The term "subcutaneous injection" refers to an injection that is made into the fatty tissue under the skin (as opposed to an intravenous injection that is done directly into the bloodstream). In this way the release of the drug is slower and therefore more suitable for the administration of vaccines and medicines (such as insulin in type I diabetics). When a doctor prescribes a drug to be taken through a subcutaneous injection, they also provide detailed instructions on how to proceed. This article is intended to provide guidelines only, any concerns should be discussed with the treating physician before performing the injection at home. Read on to learn more.
Steps
Part 1 of 3: Preparation
Step 1. Get everything you need
To properly perform a subcutaneous injection at home, you will need more than a needle, medication and a syringe. Make sure you have:
- A sterile dose of the drug or vaccine (usually a small, labeled vial).
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A suitable syringe with a sterile needle. Depending on the size of the patient, the amount of the drug may vary. You can consider following one of the following safe pairings:
- 0, 5, 1 or 2 cc syringe with a 27 gauge needle.
- Disposable pre-dispensed syringe.
- A container for safe disposal of the syringe.
- A sterile gauze (usually 5x5cm).
- A sterile patch (make sure the patient is not allergic to the adhesive, as it may irritate the injection site).
- A clean cloth.
Step 2. Make sure you have the correct medication and with the right dosage
Most drugs that are administered subcutaneously are transparent and are sold in similar containers. For this reason it is easy to confuse them. Always double check the label to make sure you don't make a mistake.
Note: Some ampoules contain only one dose of the drug, while others are sufficient for multiple injections. Make sure you have the amount needed to follow your prescription before continuing
Step 3. Prepare a clean and tidy work area
When you do a subcutaneous injection, the less you come into contact with non-sterile material, the better. Arrange everything you need in time on a clean and easily accessible surface to make the procedure quick, simple and hygienically safe. Spread a clean cloth on the work surface and lay the tools on it.
Arrange the material logically according to the order of use. You can make a small tear on the edge of the alcohol wipes package to facilitate opening operations when you need them (try not to expose the inside to avoid contamination)
Step 4. Choose the injection site
The subcutaneous injections are made in the layer of fat that is under the skin. In some parts of the body, access to this tissue is easier than in others. The drug will probably come with instructions on this, so read the leaflet, talk to your doctor or consult the pharmaceutical company's website. Here are the most commonly used injection points:
- The fat part of the triceps, in the side and back of the arm between the shoulder and the elbow.
- The fatty area of the leg, in the front and outer part of the thigh.
- The fatty part of the abdomen, below the ribs but not adjacent to the navel.
- Note: It is very important to alternate and change injection sites, because multiple consecutive punctures in the same area can cause scarring and hardening of the fatty tissue which would make future injections more difficult. Furthermore, these skin changes could also interfere with drug absorption.
Step 5. Rub the skin with a sterile alcohol wipe
Do a spiral motion from the center of the injection site outward, and do not return to the already disinfected skin. Wait for it to air dry.
- Before doing this, if necessary, expose the injection area by removing clothing, jewelry or anything that interferes. In this way, not only will the work be easier, but also reduce the risk of infections due to contact between the skin and non-sterile clothes.
- If you notice any signs of irritation, bruising, spots or other abnormalities on your skin at this point, choose another site.
Step 6. Wash your hands with soap and water
Since an injection involves piercing the skin, it is important that the person giving the drug has clean hands. Water and soap kill bacteria that are present on the skin. These, if they accidentally come into contact with the small wound, could cause an infection. After washing your hands thoroughly, dry them very well.
- You have to be methodical, every point on your hands must be covered with soap and water. Several studies have shown that the vast majority of adults do not wash their hands properly.
- If possible, wear a clean pair of gloves.
Part 2 of 3: Aspirate the Drug Dose
Step 1. Remove the tamper evident strap from the medication vial
Put it on the cloth. If this band has already been removed, as is often the case with multi-dose vials, wipe the rubber diaphragm of the vial with a sterile alcohol wipe.
Note: If you are using a pre-dispensed syringe you can skip these steps
Step 2. Grab the syringe
Hold it firmly with your dominant hand as if it were a pencil. The tip (still with the cap) must be pointing upwards.
At this point, even if the needle is still covered, you still need to handle the syringe carefully
Step 3. Remove the cap protecting the needle
Grab it with the thumb and forefinger of your non-dominant hand and pull it. Be careful that the needle does not come into contact with any surface other than the skin of the patient who is to receive the drug. Put the cap on the cloth.
- You are now handling a very small but extremely sharp needle. Move carefully, do not make awkward or sudden movements.
- Note: If you are using a pre-dispensed syringe, skip the steps below and go to the next section.
Step 4. Pull the syringe plunger
While holding the needle up and away from your person, use your non-dominant hand to pull the plunger thus filling the body of the syringe with air. The volume of air must equal the amount of drug to be injected.
Step 5. Grab the vial
Always use your non-dominant hand and hold the vial upside down. Be especially careful not to touch the rubber diaphragm, as it must remain sterile.
Step 6. Insert the needle into the diaphragm
At this point the syringe still contains air.
Step 7. Press the plunger to inject air into the vial
Air should rise to the top of the vial through the medicine. This operation has two purposes: to empty the syringe making sure that there are no air bubbles in it, and to facilitate the aspiration of the drug, since the pressure inside the vial has increased.
This may not be necessary, depending on the density of the medicine
Step 8. Draw the medication into the syringe
Making sure that the tip of the needle is always immersed in the medical liquid and that there are no air pockets in the vial, slowly bring the plunger back again until the syringe is filled with the required dose of drug.
You may need to tap the body of the syringe with your fingers to push out any air bubbles. If so, gently squeeze the plunger to push the air out of the needle forcing it back into the vial
Step 9. Repeat the previous steps as needed
It may take several tries before you have a syringe filled with the correct dose of medication and with no air bubbles.
Step 10. Remove the vial from the syringe and place it on the cloth
Never put the syringe down at this point, as this could contaminate the needle and cause infection.
Part 3 of 3: Give the injection
Step 1. Hold the syringe ready in your dominant hand
Grab it just like you would a pencil or dart. Make sure you can easily reach the plunger.
Step 2. Gently "pinch" the injection area
With the non-dominant hand, take about 3-5 cm of the patient's skin between thumb and forefinger thus creating a small "mound" of skin. Be careful not to damage the surrounding area and not to cause bruising. This operation allows you to isolate a substantial thickness of adipose tissue in which to perform the injection; you also make sure you don't accidentally hit the underlying muscle.
- When you grab the skin, don't grab the muscle tissue. You should be able to feel the tactile difference between the two types of organic tissue: fat is softer while muscle is firmer.
- Subcutaneous drugs should not be injected into the muscles as they would cause them to bleed. This is especially important for anticoagulants. In any case, the needles used for a subcutaneous injection are generally too small to reach the muscle, so this shouldn't be a problem.
Step 3. Insert the syringe needle into the skin
With a quick, firm flick of the wrist, push the needle all the way into the skin. Usually the needle must be held perpendicular to the skin surface to make sure the medication is injected into the fat. However, with people who are particularly thin or have little subcutaneous fat, it may be necessary to tilt the needle at 45 ° to avoid muscle tissue.
Act quickly and decisively but do not "stab" the patient with excessive force. Any hesitation would cause the needle to bounce off the skin or slowly penetrate it causing unnecessary pain
Step 4. Push the plunger with constant motion and pressure
Do not apply pressure to the patient but only to the syringe until all the drug has been injected. Make a continuous, controlled movement.
Step 5. Gently press a piece of gauze or cotton swab near the injection site
This sterile material will absorb any slight bleeding that may occur when the needle is removed. Furthermore, the pressure exerted on the gauze prevents the skin from being dragged by the needle as it is removed, saving the patient unnecessary suffering.
Step 6. Pull the needle out in one smooth motion
You can hold the gauze / cotton ball over the "wound" or ask the patient to do so. Do not rub or massage the injection area as this could cause bruising or bleeding under the skin.
Step 7. Safely dispose of both the needle and syringe
Carefully place them in a container designed for sharp or stinging sanitary material. It is very important that syringes and needles do not end up in the normal garbage, as they could be a vehicle for the transmission of even fatal diseases.
Step 8. Attach the gauze to the injection area
After disposing of the syringe, the gauze or cotton wool can be attached to the patient's wound with a small adhesive bandage. However, as bleeding is usually minimal, you can simply allow the patient to hold the gauze on the area for a minute or two until the blood stops. If you have decided to use a patch, make sure the person is not allergic to the adhesive.
Step 9. Put away all the material
You have successfully completed a subcutaneous injection.
Advice
- Allow the child to carry out some operations (appropriate to the age) to become an active part of the "ritual". For example, you can have him hold the needle cap after removing it, or, "when it gets big enough", you can allow him to take it off himself. Not taking treatment passively will help him calm down.
- Putting a cotton ball near the needle when you remove it avoids tugging on the skin and decreases the pain of the injection.
- You can use an ice cube to slightly numb the area.
- To prevent bruising or swelling at the injection site, apply light pressure with gauze or a cotton swab for at least 30 seconds after removing the needle. This is an excellent trick for those patients who have to have daily injections. Since the concept of "firm and constant pressure" is quite broad, let your child tell you if you are pressing too much or too little.
- Alternate the injection site: legs, arms, butt (top, bottom, top or bottom); this way you will not puncture the same area of the body more than once every two weeks. Simply follow an order of 14 injection sites and the frequency will be automatic! Also to the children like it predictability. If, on the other hand, your child wants to choose the injection site himself, allow him to do so and then check that site off the list.
- For babies, and anyone else who needs a pain-free injection, you can use Emla. It is a cream that contains a topical anesthetic that you can apply and cover with a Tegaderm patch about half an hour before the puncture.
- If you have internet access, check the drug manufacturers site.
Warnings
- Read the label on the drug package to be sure you are using the correct one and in the right concentration.
- If you have a longer needle, remember to insert the syringe at 45 degrees to the skin and pull it out at the same angle.
- When you use ice to relieve the pain of the injection, do not leave it applied for too long, because it freezes the cells and damages the tissues, causing poor absorption of the drug.
- Do not throw needles or syringes in the normal garbage, use suitable containers.
- Do not give any injections without proper instructions from your doctor.
