The classic "puncture" performed by healthcare professionals is a procedure technically called intramuscular injection and is used to administer vaccines or medicinal solutions. Subcutaneous injections, on the other hand, allow the introduction of other types of drugs, such as insulin or heparin, directly into the adipose tissue under the skin, where they are absorbed by the body. Compared to other parenteral administration procedures, subcutaneous injections are used for drugs to be introduced into the body in small quantities, which allow a slow and gradual absorption of the solution. In some cases, it is possible to practice them alone, as is often the case with diabetic patients who are prescribed insulin.
Steps
Part 1 of 3: Prepare the Required and Work Area
Step 1. Make sure your work area is clean
With injections, you go through the body's most important defense against disease: the skin. Therefore, you must be very careful to prevent the transmission of germs that cause infections. Start by washing the area where you are going to place all the necessary tools with soap and water. Wash, dry and disinfect your hands well.
Step 2. Get the supplies
On a clean and sanitized tray, table or shelf, arrange the drug to be injected, the cotton wool, the patch, the disinfectant and a sealed disposable syringe, equipped with a sterile needle. Also, prepare a container for the disposal of sharp and infectious waste.
- To facilitate the final cleaning operation, it is preferable to spread a sheet of sterile paper or clean absorbent paper before starting.
- Arrange the tools in the order you will use them. For example, keep the disinfectant wipes on hand, followed by the medication, syringe and needle, and finally the cotton wool and / or patch.
Step 3. Put on a pair of sterile gloves
Even if you have washed your hands thoroughly, you should put on a pair of disposable sterile gloves as an extra precaution. If at any time you touch a dirty object or surface, rub your eyes or scratch, throw it away and replace it.
To minimize the risk of contamination, wear them just before injecting
Step 4. Check the dosage carefully
Please take the time to read the dosage instructions to clear up any concerns. Some drugs must be taken in specific doses because, if exceeded, they can cause serious side effects. So, before proceeding, you need to know exactly how much to inject. This information should be included in the prescription or explained directly by the doctor.
- Also, make sure the syringe is large enough to hold the prescribed dose and that the medication is sufficient for the indicated administration.
- Call your doctor or pharmacist if you are unsure about the dosage.
Step 5. Choose the injection site
The choice depends on the type of injection to be performed. If it is a subcutaneous injection, such as with insulin or heparin, choose an area where there is fat under the skin. The most suitable locations are the back of the arm, the hips, the lower part of the belly (at least 2 fingers below the navel) and the thighs.
You should practice it at least 2.5cm from where you did it the previous time, especially if you are following therapy. This safety measure is called "rotation" and is adopted to prevent the onset of a lipodystrophy, that is a degenerative disorder of the adipose tissue caused by repeated trauma for injections made in very limited areas
Part 2 of 3: Load the Syringe
Step 1. Remove the vial cap
Usually, drugs that are administered parenterally are packaged in small bottles with an outer lid and an inner rubber diaphragm. Remove the lid and disinfect the rubber part with a cotton swab dipped in alcohol.
After cleaning the top of the bottle, let it air dry for a few seconds
Step 2. Open the package containing the syringe
The use of sterile, disposable syringes serves to reduce the risk of infections. Remove the needle and syringe from the package. From now on, handle them with care. If by any chance the needle touches something that has not been sterilized, do not continue: discard the syringe and get a new one. This way you will avoid the risk of an infection developing.
- If you are a nurse, take this time to check the drug name, patient name and dosage again.
- If the needle is not mounted on the syringe, you need to insert or screw it in gently. Do this before removing the cap.
Step 3. Remove the needle cap
Grab the protective cap and pull it firmly upwards. From now on, be careful not to touch the needle. Treat it with care.
Step 4. Pull the plunger to the prescribed dosage
The barrel of the syringe bears the measuring marks on the side. Move the plunger to align it with the required dosage. Some air will get inside.
Please note that it is impossible to withdraw the drug from the bottle without introducing air
Step 5. Insert the needle into the bottle
Place the bottle on a flat surface and gently insert the needle through the rubber diaphragm for the tip to penetrate inside.
Step 6. Push the plunger
Proceed gently, but firmly. Remove all air from the syringe and place it in the bottle.
- This step is very important: go to increase the internal pressure favoring the escape of the medicinal solution. This will make it easier for you to draw in the correct dose.
- Although this method is recommended in most injections, it is not necessary if you are administering insulin or heparin.
Step 7. Vacuum the contents of the bottle
Hold it with one hand while you hold the syringe with the other. Turn the bottle upside down so that the syringe is underneath, with the needle still inserted and pointing up. Make sure the solution covers the tip to prevent air bubbles from forming in the syringe barrel.
Step 8. Withdraw the dose
Pull the plunger to fill the syringe with the prescribed strength. If necessary, adjust the amount of drug inside the barrel by gently pushing or pulling the plunger.
When you're done, take the needle out of the bottle. Set the medicine aside for later use or throw it away in an appropriate medical waste container
Step 9. Let the air out
Hold the syringe with the needle pointing up and hit the barrel sideways to let the air bubbles rise. When you have moved them all, gently push the plunger to remove them. Stop as soon as you see a drop of liquid outside the tip of the needle.
- Make sure that after the air has escaped the medication remaining inside matches the prescribed dose. It's easy to go wrong, especially when it comes to small amounts, like insulin. If necessary, refill the syringe adding more medication.
- A tiny amount of air trapped in the syringe produces no harmful effects if accidentally injected into the patient's body. However, a blister injected under the skin could cause a bruise.
Part 3 of 3: Injecting
Step 1. Disinfect the injection site
Clean your chosen spot with an alcohol-soaked cotton swab or disposable disinfectant pad. Alcohol kills germs and microorganisms on the surface of the epidermis, reducing the risk of the needle driving them under the skin.
Step 2. Hold the syringe with one hand
Use the other to tighten the portion of skin you are going to inject into. You will form a bulge of fatty tissue (fold) that will allow you to have a more consistent area in which to insert the needle.
Step 3. Insert the needle while maintaining a 45 degree angle
Hold the needle as if it were a dart and insert it into the fold formed with the other hand. Do not rush! Inject the drug at a constant rate.
If you need to inject subcutaneously and the patient has little body fat, gently lift the skin to separate it from the muscle before inserting the needle
Step 4. Administer the drug
Introduce the medicinal solution into the subcutaneous layer by slowly pushing the plunger. Proceed at a steady speed. At this stage, it is normal for the patient to feel slight discomfort.
To make it easier for you, try counting to 3. Start with 1 as you insert the needle, then continue with 2 and 3 as you push the plunger
Step 5. Remove the needle and discard it
Pull it out gently, but with a steady hand. So before anything else, throw it in a special spiky waste container. Do not put the cap back on before throwing it away.
- Once the injection is finished, the used needle is considered infectious waste. Handle it carefully because very often it happens to get stung.
- Once you have pulled the needle out of the patient and discarded the syringe, apply gentle pressure to the injection site with a clean cotton ball.
Step 6. Bandage the injection site
Apply a dry cotton ball over the sting. If you want, you can hold the cotton in place with a band-aid or hold it with one hand, avoiding touching the wound. Throw everything away when the blood has clotted.
Step 7. Discard the cotton ball, needle and syringe in a suitable container
Put the contaminated material in a sturdy and properly marked container. Disinfect the work area and store the tools you used.
- If you do not have a container for sharp and / or pointed objects or a protocol for disposing of these waste, you can dispose of used needles in a sturdy container with a lid, such as a milk package or a bottle of detergent. Close it before putting it in the trash.
- Even in pharmacies it is possible to dispose of medical waste at infectious risk.
Warnings
- Before injecting, always read the package insert to make sure the medication you are giving is the right one.
- Before proceeding, make sure five things are correct: person, dosage, injection site, date and medication.
- Stop if the medicine is out of date. Check the color of the liquid and the presence of particles inside the vial.
