Subcutaneous Injections

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Subcutaneous Injections

• NURS128
• Instructor Marilyn Gilbert
• Winter 2006
• Thank you to Sherrie Bade and Susan Ross and
  Laura Ford

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Routes of Medication Administration

• Parenteral medication administration of a
  medication by injection into body tissues
• Subcutaneous (SC) into tissue below dermis of
  skin
• Intramuscular (IM) into the body muscle
• Intravenous (IV) into a vein
• Intradermal (ID) into the dermis just under the
  epidermis
• Can you give examples of above?

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Syringes

• Three main parts
• Barrel chamber that holds the medication
• Plunger part within the barrel that moves back
  and forth to withdraw and instill medication
• Tip part that the needle is attached to
• Calibration
• Syringe sizes from 1 ml to 50 ml
• Measure to a 1/10th or 1/100th depending on
  calibration

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Needles

• Shaft of the needle
• Length 3/8th of an inch 1 ½ inches
• Length chosen depends on the depth to which
  medication will be instilled
• Tip of shaft is beveled or slanted to pierce the
  skin more easily
• Gauge width of the needle (18 27 gauge) a
  smaller number indicates a larger diameter and
  larger lumen inside the needle

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Considerations when choosing a syringe and needle

• Type of medication
• Depth of tissue penetration required
• Volume of medication
• Viscosity of medication
• Size of the client

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Asepsis Sterile technique

• Sterile technique method of creating and
  maintaining an area free of all pathogens
  (microorganisms spores)
• Used for all parenteral injections including
  subcutaneous injections
• The primary purpose of asepsis for injections is
  to prevent infection

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Asepsis related to the syringe and needle

• Follow principles to keep needle and syringe
  parts sterile
• Shaft of the needle
• Inside the hub of the needle
• Tip of the syringe
• Inside the barrel of the syringe
• The part of the plunger entering the barrel of
  the syringe

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Asepsis of Medication Containers

• Vials have a rubber stopper are glass or plastic
  - single and multidose
• Must be cleansed with alcohol prior to inserting
  needle through it
• Self sealing when needle withdrawn
• Date outside of container when first used
• Ampoules glass and plastic narrow neck that is
  broken single dose
• Neck cleansed with alcohol and broken away from
  you
• Needle inserted only into opening into ampoule

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Assessments prior to administration of
subcutaneous injection

• Use Clinical Decision Making (CDM) process
• Assessment collect data (follow with analysis
  synthesis of data).
• Planning what actions to take?
• Implementation carry out actions/
  interventions.
• Evaluation did the interventions work?

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Pharmacokinetics

• The study of how drugs
• Enter the body- absorption
• Reach their site of action-distribution
• Are metabolized-metabolism
• Exit the body-excretion
• Pharmacokinetics necessary influences
• Choice of medications for a specific client
• Timing of drug administration
• Selection of route for administration

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Dosage Calculations

• Dose Ordered X Unit/Volume Amount
• Dose Available (ml, tab, cap) to give
• D/A X unit dose to give

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The 7 Rights of Drug Administration

• Right client
• Right medication
• Right dose
• Right route
• Right time
• Right reason
• Right documentation

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Administration of Medication

• Wash hands
• Compare MAR with order or note RN initials
  present indicating order checked
• Three checks of client name, allergies, date and
  time and medication
• Calculate correct dose
• PREPARE MEDICATION
• Confirm right client by checking name band,
  asking to state name or alternatives depending on
  agency
• Document on MAR document on chart if needed

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Preparing Medication Withdrawing from an Ampoule

• Tap top of ampoule to move liquid down
• Place alcohol pad around neck of ampoule
• Snap neck of ampoule away from you
• Insert needle into opening may hold upside down
  or on a flat service but keep needle tip under
  liquid
• Remove needle tap syringe remove air bubbles
  establish dosage may have to discard some med
  in sink
• Put cap back on needle ( only cap a needle that
  has not been used) NEVER RECAP A USED NEEDLE

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Preparing Medication Withdrawing from a Vial

• Select appropriate syringe and needle
• Remove cover from rubber stopper
• Clean a pre-opened vial by swabbing it firmly
  with an alcohol swab - circular motion from
  inside to outside
• Fill syringe with volume of air equal to volume
  to be withdrawn from vial
• Insert needle invert vial and hold/brace it
  while pulling on end of plunger
• Tap barrel to remove air
• Push on plunger to move medication to tip of
  needle
• Replace cap

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Insulin

• A hormone regulates glucose metabolism - only
  given parenterally (SC, IV)
• Prescribed in units insulin syringe calibrated
  in units (100 u/ml) 100 units 1ml or
  100units1cc
• Two sizes of syringes
• 0.5 ml 50 units
• 1.0 ml 100 units
• Clients generally require one or more injections
  daily
• Blood glucose monitoring (BGM) A normal range
  is 4 - 7

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Insulins

• Rapid-acting
• Humalog Onset 5 minutes, Peak 1 hour,
  Duration 2-4 hours
• Regular (Humulin R clear) Onset 1 hour, Peak
  2-4 hours, Duration 5-7 hours
• - Regular insulin is CLEAR
• Intermediate-acting
• NPH (Humulin N cloudy) Onset 1 2.5 hours,
  Peak 6-12 hours, Duration 18-24 hours

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Insulins

• Long-acting Insulin (cloudy)
• Ultralente Onset 4-8 hours, Peak 12-20
  hours, Duration 24-48 hours
• Mixed Insulins
• 30/70 most usual one
• 20/80
• 50/50
• Onset 30-60 minutes then 1-2 hours, Peak 2-4
  hours then 6-12 hours, Duration 6-8 hours then
  18-24 hours

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Mixing Insulins

• Roll cloudy vial to mix
• Cleanse rubber stoppers of both vials of insulin
• Instill an amount of air equal to the volume that
  will be withdrawn from the cloudy vial
• Repeat with clear insulin and withdraw required
  amount
• Pierce cloudy vial withdraw required units
• Always CLEAR before CLOUDY

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To Ensure Safe Drug Administration

• Focus Dont carry on a conversation
• Always Check physician orders for insulin in
  patients chart
• If uncertain ALWAYS check PRIOR to administration
  of a drug
• Check for client allergies
• Keep medications within your sight at all times
• Withhold a medication if client demonstrating an
  undesirable reaction Report and Record this
• Record drug administration as soon as possible
  after medication administration
• If an error is made, record it IMMEDIATELY so
  measures may be taken to minimize effects of the
  error an agency incident report and TRU
  incident report filled out

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Injection technique for SC

• Locate site for injection
• Cleanse with an alcohol swab cleaning from center
  outward in a circular motion 5 cm
• (2 in) circle
• Clean gloves
• Pinch up skin or spread taut depending on site
  and size of client
• Dart needle quickly and firmly into tissue at
  either a 45 or 90 angle stabilize by resting
  hand doing injection on skin surface
• Inject medication
• Withdraw needle quickly and immediately into
  sharps container DO NOT RECAP

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Administration of controlled substances i.e.
narcotics

• All narcotics in locked cabinet RN carries keys
• When narcotic taken from cabinet documentation on
  ledger of
• Clients name and Dr.s name
• Time taken from cabinet
• The count of drug remaining
• Signature of nurse administering cosign for
  wastage
• At change of shift oncoming and nurse completing
  shift do a count of all controlled substances in
  locked cabinet
• Any drug discrepancies are reported immediately

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Common Medication Errors

• Errors in mathematical calculation of doses
  check decimal point
• Incorrect reading of labels on medications
• Lack of knowledge about med administered
• Failure to properly identify client before
  administering med or failure to listen to client
  double check when a client raises questions
  about a medication
• Administration of medications without critically
  thinking ( CT)