Giving a subcutaneous injection

What is a subcutaneous injection? l. Wash your hands thoroughly. This is the

A subcutaneous injection is given in the fatty best way to prevent infection.
layer of tissue just under the skin. 2. Assemble your equipment:
Medication
• May be a multidose vial of liquid or
may be a vial with powder that
requires “reconstitution.” Follow the
manufacturer’s instructions as to what
and how much diluent to use. The
diluent is usually saline (a mixture of
salt water) or sterile water.
Syringe or pen and needle
Depending on the amount of medication
to be given and the size of the child
or adult:
• 0.5 cc,1.0 cc, or 2 cc with 27­gauge
needle (5/8 of an inch long)
• 3­cc luer lock syringe—used when
solution is more than 1 cc
• 25­gauge needle (5/8 of an inch long
or 27­gauge needle (5/8 of an inch
A subcutaneous injection into the fatty layer of tissue
long)
(pinched up to give the injection) under the skin.
• 0.3 mL insulin syringes with 31­gauge
needles (3/16 to 5/16 inches long ) are
Why are subcutaneous injections
available
given? for those who are visually impaired or
These injections are given because there is for those who need very small doses
little blood flow to fatty tissue, and the injected of medication.
medication is generally absorbed more slowly, • medication log
sometimes over 24 hours. Some medications • container for syringe disposal
that can be injected subcutaneously are • sterile 2 x 2­inch gauze pad
growth hormone, insulin, epinephrine, and • alcohol pads
other substances.
Drawing up medication
Preparing to give medication 1. Check the label for correct medication.
Subcutaneous injections are not given if the 2. Remove the soft metal or plastic cap
skin is burned, hardened,inflamed, swollen, protecting the rubber stopper of the vial.
or damaged by a previous injection. 3. If the medication vial or pen can be used for
more than one dose, record the date and
time on the label.
Patient Education 1 Giving a subcutaneous injection
 4. Clean the exposed rubber stopper syringe with the correct dose of
using an alcohol swab. medication.
5. Remove the syringe from the plastic 14.Keep the vial upside down, with the
or paper cover. If necessary, attach needle in the vial pointed upward.
the needle securely. Tap the syringe, or “flick” it with your
6. Pull back and forth on the plunger by fingertips. This helps move bubbles to
grasping the plunger handle. Grasping the top of the syringe.
the handle end will prevent contami­ 15.Once the bubbles are at the top of the
nation of the plunger shaft (which is syringe, gently push on the plunger to
sterile). force the bubbles out of the syringe
7. With the needle capped, pull back the and back into the vial.
plunger, filling the syringe with air Or, you may push all the medication
equal to the amount of medication to solution back into the vial, withdraw
be administered. again slowly, and repeat steps 14 and
8. Remove the cap covering the needle 15.
and set it on its side to prevent con­ Note: It is important to eliminate large air
tamination. Be careful not to touch the bubbles because they take up space needed
needle. The inside of the cap and for the medication, and they may cause pain
needle is sterile, and the needle will or discomfort when injected.
be covered again with this cap. 16.After removing the bubbles, check the
9. With the vial in an up­right position, dose of medication in the syringe to
push the needle through the cleansed be sure you have drawn up the cor­
rubber stopper on the vial. Push the rect amount.
needle in at a 90 degree angle, being If using a pen, skip steps 5 to 16.
careful not to bend the needle.
Do the following:
10.Inject the air in the syringe into
a. Attach needle to pen by cleaning
the vial. Air is injected into a multi­
the top with alcohol and screwing
dose vial to prevent a vacuum
from forming. If too little or no air is on the needle.
injected, withdrawing the medication b. Dial in your prime volume (usually
may be difficult. If too much air 0.02 mL) using the manufacturer’s
is injected, the plunger may be directions. .
forced out of the barrel causing the c. With pen needle pointed up, push
medication to spill. the injection button completely.
11.Turn the vial upside down, with the You should see a drop or stream
needle remaining in the vial. The of liquid. If you do not, repeat
needle will be pointing upward. priming steps until this occurs.
12.Make sure that the tip of the needle d. Dial in prescribed dose of
is completely covered by the medication.
medication. This will make it easier to
withdraw the solution (and not air). 17. After the medication is correctly
drawn up, carefully replace the
13.Pull back on the plunger to fill the needle cap to prevent contamination.
Patient Education 2 Giving a subcutaneous injection
Locating injection sites
Subcutaneous injections can be given in the arms, legs, or abdomen. Your nurse or
doctor will help you select the best sites to administer your medication.
1. To locate injection sites
on the arms, fold one arm
across the chest. Place
your hand on the shoulder
and draw an imaginary
line below your hand.
Place another hand on the
elbow..Draw an imaginary
line down the outer side of t
the arm and down the
center front of the arm,
starting at the elbow.
The area inside these
imaginary lines is where
injections are given.
(If you are injecting yourself,
imagine the hand
placement.)
Injection sites on the side of the Injection sites on the back of the arm.
arm.

2. To locate injection sites on the thighs, sit down,

place your hand above the knee, and draw an
imaginary line above it. Place your hand at the
uppermost part of the thigh and draw an imaginary
line below your hand. Draw an imaginary line down
the outer side of the leg and down the center front
of the leg. The area within these imaginary lines
is where injections may be given.
3.To locate injection sites on the abdomen, place your
hands on the lower ribs and draw an imaginary line below
them. Use this area below your hands for injections,
as far around as you can pinch up fatty tissue. Do not
use a 1­inch area around the navel.

Injection sites on the front of the thigh.

Patient Education 3 Giving a subcutaneous injection
 Rotating injection sites
It is extremely important to rotate sites to keep
the skin healthy. Repeated injections in the
same spot can cause scarring and hardening
of fatty tissue that will interfere with absorp­
tion of medication. Each injection should be
about 1 inch apart. Each injection site can be
measured with a small dot Band­Aid, providing
the patient is not sensitive to the adhesive.
Start injections at the highest point of the area
and continue down toward the point farthest
away from the body (for example, upper arm
down toward elbow). It is preferable to use all
sites available on one body part (arm or leg)
before moving on to another. However, some
parents find that children are more accepting
Injection sites on the abdomen
of injections if they are rotated from one body
part to another (arm, leg, arm, leg). Avoid giving injections in areas that are burned,
reddened, inflamed, swollen, or damaged by prior injections.

Preparing the skin Giving the injection

Since the skin is the body’s first defense 1. Take the cover off the needle. Be
against infection, it must be cleansed careful not to contaminate the needle.
thoroughly before a needle is inserted. Place the cover on its side.
Cleanse the skin with a back­and­forth 2. Hold the syringe in one hand like
motion using an alcohol swab. This pencil or a dart.
motion moves bacteria away from the 3. Grasp the skin between the thumb and
injection site. Allow the alcohol to dry index finger with your other hand and
completely by air. pinch up.
4. Quickly thrust the needle all the way
into the skin. Do not “push” the needle
into the skin slowly or thrust the needle
into the skin with great force.

Patient Education 4 Giving a subcutaneous injection

 Do not press down on the top of the gauze pad. Also, a small amount of
plunger while piercing the skin. clear fluid may appear at the site. This
may be medication that is following the
5. Insert the needle at a 90­degree (right)
needle track to the surface. Again,
angle. This angle is important to
apply pressure using a 2 x 2 gauze
ensure that the medications will be
pad.
injected into the fatty tissue. However,
for small children, and persons with lit­ If using a pen:
tle subcutaneous fat on thin skin, you Untwist needle on the pen and safely
may be taught to use a 45­degree dispose the needle. Replace pen cap
angle. and store as instructed.

If using a pen, insert the pen needle

at a 90­degree angle. Safe needle disposal
Please refer to the Clinical Center pam­
6. After the needle is completely inserted
phlet “Handling Sharp Objects Safely at
into the skin, release the skin that you
Home.”
are grasping.
o Place the syringe or needle in a hard
Press down on the plunger to release plastic or metal container with a tightly
medication into the subcutaneous secured lid.
layer in a slow, steady pace. o Do not re­cap needles after use.
If using a pen, press the injection Keep the container out of the reach of
button completely (or until it clicks). children or pets.
Count 10 seconds before removing o When the container is three­quarters
the needle from the skin. full, take it to a health care facility
7. As the needle is pulled out of the skin, (hospital or doctor’s office) for proper
gently press a 2 x 2 gauze onto the nee­ disposal. If you live within driving
dle insertion site. Pressure over the site distance of NIH, you can bring your
while removing the needle prevents skin container to NIH for proper disposal.
from pulling back, which may be uncom­
fortable. The gauze also helps seal the
punctured tissue and prevents leakage.
8. If instructed to do so, press or rub the
site for a few seconds.
9. It is not serious if you notice blood at
the site after the needle is removed.
You may have nicked a surface blood
vessel when you injected, and blood is
following the needle track out to the sur­
face. Simply press the site with a 2 x 2

Patient Education 5 Giving a subcutaneous injection

 Medication

Dose

Schedule

Primary Nurse

Phone

Physician

Phone

This information is prepared specifically for persons

taking part in clinical research at the National
Institutes of Health Clinical Center and may not apply
to patients elsewhere. If you have questions about the
information presented here, talk to a member of your
health care team.
Products/resources named serve as examples and do
not imply endorsement by NIH. The fact that a certain
product/resource is not named does not imply that
such product/resource is unsatisfactory.
National Institutes of Health Clinical Center
Bethesda, MD 20892
Questions about the Clinical Center?
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6/2012

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Patient Education 6 Giving a subcutaneous injection