Administering Subcutaneous Injections

CPD
3m

Published: 23 June 2020

Subcutaneous injections are a common practice for care providers. However, it is important to understand the basic principles of administering medication in this manner.

What are Subcutaneous Injections?

subcutaneous injection diagram
Subcutaneous injections are used to administer medication into the fatty tissue layer between the skin and the muscle.

Subcutaneous injections are used to administer medication into the fatty tissue layer between the skin and the muscle (subcutaneous tissue). The subcutaneous tissue has a smaller blood supply, meaning the medication is absorbed more slowly than if inserted into a vein (Case-Lo 2018; Shepherd 2018).

This type of injection may be beneficial for medications such as insulin and heparin that require continuous absorption (Shepherd 2018).

Additionally, subcutaneous injections are a less expensive, easier and sometimes more effective way of administering certain medications (Case-Lo 2018).

The needles used should generally be 16mm long and 25 to 27 gauge (DoH 2018).

What Kinds of Medications can be Administered Subcutaneously?

  • Medications that can be administered in small doses (less than one to two mL);
  • Medications that need to be administered quickly;
  • Medications that need to be administered daily or at home;
  • Insulin;
  • Anticoagulant medication;
  • Some fertility medications;
  • Autoimmune medications;
  • Certain hormones;
  • Analgesics (e.g. morphine);
  • Antiemetics; and
  • Some vaccines and allergen immunotherapies.

(Case-Lo 2018; Villines 2018)

Subcutaneous Injection NDIS Quality Indicators

Subcutaneous Injections are listed as a practice Standard under the High Intensity Daily Personal Activities Module outlined in the NDIS Practice Standards and Quality Indicators module for High Intensity Daily Personal Activities.

Under these standards, NDIS providers must meet the following quality indicators:

  • Clients are enabled to participate in the assessment and development of a subcutaneous injection plan that includes dosage measurement and calculation. This plan identifies possible risks, incidents and emergencies, and what actions need to be taken to manage these situations, including the escalation of care, if necessary. The client’s health status is reviewed regularly (with the patient’s consent).
  • The patient has been provided with a written prescription or phone order prescribing the medication that will be administered subcutaneously. This prescription must be documented.

(NDIS 2020)

The following skills are required by NDIS providers administering subcutaneous injections:

  • Confirming the patient’s identity through three identifiers and their need for subcutaneous injections.
  • Following the ‘13 Rights of Medication Administration’;
  • Calculating and measuring medication dosages. If being performed by a support worker, they must be supervised and checked by a clinician.
  • Administering medication with pens and pumps.
  • Understanding and recognising the symptoms of an adverse medication reaction.
  • Disposing of needles safely.
  • Maintaining the patient’s records.
  • Following hygiene and infection control procedures.
  • An understanding of the patient’s underlying conditions (e.g. diabetes), if there is one.

(NDIS 2018)

Choosing an Injection Site

diagram of subcutaneous injection sites
Subcataneous injection sites, showing the average values of the thickness of the subcutaneous fat.

The needle must be injected into a site with a layer of subcutaneous tissue. Recommended areas include:

  • Umbilical region of the abdomen, about two inches from the navel (avoid the navel);
  • Back or side of the upper arm;
  • Top of the thigh; and
  • Top of the buttocks.

(Villines 2018; Shepherd 2018; Case-Lo 2018)

Avoid areas of skin that have:

  • Infection;
  • Wounds;
  • Oedema;
  • Skin lesions;
  • Scars;
  • Birthmarks;
  • Bony prominences;
  • Large underlying muscles;
  • Blood vessels or nerves;
  • Burns;
  • Bruises; and
  • Broken skin.

(Shepherd 2018; QLD DoH 2020)

It is important to note that each patient has varying levels of subcutaneous fat, so each individual should be assessed before proceeding with the injection. Lifting the skin fold can help separate the subcutaneous away from the muscle underneath (which should be avoided) (Shepherd 2018).

If the patient requires frequent injections, you should rotate injection sites to allow each area to heal (Villines 2018).

Method of Injection

  1. Perform hand hygiene. While the WHO does not recommend wearing gloves for administering injections, use your own judgement. Wear gloves if bleeding is expected.
  2. Prepare an appropriate syringe with the required dosage. Disperse any air bubbles.
  3. Place the patient into a reclined position.
  4. Choose the injection site.
  5. Perform hand hygiene.
  6. If required, cleanse the chosen injection site and wait for it to dry.
  7. Hold the syringe with your dominant hand. With your non-dominant hand, lift a 5 cm fold of skin to separate the subcutaneous layer from the muscle tissue underneath.
  8. Using a quick, dart-like technique, insert the syringe at a 45 to 90-degree angle - follow product information for specific guidelines for each medication.
  9. Hold the barrel of the syringe firmly and inject the contents for 10 to 30 seconds. The plunger should be pressed all the way down.
  10. Wait 10 seconds, then remove the needle and immediately dispose of it into a sharps container.
  11. Do not rub the injection site.
  12. Apply a dressing if the site bleeds.
  13. Record the injection using the required documentation.
  14. Monitor for any adverse reactions or complications.

(QLD DoH 2020; Shepherd 2018; John Hopkins Arthritis Center 2012; WHO 2010)

subcutaneous injection syringe insertion diagram
old the syringe with your dominant hand. With your non-dominant hand, lift a 5 cm fold of skin to separate the subcutaneous layer from the muscle tissue underneath.

Complications

The patient may experience discomfort at the injection site, such as:

  • Pain;
  • Bleeding;
  • Redness;
  • Swelling;
  • Warmth;
  • Tenderness;
  • Haematoma;
  • Leakage; and
  • Infection.

(Case-Lo 2018; QLD DoH 2020)

Conclusion

While administering subcutaneous injections is considered fairly low-risk, it is still important to ensure providers adhere to correct procedure and manage risks appropriately (ACIA 2018).

Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your organisation’s policy on administering subcutaneous injections.

Additional Resources

References

Author

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