To ensure that a subcutaneous medication reaches subcutaneous tissue, these rules should be used to determine the angle of injection:. An injection pen allows the patient to self-administer medications e. This offers a convenient delivery method using prefilled, disposable cartridges.
The patient inserts the needle and injects a predetermined medication dose. Teaching is essential to ensure that the patient uses the correct injection technique and delivers the correct dose of medication. Insulin pen use is increasing. These medication administration devices have been associated with increased patient compliance and decreased hypoglycemia when compared to the vial and syringe method.
Insulin pens contain a cartridge filled with medication and a removable needle tip Figure 4. The needle is changed after each dose. Injection supplies and devices should never be used for more than one person. A jet injection system may be used for the administration of subcutaneous medication Figure 5. Jet injection is a needleless system that injects fluid through the skin.
A new subcutaneous device is available that allows medication to be delivered into a cannula placed into the tissue Figure 6. The cannula remains in the subcutaneous tissue for several days. Injection site rotation has changed because newer human insulins carry a lower risk for hypertrophy.
The patient chooses one anatomic area e. Insulin absorption occurs most quickly in the abdomen, followed by the arms, thighs, and buttocks. Pain during insulin injections may be decreased by allowing alcohol skin preparation to dry before injecting insulin, relaxing muscles around the injection site, injecting room temperature insulin, and inserting the needle quickly.
Needle length may also affect pain during insulin injections. Patients with diabetes experience significantly less pain when a shorter, straight insulin needle is used, rather than a long, tapered needle. Insulin administration should be coordinated around mealtimes to ensure timely blood glucose monitoring and the prevention of hyperglycemia and hypoglycemia. Patients receiving heparin are at risk for bleeding, including bleeding gums, hematemesis, hematuria, and melena.
Results from coagulation blood tests e. Before administering heparin, the nurse should assess for preexisting conditions that contraindicate the use of heparin, as well as for conditions in which increased risk for hemorrhage are present. The patient's current medication regimen, including use of over-the-counter and herbal medications e. When heparin is administered subcutaneously, it should be injected at a degree angle and administered over a second period.
To minimize the pain and bruising associated with low molecular weight LMW heparin, the medication is given subcutaneously on the right or left side of the abdomen, at least 5 cm 2 in away from the umbilicus.
If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. Cookies are used by this site. To decline or learn more, visit our cookies page. OVERVIEW Subcutaneous tissue is not as richly supplied with blood vessels as are muscles; therefore, medications are absorbed more slowly via subcutaneous injections than with intramuscular IM injections.
To ensure that a subcutaneous medication reaches subcutaneous tissue, these rules should be used to determine the angle of injection: For patients with significant fatty tissue, the needle should be inserted at a degree angle across pinched skin.
Special Considerations for Insulin Administration Injection site rotation has changed because newer human insulins carry a lower risk for hypertrophy. Instruct the patient to wear a medical identification bracelet, indicating important medical information, including bleeding tendencies, illnesses e. Teach the patient the techniques for self-administration. Begin this teaching as early as possible, and teach injection techniques to the caregivers as well. Explain to the patient, family, and caregivers the purpose of the medication, why this route is preferred, and why site rotation is important.
Provide the patient, family, and caregivers written information on the medication the patient should be taking. Instruct the patient regarding the potential side effects of the medication, including delayed hypersensitivity and anaphylaxis, which may occur after the patient has received several doses of medication.
For vaccinations, provide the corresponding vaccination information sheets VIS. Emphasize to the patient, family, and caregivers that sharing medications with other people is dangerous. Explain to the patient, family, and caregivers that medications should be taken as prescribed until the practitioner directs otherwise.
Explain to the patient, family, and caregivers the importance of managing medication information to identify and resolve discrepancies. Allow the patient to discuss any unresolved concerns about the medication. Encourage questions and answer them as they arise. Introduce yourself to the patient, family, and caregivers. Verify the correct patient using two identifiers. Explain the procedure to the patient, family, and caregivers and ensure that the patient agrees to treatment.
Obtain and update information on the medications the patient is currently taking. Assess the patient for contraindications to receiving the medication and advise the practitioner accordingly.
Assess the patient for drug, food, component, and latex allergies. The dose may need to be given in a controlled environment, and an order may need to be obtained for an anaphylaxis kit and the kit obtained before administration. Assess for factors such as circulatory shock or reduced local tissue perfusion. Assess baseline vital signs. Assess the patient for adequate adipose tissue. A lifted skinfold technique pinching or bunching the skin can be used to lift the subcutaneous layer away from the underlying muscle Down and Kirkland, Fig 3.
This method reduces the risk of inadvertent intramuscular injection when undertaken correctly; however, releasing the skin too quickly before the injection is completed or lifting it incorrectly can increase that risk Down and Kirkland, Safety needles should be used for subcutaneous injections to reduce the risk of needle- stick injury Health and Safety Executive, Some drugs such as heparin come in a pre-loaded syringe and patients prescribed insulin may use insulin delivery devices.
Needle size is measured in gauges diameter of the needle — a 25G is commonly used for subcutaneous injections Dougherty and Lister, ; Public Health England, Needle size depends on the viscosity of the liquid being injected Dougherty and Lister, Needles need to be long enough to inject the drug into the subcutaneous tissue. They come in lengths of mm. Dougherty and Lister suggest the required needle length can be estimated by pinching the skin using the lifted skinfold technique Fig 3 and selecting a needle that is 1.
There is debate around the use of alcohol-impregnated swabs to clean injection sites. The World Health Organization suggested that if a patient is physically clean and generally in good health, swabbing of the skin before injection is not required.
It is common practice to draw back on a syringe after the needle has been inserted to check whether it is in a blood vessel. This is not recommended for subcutaneous injections as this is unlikely to occur Lister et al, The WHO ; stated that gloves need not be worn for this procedure if the skin of both health worker and patient is intact. It also notes that gloves do not protect against needlestick injury. Nurses need to assess risk in each individual patient Royal College of Nursing, and be aware of local policies for glove use.
It is recommended that subcutaneous injections, particularly of insulin, are administered at a degree angle to ensure that the medication is delivered into the subcutaneous tissue Down and Kirkland, ; Hunter, However, patient assessment is vital — patients who are cachectic and therefore have minimal amounts of subcutaneous tissue may require injections to be delivered at a degree angle.
PHE recommends that subcutaneous vaccinations are given with the needle at a degree angle to the skin and the skin should be pinched together PHE, Tagged with: Coronavirus zone: diabetes Newly qualified nurses: practical procedures.
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Editorial team. How to give a heparin shot. Your doctor prescribed a medicine called heparin. It has to be given as a shot at home. To get prepared: Gather your supplies: heparin, needles, syringes, alcohol wipes, medicine record, and container for used needles and syringes. If you have a pre-filled syringe, make sure you have the right medicine at the right dose.
Do not remove the air bubbles unless you have too much medicine in the syringe. Skip the section on "Filling the Syringe" and go to "Giving the Shot. Filling the Syringe. Follow these steps to fill the syringe with heparin: Wash your hands with soap and water, and dry them well. Check the heparin bottle label.
Make sure it is the right medicine and strength and that it has not expired. If it has a plastic cover, take it off. Roll the bottle between your hands to mix it. Do not shake it. Wipe the top of the bottle with an alcohol wipe. Let it dry. Do not blow on it. Know the dose of heparin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile.
Pull back the plunger of the syringe to put as much air in the syringe as the dose of medicine you want. Put the needle into and through the rubber top of the heparin bottle. Push the plunger so the air goes into the bottle. Keep the needle in the bottle and turn the bottle upside down.
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