Subcutaneuous injection

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions)
• Medication in ampule or vial
• needle size of 0.8x 40 mm (green needle hilt);
• 2 ml syringe with a needle of 0.6x25–35 mm (blue needle hilt);
• medical records

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. The doctor prescribed to the patient a subcutaneous administration of the medication. Follow doctor's prescription

Order of the skill performance:

Preparatory stage:

• inform the patient about the injection, get verbal consent to giving it, ask him to take the required position
• withdraw the required medication into a syringe from an ampule (vial) and change the needle (see PS5 - Withdrawing of medicine from an ampule  into a syringe) or (PS6 - Withdrawing of medicine from a vial into a syringe)

Maine stage:

• select, examine and palpate a injection site with your dominant hand (region of the deltoid muscle on the shoulder)
• take two swabs with your dominant hand, wet it with skin antiseptic;
• treat the skin at the injection site 2-3 times in one direction:
  
  • with one swab a “large field” (10x10 cm in size);
  • wtithe second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the disinfectant has completely evaporated from the surface of the skin;
• take one swab and wet it with skin antiseptic;
• keep this swab with fourth and fifth finger of non dominant hand
• take the syringe with a medication from the opened package with your dominant hand, place the second finger on the needle hilt, grasp the syringe barrel with others fingers;
• place the package in the "Package" container;
• remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand, place the cap in the "Plastic" container
• gather a triangular fold of the skin in the area of the outer surface of the shoulder at the border of the upper and middle third with the first, second and third fingers of the left hand
• insert the needle with a quick movement into the base of the fold at an angle of 45° to the skin surface to a depth of 2/3 of the needle;
• 
• release the skin fold;
• pull little back the plunger with non dominant hand (if blood enters syringe, move needle slightly back and check it again, if no blood appears, inject the medication)
• administer the medication by pressing on the syringe plunger with the first finger of the non dominant hand;
• press the swab with antiseptic to the injection site
• 
• remove the needle with a quick movement

Final stage:

• disinfect syringe and injection needle (see PS3 - Disinfection of disposable syringes and injection needles);
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• wash your hands (see Hygienic hand washing)
  
• register the medication administration in medical records;
• observe the patient for 5-7 minutes to detect an allergic reaction