06.07 SubQ Injections

Overview

1. Purpose
   1. Some medications are given under the skin in the subcutaneous layer
   2. Improper administration can make the medication be too shallow (intradermal) or too deep (intramuscular)

Nursing Points

General

1. Supplies needed
   1. Required medication vial
   2. Appropriate size syringe
      1. Insulin syringe
      2. 1 mL
      3. 3 mL
   3. Appropriate size needle
   4. Alcohol pad
   5. Gauze
2. Injection sites
   1. Anterolateral thigh
   2. Upper outer tricep
   3. Upper buttocks
   4. Abdomen
3. Needle size
   1. Length – ½ – ⅝”
   2. Gauge – 26 – 30 g
4. NOTES
   1. Rotate sites with frequent injections
      1. Especially insulin – risk for maldistribution of fat
   2. Must choose site with good subcutaneous fat layer
   3. With heparin
      1. Do not inject over a bruise
      2. Do NOT press or massage

Nursing Concepts

1. Steps and Nursing Considerations
   1. Verify provider order
   2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
   3. ALWAYS prepare medications at the patient’s bedside
   4. Gather supplies
   5. Perform hand hygiene
   6. Don clean gloves
   7. Let the patient know what meds they will be receiving
   8. Draw up medication in appropriate syringe
   9. Select appropriate site
      1. Rotate from previous site
   10. Select appropriate needle size and attach needle
   11. Clean the site with alcohol in circles starting at the center and working outward – LET DRY
   12. Pinch the skin up off the muscle so there’s a layer of subcutaneous fat between your fingers
   13. Insert the needle at a 45-90 degree angle
   14. Inject medication slowly
   15. Remove needle
   16. Apply gentle pressure with gauze
       1. Do NOT massage
   17. Activate safety and/or dispose of needle in sharps container
   18. AFTER administration
       1. Document administration and patient’s response
       2. If using barcode medication administration
          1. Scan all meds before preparing
          2. Confirm administration AFTER giving to patient
   19. Discard all used supplies
   20. Remove gloves
   21. Perform hand hygiene
   22. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

1. Indication and possible side effect(s) of medication(s)
2. Signs to report to nurse or provider