Giving a subcutaneous injection is a nursing skill that nurses must master to perform their jobs accurately. Nurses must have an exceptional level of expertise in human anatomy and injection techniques in order to administer these injections with the least amount of pain. Once nurses get the hang of giving a subcutaneous injection, they will likely be one of the requested nurses from patients receiving this injection. Subcutaneous injections are necessary for patients receiving certain medications.
Patients who need medications such as epinephrine and insulin must receive their required dosage by way of subcutaneous injections. Nurses must use special needles to administer the injections to patients. The medications that nurses administer into the fatty layer under the skin by way of subcutaneous injections are absorbed over several hours.
These medications require that patients receive a slow-release dosage over time. The legsabdominal regionand arms are excellent areas to administer subcutaneous injections to patients. Nurses will suggest the optimal location for patients to receive their injections based on their personal medical needs. Nurses can minimize the pain that their patients experience during injections by doing the following:. There are minor complications that can take place during a subcutaneous injection.
Patients may experience soreness, redness, or bleeding at the injection site that will go away in a short amount of time. At times, patients may experience blood in the solutions, and nurses should select another injection site to give the subcutaneous injection.
Enter your email addressThis learning module has been accredited by the Royal College of Nursing and was last updated in All modules are subject to external double-blind peer review and checked for plagiarism using automated software.
Read this learning module to update your knowledge and skills in the administration of subcutaneous injections. The evidence base in this area is reviewed and a framework for safe practice provided.
Injections are routinely administered by nurses in acute care settings and in the community. Nurses require a thorough understanding of anatomy and physiology, pharmacological principles and equipment, and potential risks to the patient of injections. Nurses should also take an active approach to patient assessment before injecting medicines.
This learning module provides an evidence-based review of injection administration, with particular reference to subcutaneous injections, and suggests a framework for best practice. Please note that information provided by RCNI Learning is not sufficient to ensure competence in the skill.
Assessment of competence should take place in line with local practice. Practice should always align with local protocols and procedures, latest guidelines and any regulatory Code. Sign in Register Free modules Subscribe. Organisational enquiries. Toggle navigation. Subscribe Free modules Register.
Home CPD modules An evidence-based approach to subcutaneous injection technique. An evidence-based approach to subcutaneous injection technique This learning module has been accredited by the Royal College of Nursing and was last updated in Short description Read this learning module to update your knowledge and skills in the administration of subcutaneous injections.
Detailed description Injections are routinely administered by nurses in acute care settings and in the community.
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Failure to comply may result in legal action. Medically reviewed by Drugs. Last updated on Feb 3, A subcutaneous injection is a shot given into the fat layer between the skin and muscle. Subcutaneous injections are used to give small amounts and certain kinds of medicine. There are 3 parts to a syringe: the needle, the barrel, and the plunger. The needle goes into your skin. The barrel holds the medicine and has markings on it like a ruler.
The markings are for milliliters mL. The plunger is used to get medicine into and out of the syringe. Subcutaneous injections can be given straight in at a 90 degree angle or at a 45 degree angle. Give the injection at a 90 degree angle if you can grasp 2 inches of skin between your thumb and first finger. If you can grasp only 1 inch of skin, give the injection at a 45 degree angle.
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It is important to dispose of the needles and syringes correctly. Do not throw needles into the trash. You may receive a hard plastic container made especially for used syringes and needles.
You can also use a soda bottle or other plastic bottle with a screw lid. Make sure that both the syringe and needle fit into the container easily and cannot break through the sides. Ask your healthcare provider or a pharmacist what your state or local requirements are for getting rid of used syringes and needles. You may get an infection, have the needle break in your skin, or hit a nerve.
You may have scarring, lumps, or dimpling of the skin from a subcutaneous injection. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records.
About About Drugs.Analysis of medically attended injection site events data provides a vehicle to appreciate the inadequacies of vaccination practice for deltoid intramuscular injection and to develop best practice procedures. The aim of this review is to formulate best vaccination practice procedures for deltoid intramuscular injection of vaccines through the collation and analysis of medically attended injection site events.
Increasing public concerns regarding vaccine safety 1 in the context of a decreasing prevalence of vaccine preventable diseases mandates the use of best vaccination practice. However, it is evident from the increasing range and extent of medically attended injection site event data, following deltoid intramuscular injection of vaccines, retrieved for this review that there are significant inadequacies in current vaccination practice which need prompt attention.
Medically attended events 3 range from any condition for which medical attention is sought to serious adverse events resulting in death, hospitalization and persistent or significant disability. However, due to their method 4 of reporting there is likely to be a bias toward under-reporting of less severe events. The aim of this review is to analyze medically attended injection site events data following deltoid intramuscular injection and to formulate best vaccination practice.
The radial nerve and the anterior branch of the axillary nerve are susceptible to injury following intended intramuscular injection into the deltoid muscle. The radial nerve is susceptible 5 to injection injury where it passes obliquely around the upper humerus, proximal to and in the spiral groove which ends just distal to the deltoid tuberosity on the lateral margin of the humerus.
Radial nerve palsy is the second most common traumatic injection neuropathy seen in developing countries 6,7 and in this setting is due to injections being given by untrained and unlicensed practitioners.
Radial nerve palsy has been reported 9,10,11 post vaccination. In the latter case Magnetic Resonance Imaging MRI and ultrasound were interpreted as showing that the nerve palsy was secondary to an inflammatory demyelinating process around the nerve rather than direct axonal injury.
Four other cases of radial nerve palsy post vaccination satisfying the inclusion criteria for this review were retrieved from the VAERS database. The anterior branch of the axillary nerve 12 takes a tortuous path around the surgical neck of the humerus and provides motor innervation to the anterior and middle parts of the deltoid muscle.
Two cases of this nerve palsy have been reported. The clinical diagnosis of anterior branch of the axillary nerve palsy was confirmed by nerve conduction studies. The sensory loss noted in these cases can not be accounted for on the basis of lone injury to the anterior branch of the axillary nerve, as the posterior branch subserves this function.
It has been suggested 12 that sensory deficit in these cases may be due to a cutaneus neuropathy due to the injectate. This effect has been reported with an antiemetic 12 but not with a steroid injection. Magnetic Resonance Imaging MRI offers a paradigm shift in the diagnosis and management of medically attended injection site reactions as it allows concurrent assessment of both soft tissue and bony injury following vaccination. Six cases of periosteal reaction boney contusion following vaccination have been reported, 4 from published reports and 2 with adequate clinical and MRI data from the VAERS database.
Three cases of osteonecrosis due to probable osseus injection have been reported.
Subcutaneous Injection Technique | How to Give a Subcutaneous (Sub-q) Injection
Three cases of inadvertent intra-articular injection of vaccines have been reported. These authors postulated that vaccines were administered into the subdeltoid bursa with its communication with the subacromial bursa resulting in its inflammation and subsequent inflammation of the biceps tendon and shoulder capsule.
The intrinsic group is associated with tendinopathies which as previously discussed can be a consequence of vaccine administration. The central role of route of administration in the genesis of subcutaneous nodules is seen in clinical trials with anthrax and botulinum F toxoid vaccines. Localized lipoatrophy is characterized 38 clinically by a non-inflammatory focal loss of subcutaneous tissue, and histologically by fat lobule involution.
This reaction has been seen at the injection site of a number of medications 38 antibiotics, corticosteroids, human growth hormone, insulin and vasopressin and vaccines. Thirty nine cases of localized lipoatrophy following vaccination were obtained from a combination of published case reports and the VAERS database. Localized lipoatrophy has been suggested 43 as being due to non-vaccine specific administration trauma to subcutaneous tissue.
Support for this thesis can be drawn from the observation of this reaction following accupuncture 44 and the suggestion 45 that trauma rather than immune activation of macrophages underpins the localized lipoatrophy following steroid injection.
The female dominance of this reaction may be accounted for on the basis of a greater sensitivity of their subcutaneous tissue to this reaction than males, as reflected by the greater rate of injection site reactions reported by females compared with males with a number of vaccines 46 anthrax, DT booster in adolescents, Hib-tetanus toxoid conjugate in infants, influenza and pneumococcal vaccines.
The Brighton Collaboration Local Reactions Working Group for abscess at injection site defined 47 a sterile abscess with level 1 diagnostic certainty as — spontaneous or surgical drainage from the mass AND material obtained from the mass prior to initiating antimicrobial therapy, but with negative evaluation for infectious etiology which may include Gram stain, culture or other tests.
Route of administration of adjuvanted vaccines has been shown to be a determinate of sterile abscess formation. Subcutaneous emphysema has been reported following deltoid intramuscular injection of vaccines.NCBI Bookshelf.
Geneva: World Health Organization; Mar. This chapter assimilates the best practices for delivering injections in health-care and related facilities. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection 7.
The chapter outlines recommended practices, skin preparation, preparation and administration of injections, and related health procedures. Best injection practices described are aimed at protecting patients, health workers and the community. This section describes the following practices that are recommended to ensure the safety of injections and related practices:. Hand hygiene is a general term that applies to either handwashingantiseptic handwash, antiseptic hand rub or surgical hand antisepsis It is the best and easiest way to prevent the spread of microorganisms.
Hand hygiene should be carried out as indicated below, either with soap and running water if hands are visibly soiled or with alcohol rub if hands appear clean. You may need to perform hand hygiene between injections, depending on the setting and whether there was contact with soil, blood or body fluids. Avoid giving injections if your skin integrity is compromised by local infection or other skin conditions e. Indications and precautions for hand hygiene are shown in Table 2.
Health workers should wear non- sterilewell-fitting latex or latex-free gloves when coming into contact with blood or blood products Indications for glove use in injection practice are shown in Table 2. Masks, eye protection and other protective clothing ARE NOT indicated for the injection procedures covered by this document unless exposure to blood splashes is expected. When using single-use personal protective equipmentdispose of the equipment immediately after use. Table 2.
To disinfect skin, use the following steps 27 — 29 :.
DO NOT pre-soak cotton wool in a container — these become highly contaminated with hand and environmental bacteria. DO NOT use alcohol skin disinfection for administration of vaccinations.
The steps outlined above are summarized in Table 2. Health-care settings should ensure that an adequate supply of single-use devices is available, to allow providers to use a new device for each procedure. When using a sterile single-use device i.Complete Question: What is the current practice for giving an IM injection across the lifespan? Should the nurse aspirate the syringe?
CDC recommends no per my resources. Please provide guidance. Several members of the Clinical Practice Committee reviewed and investigated an answer to this question. Answer: Aspiration is the process of pulling back on the syringe plunger by applying negative pressure for seconds after the needle has been inserted into tissue, but before administration of the medication CDC, ; Sepah et al, The rationale for aspiration has traditionally been to avoid inadvertent intravenous administration of the medication.
This concern is based on tradition, but not supported by evidence CDC, ; Sepah et al, In addition, many auto-disable safety syringes prevent aspiration, making the process impossible during medication administration Sepah et al, The CDC also notes that the length of the needle should be carefully selected in order to ensure the medication reaches the muscle tissue, but not so long that it reaches underlying tissue, including blood vessels.
Recommended sites for intramuscular injection generally do not include blood vessels, which should eliminate the need for aspiration. The CDC guidelines are directed specifically at administration of vaccines and toxoids, which have a low risk of adverse effects if they are injected systemically.
The following recommendations are based on currently available evidence. In order to avoid unnecessary aspiration during IM medication administration, and minimize the risk of inappropriate systemic intravenous or intra-arterial administration:.
Preparing and Administering Subcutaneous Medications
Updated Jan. Clinical Practice Questions Home. No materials, including graphics, may be reused, modified, or reproduced without written permission. Skip to main content. Nov The nurse should consider the size of the muscle, viscosity of the medication, and volume to be administered when selecting the needle length and gauge. A gauge needle is generally appropriate. To avoid injection into subcutaneous tissue, spread the skin of the selected vaccine administration site taut between the thumb and forefinger, isolating the muscle.
Another technique, acceptable mostly for pediatric and geriatric patients, is to grasp the tissue and "bunch up" the muscle. Withdraw the needle and apply light pressure to the injection site for several seconds with a dry cotton ball or gauze. In order to avoid unnecessary aspiration during IM medication administration, and minimize the risk of inappropriate systemic intravenous or intra-arterial administration: Select the site and needle size which are most appropriate for the patient.
This will increase the likelihood of medication administration into muscle tissue, and not blood vessels CDC, Aspiration is generally not recommended during IM injection of medications with a low risk of adverse effects if the medication is inadvertently injected systemically instead of via the IM route. Aspiration may be indicated if the medication has a high risk of adverse effects and if it is inadvertently administered systemically instead via the intended IM route Sepah et al.
References Centers for Disease Control and Prevention. Vaccine administration: General best practice guidelines for immunization: best practices guidance of the advisory committee on immunization practices ACIP. Vaccine-related pain: Randomised controlled trial of two injection techniques. Archives of Disease in Childhood, 92 12 Aspiration in injections: Should we continue or abandon the practice? F Research, 3 Aspirating during the intramuscular injection procedure: A systematic literature review.
Journal of Clinical Nursing, 24 17 Blood aspiration during IM injection.Thanks for helping us catch any problems with articles on DeepDyve. We'll do our best to fix them. Check all that apply - Please note that only the first page is available if you have not selected a reading option after clicking "Read Article".
Include any more information that will help us locate the issue and fix it faster for you. Injections are routinely administered by nurses in acute care settings and in the community.
Nurses require a thorough understanding of anatomy and physiology, pharmacological principles and equipment, and potential risks to the patient of injections. Nurses should also take an active approach to patient assessment before injecting medicines.
This article, the first of two, provides an evidence-based review of injection administration, with particular reference to subcutaneous injections, and suggests a framework for best practice. Keywords: Best practice heparin injection insulin administration medication medicines management subcutaneous injection.
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Subcutaneous injection technique: an evidence-based approach Ogston-TuckSherri. Read Article. Download PDF. Share Full Text for Free beta. Web of Science. Let us know here. System error. Please try again! How was the reading experience on this article?