• Medication
• Subcutaneous injection general guidelines

Process - Step by Step

• Injections that are given via the subcutaneous route deposit a drug dose into adipose tissue immediately below the dermal layer. 
  • Blood supply to this layer is lower than to muscle tissue, so medication given this way acts as a depot and is absorbed slower than via intramuscular injection.
• Medication administered via subcutaneous injection includes anticoagulants such as heparin tinzaparin, and insulin. 
  • Medications administered this way must be water-soluble and low volume, typically below 2 ml.
• This process is only for HWH staff who have completed the necessary training and competencies to administer medication via subcutaneous injection.

• Confirm the client's prescription:
  • Check the prescription details and confirm you understand them clearly and without ambiguity
  • Select the correct medication and the correct dose
  • Check that the expiry date of the medication has not elapsed
  • Check that the medication has been stored as required, e.g. insulin must be refrigerated—do not use if in any doubt.

• Prepare the client:
  • Explain the process to the client and gain consent
  • ensure the client has privacy during the process
  • Check whether the client has any allergies
  • Check that the prescription is correct and follow the ‘five rights’ of medicines administration and the local medicines administration policy to reduce the risk of error (refer to Medication policy)
  • identify the most suitable injection site, considering the person’s preferences.

• Manage cross-infection risks:
  • Use appropriate PPE, i.e. apron
  • Wash hands and follow recommended hand washing techniques and dry thoroughly.

• Prepare the medication:
  • Assemble the syringe and needle, if required.
  • Carefully unsheathe the needle.
  • Draw the required amount of drug from the ampoule—some drugs are available in pre-filled syringes—follow the manufacturer’s instructions.
  • Disperse any air bubbles from the syringe.
  • Change the needle to ensure the one you use for injecting the drug is sharp, thereby reducing pain.
  • Always use a safety-engineered needle for the injection to reduce the risk of sharps injury.
  • Dispose of the needle used to draw the drug in a sharps-approved container.

• Give the client the injection:
  • Place the injection in a tray and take it to the person along with a sharps container for disposal immediately after
  • Check the person’s identity using their medication chart (refer to the Medication policy)
  • position the person comfortably with the selected injection site exposed
  • Check the site for signs of oedema, infection or skin lesions—if any of these are present, select a different site
  • wash and dry hands
  • If gloves are considered necessary following a risk assessment, put gloves on
  • Ensure the skin is clean.
  • If skin cleansing is considered necessary, swab for 30 seconds with isopropyl alcohol and then allow to dry for 30 seconds
  • Inform the patient that you are going to carry out the injection—use distraction and relaxation techniques to reduce anxiety if needed
  • Hold the syringe and needle in your dominant hand and pinch the skin together using the non-dominant hand to lift the tissue away from the underlying muscle
  • Insert the needle at the required angle (usually 90 degrees) using a dart-like action—an aspiration to check whether the needle is in a blood vessel is not necessary
  • Depress the plunger and inject the drug slowly over 10-30 seconds
  • Wait 10 seconds before withdrawing the needle—this will prevent backtracking of the drug—then withdraw the needle (do not massage the area, as this can lead to bruising following administration of heparin and speed up absorption times with insulin)
  • Release the lifted skinfold
  • dispose of sharps directly into the sharps bin and the syringe in general waste.

• After the injection:
  • Ensure the client is comfortable and you wash your hands
  • Record the administration on the person’s medication chart (to avoid lipohypertrophy, also record the site of the injection)
  • Monitor the patient for any effects of the prescribed medicine and problems with the injection site.