A subcutaneous injection is an injection that is injected into the layer of fat just under the skin (as opposed to an intravenous injection, which is injected directly into the bloodstream). Because drug release into the body system is slower and more gradual by subcutaneous injection than by intravenous injection, subcutaneous injection is often used to inject various vaccines and drugs (for example, in the case of type I diabetes, insulin is often injected by this type of injection). Prescriptions for drugs given by subcutaneous injection are usually accompanied by detailed instructions on the correct way to administer the injection. The instructions in this article are intended to be used as a reference only - consult a medical professional before you administer the injection yourself at home. Read the steps below for detailed instructions.
Step
Part 1 of 3: Preparing for Subcutaneous Injection
Step 1. Prepare the equipment
Performing a subcutaneous injection properly requires more than just a needle, syringe, and medication. Before proceeding, make sure you also prepare the things below:
- A sterile dose of a drug or vaccine (usually packaged in a small, labeled vial)
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A suitable syringe, with a sterile needle tip. Depending on the patient's body size and the amount of medication given, you can choose to do one of the settings below or have another safe and sterile injection method:
- 0, 5, 1, or 2 cc syringe with 27. needle
- Disposable prefilled syringe
- Container for safe disposal of syringes.
- Sterile gauze (usually 5 x 5 cm)
- Sterile plaster (note - make sure the patient is not allergic to the plaster as it can cause irritation near the injection site)
- Clean towels
Step 2. Make sure you prepare the right medication and dosage
Most drugs that are injected subcutaneously are usually clear and packaged in containers of similar size. Therefore, it is very easy to take the drug wrongly. Double-check the label on the medication vial to make sure you are taking the correct medication and dose before proceeding.
Note - some drug vials contain only a single dose, while there are also multidose drug vials. Make sure you take the medication at the recommended dose before proceeding
Step 3. Prepare a clean and tidy work area
When performing a subcutaneous injection, the less you come into contact with an unsterilized object, the better. Setting up all equipment in advance in a clean and easily accessible work area makes the injection process faster, easier and cleaner. Place the towel on a clean surface that is easily accessible from the work area. Place the utensils on a towel.
Arrange the utensils on the towels according to the order of use. Note - You can make a small tear at the end of the alcohol wipes pack (the tears don't tear the inner bag containing the alcohol wipes) to make them easier to open quickly when you need them
Step 4. Select the injection site
The target for subcutaneous injection is the layer of fat under the skin. Certain body locations provide easier access to the fat layer than other body locations. Medications may also come with instructions for specific injection sites that can be used - check with your nearest professional medical provider or drug manufacturer if you are not sure where to inject the drug. The following is a list of locations commonly used for subcutaneous injections:
- Fatty part of the triceps muscle on the side and back of the arm between the elbow and shoulder
- Fatty part of the leg on the outer quadriceps between the hip and knee
- Fatty part of the belly below the ribs, above the hips, and "no" right next to the belly button
- Note: It is important to rotate the injection site because repeated injections at the same site can cause scarring and hardening of the fatty tissue, making subsequent injections more difficult and affecting drug absorption.
Step 5. Clean the injection site
Use a new, sterile alcohol wipe to clean the injection site with gentle strokes in a spiral motion from the center outward; be careful not to re-wipe the cleaned part. Let the location dry on its own.
- Before wiping with alcohol wipes, if necessary, describe the location of the body where the injection will be made by removing all clothing, jewelry, etc. covering. This will not only make it easier to give the injection without a hitch, but it will also reduce the risk of infection that can result from unsterilized clothing coming into contact with the injection wound prior to plastering.
- If, at this stage, you find that the skin at your chosen injection site is irritated, bruised, discolored, or otherwise abnormal, choose another injection site.
Step 6. Wash hands with soap and water
Because subcutaneous injections penetrate the skin, it is very important for the person giving the injection to wash their hands first. Hand washing kills all bacteria on the hands, which, if accidentally transferred to a small cut from an injection, can cause infection. After washing your hands, dry your hands properly.
- Be sure to wash your hands properly so that all parts of your hands are exposed to soap and water. Research has shown that most of the adults do not wash their hands properly which kills all the bacteria.
- Wear sterile gloves if possible.
Part 2 of 3: Inserting a Drug Dose into the Syringe
Step 1. Remove the cap of the medication vial
Place it on a towel. Once the cap has been removed, as in a multidose vial, wipe the vial's rubber diaphragm with a clean alcohol wipe.
Note - if using a prefilled syringe, skip this step
Step 2. Hold the syringe
Hold the syringe firmly in your dominant hand. Hold it like a pencil, with the needle (still closed) pointing up.
Even if, at this stage, the syringe cap has not been removed, still handle the syringe with care
Step 3. Remove the needle cap
Grasp the needle cap with the thumb and index finger of the other hand and pull the cap off the needle. From now on, be careful not to touch the needle to anything but the patient's skin when administering the injection. Place the needle cap on the towel.
- You are now holding a small but very sharp needle - handle it with care, not pointing recklessly or making sudden movements with the syringe in your hand.
- Note - if using a prefilled syringe, skip this step and go straight to the next step.
Step 4. Pull the syringe piston back
Keeping the needle pointing up and away from you, use your non-dominant hand to pull on the piston so that the syringe tube fills with as much air as desired.
Step 5. Take the vial of medicine
Carefully use your non-dominant hand to pick up the vial. Hold it upside down (bottom of vial is on top). Be careful not to touch the rubber diaphragm of the vial which must remain sterile.
Step 6. Insert the needle through the rubber diaphragm of the vial
At this stage, the syringe is still filled with air.
Step 7. Press the piston to inject air into the medication vial
The air will rise through the medicinal liquid to the highest point of the vial. This serves two purposes - first, to empty the syringe, thereby ensuring that no air bubbles will be injected with the medication. Second, it facilitates the withdrawal of the drug into the syringe by increasing the air pressure in the vial.
This step may not be necessary, depending on the viscosity of the drug
Step 8. Withdraw medication into the syringe
Make sure the tip of the needle is submerged in the liquid medicine and not in the air pocket in the vial, pull the piston slowly and carefully until you reach the desired dose.
You may need to tap on the sides of the syringe to force the air bubbles to the top, then remove them by gently pushing the piston back into the medication vial
Step 9. Repeat previous steps if needed
Repeat pulling the medication into the syringe and blowing out the air bubbles until you get the desired dose in the syringe without any air bubbles.
Step 10. Pull the needle out of the vial
Place the vial back on the towel. Do not place the syringe at this stage as the needle can become contaminated and cause infection.
Part 3 of 3: Giving Subcutaneous Injection
Step 1. Grasp the syringe with your dominant hand
Hold the syringe in your hand like holding a pencil or small arrow. Make sure you can easily reach the syringe piston.
Step 2. Gently “pinch” the injection site
With your non-dominant hand, pinch the skin about 4 - 5 cm between your thumb and index finger to form a slight mound; be careful not to injure the surrounding area. These mounds allow you to inject into thicker areas of fat, ensuring that the entire dose of medication is injected into the fat, not the underlying muscle.
- When collecting the skin, do not collect the underlying muscle tissue. You should be able to feel the difference between the soft layer of fat above and the tougher muscle tissue below.
- Subcutaneous drugs are not intended to be injected into a muscle and, if injected into a muscle, can cause bleeding into the muscle tissue. This is especially likely if the medication contains blood-thinning ingredients. However, the syringe used for subcutaneous injection is usually too small to fit into the muscle. So, this shouldn't be a problem.
Step 3. Insert the needle into the skin
With a slight pushing motion with the wrist, insert the needle into the skin. Usually, the needle needs to be inserted into the skin at a 90 degree angle (perpendicular to the skin) to ensure that the drug is injected into the fatty tissue. However, for people who are too thin or too muscular who have little subcutaneous fat, the needle may need to be inserted at a 45 degree (diagonal) angle to prevent the drug from being injected into the muscle tissue.
Do it quickly and surely, but without sticking the needle into the patient with excessive force. Indecision can cause the needle to bounce off the skin or prick the skin slowly, increasing the pain
Step 4. Press the piston with firm and even pressure
Push the piston without applying excessive pressure into the patient's skin until all the medication has been injected. Do this in one steady, controlled motion.
Step 5. Gently press the gauze or cotton ball next to the needle at the injection site
This sterile material will absorb any bleeding that occurs after the needle is pulled out. Pressure applied to the skin through gauze or cotton wool will also prevent the needle from pulling on the skin as the needle is pulled out, which can be painful.
Step 6. Pull the needle out of the skin in one smooth motion
Gently hold the gauze or cotton ball over the wound or instruct the patient to do so. Do not rub or massage the injection site as this may cause bruising or bleeding under the skin.
Step 7. Dispose of needles and syringes safely
Place needles and syringes carefully in a special tear-resistant container for disposing of sharp objects. It is very important to ensure that needles are not disposed of in the “normal” trash can because used needles have the potential to spread deadly blood-borne diseases.
Step 8. Apply gauze at the injection site
After disposing of the syringe, you can apply gauze or cotton swab to the patient's wound with a small bandage. However, since there is likely to be very little bleeding, you can also simply ask the patient to apply pressure to the gauze or cotton pad for a minute or two until the bleeding stops. If you use a plaster, make sure the patient is not allergic to the adhesive.
Step 9. Store all equipment
Subcutaneous injection has been successfully administered.
Tips
- Give your child the option to participate in rituals, such as holding the needle cap after you remove it from the syringe, and when “the child is old enough”, allow the child to remove the needle cap from the syringe. Taking an active part and learning to take care of yourself can calm your child down.
- Placing a piece of cotton or gauze at the injection site before pulling the needle out will prevent the skin from being pulled out as the needle is pulled out and reduce pain from the injection.
- Ice cubes can be used to slightly numb the site to be injected.
- To prevent bruising or small bumps from forming at the injection site, hold down the injection site with gauze or cotton for at least 30 seconds after withdrawing the needle. This is a great trick for anyone who needs daily injections. Within the “firm pressure” range, ask the child if he or she wants more or less pressure.
- Also, rotate the injection sites covering the legs, arms, and middle (left and right, front and back, up and down) so that the injection is not given to the same body part more than once every two weeks. Just follow the same order from the list of 14 injection sites, and the times will automatically be correctly spaced! Children “love” routines. Or, if they feel better about choosing the injection site themselves, make a list and cross out the locations that have been used.
- For more information on subcutaneous injection, visit the Patient Information Publications page at
- For children, or anyone else who needs a painless injection, apply Emla, a topical anesthetic applied to the injection site with a Tegaderm patch for half an hour before the injection.
- If you have internet access, you can find out about your medication on the manufacturer's website.
Warning
- Read drug labels carefully to make sure you are taking the right medication and dosage.
- When using ice cubes to reduce pain from the injection, do not keep the ice cubes on for too long as it can freeze cells, damage tissues, and reduce drug absorption.
- Do not throw needles or syringes in the regular trash, always use a special impermeable container to dispose of sharp objects.
- Do not attempt to give any injection without proper instructions from a healthcare provider.
