PREFACE
First at all, give thanks for Gods love and grace for us. Thanks to God for helping and for
giving us chance to finish this papers on time. In addition, I would like to say thank you to NEC that
always facilitates us and give much knowledge about how to practice English well.
This paper is one of English tasks entitled Subcutaneous Injection. I realized that this paper is
not perfect. However, I hope it can be useful for us. Critics and suggestion is needed here to make this
paper be better.
We hope that we as students in Nursing Academy of RS. Efarina Purwakarta can work more
professionally by using English well. Thank you.
Purwakarta, June 2, 2016
Writers
A. OVERVIEW OF THE SKILL
A subcutaneous injection is a method used to administer medications into the loose connective
tissues just below the dermis of the skin. Medications that do not need to be absorbed as quickly as
those given intramuscularly are given subcutaneously due to the less richly supplied blood vessels
in the subcutaneous tissue. However, the client may respond more rapidly to a subcutaneous
injection than oral medication and should be monitored for potential side effects, allergic reactions,
the risk of infection, or bleeding.
Only small (0.5- to 1-ml) doses of isotonic, nonirritating, non-viscous, and water-soluble
medications should be given subcutaneously, such as insulin, tetanus toxoid, allergy medications,
epinephrine, and vitamin B12. If larger volumes of medications remain in these sensitive tissues, a
sterile abscess could form, causing a hard, painful lump.
The most common sites for subcutaneous injections are the vascular areas around the outer
aspect of the upper arms, the abdomen, and the anterior aspect of the thighs. Since these areas are
easily accessible, the client may learn how to self-administer medications. Rotation of sites of
injections should be observed so that no site is used more often than every 67 weeks.
For a subcutaneous injection, a 2- to 3-ml syringe or a 1-ml syringe is recommended. U-100
insulin syringes in 30-, 50-, and 100-unit sizes are used for subcutaneous insulin injections. The
most commonly used needle for a subcutaneous injection is a 58-inch 25-gauge needle.
Adjustments need to be made for pediatric, obese, or cachectic clients.
B. ASSESSMENT
1. Review physicians or qualified practitioners order so that the drug is administered safely and
correctly.
2. Review information regarding the drug ordered such as action, purpose, time of onset and peak
action, normal dosage, common side effects, and nursing implications to anticipate the drugs
effects and anticipate a reaction.
3. Assess client for factors that may influence an injection such as circulatory shock or reduced
local tissue perfusion since reduced tissue perfusion will interfere with the absorption and
distribution of the drug.
4. Assess for previous subcutaneous injections in order to rotate sites and avoid repeating a dose in
the same site.
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5. Assess for the indications for subcutaneous injection since an injection is preferred for clients
who are confused or unconscious, are unable to swallow a tablet, or have a gastrointestinal
disturbance including the use of nasogastric suction
6. Assess the clients age since older clients or pediatric clients have special needs based on their
physiologic status.
7. Assess clients knowledge regarding the medication to be received so that client education may
be tailored according to their need.
8. Assess the clients response to discussion about an injection since some clients may express
anticipatory anxiety, which may increase pain.
C. DIAGNOSIS
1.2.1.1
Risk for Infection
1.6.2.1.2.1 Impaired Skin Integrity
9.3.1
Anxiety, related to the injection
8.1.1
Knowledge Deficit, related to the injection
D. PLANNING
Expected Outcomes:
1. The client will experience only minimal pain or burning at the injection site.
2. The client will experience no allergic reaction or other side effects from the injection.
3. The client will be able to explain the action, side effects, dosage and schedule of the medication,
and rationale for rotation of sites.
Equipment Needed (see Figure 5-9-2):
a.
b.
c.
d.
e.
f.
Syringe appropriate for the medication being given
Needle (2527 gauge, 3858 inch)
Antiseptic or alcohol swabs
Medication ampoule or vial
Medication record
Disposable gloves
E. CLIENT EDUCATION NEEDED:
1) The client should be taught the rationale for administering the medication subcutaneously rather
than orally.
2) The client should be told what to expect when receiving a subcutaneous injection.
3) The client should be told to report any bleeding, itching, pain, or other side effects as a result of
the injection.
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4) Clients and caregivers can be taught to administer subcutaneous injections.
5) The client should be provided with written, illustrated instructions on administration of a
subcutaneous injection.
F. IMPLEMENTATION-ACTION/RATIONALE
1. ACTION
a. Wash hands and put on clean gloves.
b. Close door or curtains around bed and keep gown or sheet draped over body. Identify client.
c. Select injection site.
Inspect skin for bruises, inflammation, edema, masses, tenderness, and sites of
previous injections.
Use anatomic landmarks
d. Select needle size:
Measure skinfold by grasping skin between thumb and forefinger.
Be sure needle is one-half the length of the skinfold from top to bottom.
e. Assist client into a comfortable position:
Relax the arm, leg, or abdomen.
Distract client by talking about an interesting subject or explaining what you are doing
f.
g.
h.
step by step.
Use antiseptic swab to clean skin at site.
While holding swab between fingers of non-dominant hand, pull cap from needle.
Administer injection:
Hold syringe between thumb and forefinger of dominant hand like a dart.
Pinch skin with non-dominant hand (see Figure 5-9-4).
Inject needle quickly and firmly (like a dart) at a 45- to 90-degree angle (see Figure 5-9
5).
Release the skin.
Grasp the lower end of the syringe with non-dominant hand and position dominant hand
to the end of the plunger. Do not move the syringe.
Pull back on the plunger to ascertain that the needle is not in a vein. If no blood appears,
slowly inject the medication. (Aspiration is contraindicated with some medications,
check with the pharmacy if you are unclear.)
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i. Quickly withdraw the needle while applying pressure with the antiseptic swab. Do not push
down on the needle with the swab while withdrawing it, as this will cause more pain.
j. Gently massage the site. Some medications should not be massaged. Ask the pharmacy if
you are unclear.
k. Assist the client to a comfortable position.
l. Discard the uncapped needle and syringe in a disposable needle receptacle.
m. Remove gloves and wash hands.
2. Rationale
a. Reduces the number of microorganisms.
b. Provides privacy. Assures medication is given to right client.
c. Injection site should be free of lesions.
Repeated daily injections should be rotated.
Avoids injury to underlying nerves, bone, or blood vessels.
d. Ensures that needle will be injected into subcutaneous tissue.
e. Relaxation minimizes discomfort. Distraction reduces anxiety.
f. Circular motion and mechanical action of swab remove microorganisms.
g. Swab remains accessible during procedure.
h. Prevents contamination of needle.
Quick, smooth injection is easier with proper position of syringe.
Needle penetrates tight skin easier than loose skin. Pinching skin elevates subcutaneous
i.
j.
k.
l.
m.
tissue.
Quick, firm injection minimizes discomfort.
Injection requires smooth manipulation of syringe parts. Movement of syringe may
cause discomfort.
Aspiration of blood indicates intravenous placement of needle so procedure may have to
be abandoned.
Supporting tissue around injection site minimizes discomfort.
Stimulates circulation and improves drug distribution and absorption.
Promotes comfort.
Decreases risk of needle stick.
Reduces transmission of microorganisms.
G. EVALUATION
1. Ask the client if they feel any pain, burning, numbness, or tingling at the injection site.
2. Assess the clients response to the medication 30 minutes later.
3. Ask the client to discuss the purpose, action, schedule, and side effects of the medication.
H. DOCUMENTATION
Medication Administration Record
Document the date, time, dose, route, site of injection, and signature or initials.
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Nurses Notes
Document date and time of response to the medication.
Document date and time of any side effects of the medication.
I. CRITICAL THINKING SKILL
Introduction
A subcutaneous injection is intended for the tissue below the skin, not a vein. It is important to
check the needle position before injecting the medication.
Possible Scenario
A thin client with prominent superficial veins requires a subcutaneous injection so the nurse
assesses the client for the best site. When the client states that she prefers the upper arm, the nurse
honors her request and inserts the needle. When she aspirates to check for position of the needle,
blood appears in the syringe.
Possible Outcome
The nurse removes the needle and syringe and applies pressure to the injection site. Then she
discards the needle, medication, and syringe and prepares a new dose of the medication in another
syringe. She assesses the abdomen and successfully injects the medication into subcutaneous tissue
and not a vein.
Prevention
The nurse should have assessed the upper arm for the presence of veins close to the surface and
instructed the client about the rationale for using the abdomen to avoid injecting medication into a
vein.
