Administering Subcutaneous Medication

Administering Subcutaneous Medication

Equipment
■ Syringe and needle appropriate for volume and site.
■ Alcohol prep pad or CHG-alcohol product.
■ Gauze pad (optional).

Assessment
■ Check the area for previous injection sites.
■ Do focused assessments for the specific medication being administered.
■ Insulin—Be Safe! Check capillary blood sugar level, and determine when the patient will be having the next meal; check for signs of hypoglycemia or hyperglycemia.
■ Heparin Check aPTT and for signs of bleeding (e.g., bleeding from gums, IV sites, and so on).

Post-Procedure Reassessment
■ Reassess for anticipated response and adverse reaction to the medication.
■ Be Smart! For insulin, check blood glucose levels and clinical signs that patient’s blood sugar level has returned to normal. For heparin, observe that patient has no signs of bleeding.

Key Points
■ Maintain sterile technique and standard precautions.
■ Usually you will use a 1-mL syringe and a 25- to 27-gauge needle that is less than 1 in. long (usually 3/8 to 5/8 in.) For doses of a full mL or more (especially medications other than insulin or heparin), use a 3-mL syringe so you will be better able to aspirate.
■ Be Safe! A subcutaneous dose is typically no more than 1 mL.
■ Most common injection sites: outer aspect of the upper arms, abdomen, and anterior aspects of the thighs.
■ Pinch the skin to inject, as a general rule.
■ For an average-weight or thin client, inject at a 45° angle; for an obese client, inject at a 90° angle, as a general rule.
■ Aspiration is optional for most subcutaneous medications, but do not aspirate when injecting heparin or insulin.
■ Be Safe! Do not massage the site.

Documentation
■ Document scheduled medications on the MAR.
■ Document PRN medications in the nursing notes, including the reason given and response.
■ Chart medication, time, dose, and route given; therapeutic and adverse drug effects, nursing interventions, and teaching.
■ Some agencies have a specific code for documenting subcutaneous injections, which allows exact site documentation on an outline of the body.
■ In nursing notes, document any related patient assessment findings, such as capillary blood sugar, signs of hypoglycemia or hyperglycemia, bruising, and so on.

Subcutaneous tissue injection using 45° and 90° angles