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Saturday, April 18, 2009

Fundamentals of Nursing: Subcutaneous Injection

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Subcutaneous Injection - Presentation Transcript

1. Patient Information Publications Warren Grant Magnuson Clinical Center National Institutes of Health Giving a Subcutaneous Injection What is a subcutaneous Preparing to give medication injection? Subcutaneous injections are not given if the skin is burned, hardened,inflamed, swollen, A subcutaneous injection is given in the fatty or damaged by a previous injection. layer of tissue just under the skin. l. Wash your hands thoroughly. This is the best way to prevent infection. 2. Assemble your equipment: medication • May be a multidose vial of liquid or may be a vial with powder that requires “reconstitution.” Follow the manufac- turer’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 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 27-gauge A subcutaneous injection into the fatty layer of needle (5/8 of an inch long) tissue (pinched up to give the injection) under the • 3 cc luer lock syringe—used when skin. solution is more than 1 cc • 25-gauge needle (5/8 of an inch long Why are subcutaneous injections or 27-gauge needle (5/8 of an inch long) given? • 0.3 mL insulin syringes with 28-gauge These injections are given because there is needles (1/2 inch long ) are available little blood flow to fatty tissue, and the injected for those who are visually impaired or medication is generally absorbed more slowly, for those who need very small doses sometimes over 24 hours. Some medications of medication. that can be injected subcutaneously are • medication log growth hormone, insulin, epinephrine, and • container for syringe disposal other substances. • sterile 2 x 2 -inch gauze pad • alcohol pads 1 Patient Information Publications Giving a Subcutaneous Injection
2. little or no air is injected, withdrawing the Drawing up medication medication may be difficult. If too much 1. Check the label for correct medication. air is injected, the plunger may be forced out of the barrel causing the medication 2. Remove the soft metal or plastic cap to spill. protecting the rubber stopper of the vial. 11. Turn the vial upside down, with the needle 3. If the medication vial can be used for remaining in the vial. The needle will be more than one dose, record the date and pointing upward. time on the label. 12. Make sure that the tip of the needle is 4. Clean the exposed rubber stopper using completely covered by the medication. an alcohol swab. This will make it easier to withdraw the 5. Remove the syringe from the plastic or solution (and not air). paper cover. If necessary, attach the 13. Pull back on the plunger to fill the syringe needle securely. with the correct dose of medication. 6. Pull back and forth on the plunger by 14. Keep the vial upside down, with the needle grasping the plunger handle. Grasping the in the vial pointed upward. Tap the syringe, handle end will pre-vent contamination of or “flick” it with your fingertips. This helps the plunger shaft (which is sterile) and move bubbles to the top of the syringe. help check for easy movement. 15. Once the bubbles are at the top of the 7. With the needle capped, pull back the syringe, gently push on the plunger to force plunger, filling the syringe with air the bubbles out of the syringe and back equal to the amount of medication to into the vial. be administered. Or, you may push all the medication 8. Remove the cap covering the needle and set solution back into the vial, withdraw it on its side to prevent contamination. Be again slowly, and repeat steps 14 and 15. careful not to touch the needle. The inside of the cap and needle is sterile, and the Note: It is important to eliminate large air bubbles needle will be covered again with this cap. because they take up space needed for the medica- tion, and they may cause pain or discomfort 9. With the vial in an up-right position, push when injected. the needle through the cleansed rubber 16. After removing the bubbles, check the dose stopper on the vial. Push the needle in at of medication in the syringe to be sure a 90 degree angle, being careful not to you have drawn up the correct amount. bend the needle. 17. After the medication is correctly drawn 10. Inject the air in the syringe into the vial. up, carefully replace the needle cap to Air is injected into a multi-dose vial to prevent contamination. prevent a vacuum from forming. If too 2 Patient Information Publications Giving a Subcutaneous Injection
3. 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 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. Injection sites on the thighs. 3 Patient Information Publications Giving a Subcutaneous Injection
4. 3. To locate injection sites on the abdomen, place your hands on the lower ribs and draw an imagi- nary 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 1-inch area around the navel. 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 absorption of medication. Each injection should be about 1 inch apart. Each injection site can be measured with a small dot Band-Aid, providing the patient is not sensitive to the adhesive. Start injections at the highest Injection sites on the abdomen 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 of injections if they are rotated from one body part to another (arm, leg, arm, leg). Avoid giving injections in areas that are burned, red- dened, inflamed, swollen, or damaged by prior injections. 3. Grasp the skin between the thumb and Preparing the skin index finger. Since the skin is the body’s first defense against infection, it must be cleansed thoroughly 4. Quickly thrust the needle all the way into before a needle is inserted. the skin. Do not “push” the needle into the skin slowly or thrust the needle into the Cleanse the skin in a circular motion using an skin with great force. Do not press down alcohol swab. Begin at the center of the site on the top of the plunger while piercing and progress outward. This motion moves the skin. bacteria away from the injection site. Allow the alcohol to dry completely either by air or 5. Insert the needle at a 90-degree (right) by using sterile 2x2 gauze. angle. This angle is important to ensure that the medications will be injected into the Giving the injection fatty tissue. However, for small children, and persons with little subcutaneous fat 1. Take the cover off the needle. Be careful on thin skin, you may be taught to use not to contaminate the needle. Place the a 45-degree angle. cover on its side. 2. Hold the syringe in one hand like a pencil or a dart. 4 Patient Information Publications Giving a Subcutaneous Injection
5. 6. After the needle is completely inserted the site with a 2 x 2 gauze pad. Also, a into the skin, release the skin that you small amount of clear fluid may appear at are grasping. the site. This may be medication that is following the needle track to the surface. 7. With your free hand, grasp the syringe Again, apply pressure using a 2 x 2 gauze near its base to stabilize it. pad. 8. Gently pull back on the plunger and Safe needle disposal check for the appearance of blood in the syringe. Please refer to the Clinical Center pamphlet Note: Not all injections require you to “Handling Sharp Objects Safely at Home.” check for blood. Before you are dis- charged, your nurse will let you know if you need to do this. If you do not, then skip down to step 10. Medication 9. If blood appears, remove the needle, discard it, and start over. Blood in the syringe means that you may be in a blood vessel, Dose so discard the syringe with medication. Do not inject medication into a blood vessel: the medication is absorbed too Schedule rapidly if it is injected there. 10. If no blood appears, inject the medication at a slow, steady rate. Medication should Primary Nurse be injected within 5 seconds. Phone 11. As the needle is pulled out of the skin, gently press a 2x2 gauze onto the needle Physician insertion site. Pressure over the site while removing the needle prevents skin from pulling back, which may be uncomfortable. Phone The gauze also helps seal the punctured tissue and prevents leakage. 12. If instructed to do so, press or rub the site for a few seconds. 13. 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 surface. Simply press 5 Patient Information Publications Giving a Subcutaneous Injection
6. This information is prepared specifically for patients participating in clinical research at the Warren Grant Magnuson Clinical Center at the National Institutes of Health and is not neces- sarily applicable to individuals who are patients elsewhere. If you have questions about the information presented here, talk to a member of your healthcare team. 2002 Where applicable, brand names of commercial products are provided only as illustrative exam- ples of acceptable products, and do not imply endorsement by NIH; nor does the fact that a particular brand name product is not identified imply that such product is unsatisfactory. National Institutes of Health Warren Grant Magnuson Clinical Center Bethesda, MD 20892 Questions about the Clinical Center? 6 Patient Information Publications Giving a Subcutaneous Injection

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