syringes with 31­gauge needles (3/16 to 5/16 inches long ) for people who are visually impaired or who need very small doses of medication. 

Follow these instructions when drawing up the medication:
  • Read the label to make sure you have the correct medication.
  • Remove the cap that protects the vial’s rubber stopper.
  • Clean the stopper with an alcohol swab.
  • Remove the syringe from its cover.
  • Grab the plunger handle (so as to avoid contamination of the sterile plunger shaft) and pull it back and forth. 
  • If need be, securely attach the needle, and with the needle capped, pull the plunger back to fill the syringe with air in an amount equal to the medication dose that will be injected.
  • Remove the needle cap without touching the needle. Both the inside of the cap and the needle are sterile. Set the cap on its side so it is not contaminated when you replace the cap on the needle.
  • Hold the vial upright and push the needle through the stopper at a 90˚ angle, without bending the needle.
  • The air with which you previously filled the syringe must be injected into a multi-dose vial in order to keep a vacuum from forming that would make it difficult to withdraw the medication. Be careful not to inject too much air, though, lest the plunger is forced out of the barrel and the medication spills. 
  • Turn the vial upside down so that the needle, still inside the vial, points upward and the tip is fully covered by the medication. This will facilitate the withdrawal of the medicine.
  • Fill the syringe with the correct dose by pulling the plunger back.
  • While still holding the same position, tap or flick the syringe with your fingers to move bubbles to the top of the syringe, from where you can push them back into the vial by pushing gently on the plunger.
  • Make sure that the dose is still correct after removing the bubbles.
Injection sites
Arms. Fold one arm across the chest and put one hand on the shoulder and the other on the elbow. Picture a line below the hand on the shoulder and another line down the outer side of the arm and down the center front of the arm, starting at the elbow. The injection is administered inside that area.
Thighs. Put one hand above the knee and picture a line above it. Put the other hand on the uppermost thigh and picture another line below it. Picture a line down the outer side of the leg and down the center front of the leg. The injection is administered inside that area.
Abdomen. Put your hands on the lower ribs and picture a line below them. Fatty issue in the area below your hands may be injected. Use a 1’’ area around the navel.
*Injection sites should be rotated to avoid scarring and hardening of fatty tissue. Injections should be given one inch apart from each other within one particular site, starting at the highest point and working your way down to the point farthest away from the body.
Follow these steps to administer the injection:
  • Meticulously clean the skin with an alcohol swab. Use back and forth movements to push bacteria away from the site. Let alcohol air dry.
  • Remove the cover from the needle and set it on its side. The needle must not be contaminated.
  • Grab the syringe like you would a pencil or dart.
  • Pinch the skin between the thumb and index with the hand not holding the syringe.
  • Quickly yet gently thrust the needle all the way into the skin at a 90˚ angle to make sure the medication is injected into the fatty tissue (a 45˚ angle may be used in small children and individuals with little subcutaneous fat on thin skin). Do not push the needle slowly or forcefully.
  • Release the skin once the needle is entirely inserted. Slowly and steadily press the plunger down to inject the medication into the subcutaneous layer.
  • Press a 2”x2” gauze onto the injection site while you pull the needle out, and press and rub for a few seconds if your doctor has instructed you to do so. Blood and clear fluid at the injection site is normal. 

    Related Read: BD Conventional Syringe for Insulin Administration