Chapter 7. Parenteral Medication Administration Show
Subcutaneous (SC) injections are administered into the adipose tissue layer just below the epidermis and dermis. This tissue has few blood vessels, so drugs administered by this route have a slow, sustained rate of absorption. Sites for SC injections include the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crest) within one inch of the belly button, anteriolateral aspects of the thighs, and upper ventral gluteal area (Lynn, 2011) (see Figure 7.15). Figure 7.15 Subcutaneous injection sitesChoose a site that is free of skin lesions and bony prominences. Rotate sites for most SC medications (see note about insulin below) to prevent the formation of lipohypertrophy or lipoatrophy in the skin. Physical exercise or application of hot or cold compresses influences the rate of drug absorption by altering local blood flow to the tissues. Any condition that impairs that blood flow to the subcutaneous tissue contradicts the use of subcutaneous injections. Examples of subcutaneous medications include insulin, opioids, heparin, epinephrine, and allergy medication (Perry et al., 2018). To administer an SC injection, a 25 to 30 gauge, 3/8 in to 5/8 in needle is used. Some subcutaneous injections come prefilled with the syringe attached. Always confirm that the right-size needle is appropriate for the patient before use. Subcutaneous injections are usually given at a 45- to 90-degree angle. The angle is based on the amount of subcutaneous tissue present. Generally, give shorter needles at a 90-degree angle and longer needles at a 45-degree angle (Lynn, 2011). SC injections do not need to be aspirated, as the likelihood of injecting into a blood vessel is small. Lynne (2011) suggests that no more than 1 ml of medication is given subcutaneously, as larger amounts may cause discomfort to the patient and may not be absorbed appropriately. Other sources suggest up to 1.5 ml can be injected at once (Perry et al, 2018). Given that, the nurse will have to judge each individual situation. There are varying opinions on whether to pinch the skin during administration. Pinching is advised for thinner patients in order to lift the adipose tissue up and away from the underlying muscle and tissue. If pinching is used, release the pinch when the needle is inserted to avoid injecting into compressed tissue. Note, too, that elevating or pinching the skin has been found to increase the risk of injury, as the needle may pierce the opposite side of the skin fold and enter the skin of the health care worker (Black, 2013). The abdomen is the best location for an SC injection if a patient has little peripheral SC tissue. If patient is obese, use a needle that is long enough to insert through the tissue at the base of the skin fold (Perry et al., 2018). Insulin SC InjectionsInsulin is considered a high-risk medication, and special care must be taken to ensure the correct amount of medication and type of insulin is administered at the correct time. As well, safety checks related to a patient receiving SC insulin should be carried out (Ellis & Parush, 2012). Table 7.4 lists specific guidelines for administering insulin.
Special considerations:
Heparin SC InjectionsHeparin is an anticoagulant used to reduce the risk of thrombosis formation by suppressing clot formation (Perry et al., 2018). Heparin is also considered a high-alert medication (ISMP, 2014). Table 7.5 provides specific guidelines to consider before and after administering heparin.
Checklist 58 provides the steps to complete a subcutaneous injection.
Watch the video Administering a Subcutaneous Injection developed by Renée Anderson and Wendy McKenzie (2018) of TRU School of Nursing. Indwelling Subcutaneous Devices If a patient requires frequent SC injections, inserting a device that remains in place can significantly reduce the number of needle pokes (thus discomfort for the patient). Likewise a SC infusion of IV fluids and/or medications may require the placement of an indwelling device. Different brands of indwelling SC devices are on the market. Check your agency for specific directions about insertion, time between changes, and medication administration via an indwelling device. Some general considerations for SC indwelling devices include:
Watch the video Insertion of an Indwelling Subcutaneous Device developed by Renée Anderson and Wendy McKenzie (2018) of TRU School of Nursing. What is the subcutaneous injection position?Choose Your Injection Site. Upper arms. At least 3 inches (7.5 centimeters) below your shoulder and 3 inches (7.5 centimeters) above your elbow, on the side or back.. Outer side of upper thighs.. Belly area. Below your ribs and above your hip bones, at least 2 inches (5 centimeters) away from your belly button.. Which of the following is the proper needle position for subcutaneous injection quizlet?Rationale: Systematic rotation within one anatomical location will allow consistent insulin absorption. The correct needle angle for a subcutaneous injection is 45 to 90 degrees. Administering the injection at a 30-degree angle will not deliver medication to the subcutaneous tissue.
Which angle should the needle be positioned when administering a subcutaneous injection?Generally, a 25- to 27-gauge, 5/8-inch-long needle is appropriate. If you can pinch a 1-inch (2.5-cm) tissue fold, insert the needle at a 45-degree angle; for a 2-inch (5-cm) fold, insert it at a 90-degree angle. Warm the medication as recommended.
Which of the following statements describes the correct technique for administering a subcutaneous injection quizlet?Which of the following statements describes the correct technique for administering a subcutaneous injection? Pinch the skin firmly and insert the needle in one quick motion (Pinching the skin lifts the subcutaneous tissue, making it easier to target.)
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