Videos

Subcutaneous injection animation demonstration

Demonstration of subcutaneous injection techniques, including how to identify an appropriate site for injection.

1) Equipment needed

  • Non-sterile gloves

  • Apron

  • Cotton wool or gauze

  • Small sticking plaster (ideal)[62]

  • Disposable tray

  • Sharps bin

  • Medicine for injection

  • Fluid for reconstitution or dilution

  • Filter needle to draw up medication

  • Appropriate needle size for the injection; 8 mm is the needle length most commonly used.[63]

Some medications for subcutaneous injection are available in preloaded syringes with integrated needles (e.g., low molecular weight heparins such as enoxaparin sodium, and insulin [insulin pens]). Follow the manufacturer’s instructions on injection preparation and technique accordingly for these devices.

2) Contraindications

  • You should not administer injections through infected or broken skin

  • Take careful note of any previous allergic reactions, hypersensitivity, or other adverse effects by both asking the patient and checking their notes. If the patient is allergic to the medication, do not inject the medication.

Cautions

  • You should always adhere to manufacturer’s guidelines for the route of administration, dilution, dosage, and infusions

  • Clean skin with soap and water.[64] Skin cleaning policies may vary; follow local guidance.

3) Indications

Some oral medicines undergo extensive first pass metabolism by the liver or are not well absorbed from the gastrointestinal tract, so alternative routes of administration are preferable. In other situations patients may be nil by mouth, or too unwell to take oral medications. For each medicine required, consider the routes of administration available and which is the most appropriate for the clinical setting. The following key issues have been described as important to consider when choosing the most appropriate route:[65]

  • Safety

  • Efficacy

  • Patient preference

  • Pharmacoeconomics.

Medicine that is injected subcutaneously will undergo slow absorption but may continue to have a systemic effect for longer than via the intravenous or intramuscular route. You can only administer small volumes via this route. The subcutaneous route is suitable for regular injections of medication (e.g., by patients with diabetes who are dependent on insulin). Patients who inject medication regularly should rotate the injection site frequently.

4) Complications

Complications that may occur as a result of injection include:

  • Bleeding, bruising, or haematoma formation

  • Local infection and formation of an abscess

  • Fainting

  • Allergic reaction

  • Formation of a sterile abscess

  • Paraesthesia/nerve damage

  • Pain (local anesthetics initially)

  • Lipoatrophy (subcutaneous insulin).

5) Aftercare

  • Monitor the patient for the desired responses after medications have been administered. Also be vigilant for potential adverse effects from the injection

  • Observe the injection sites for haematoma formation, bleeding, infection, and hypersensitivity reactions

  • Ensure that you correctly document all medications administered.