Subcutaneous injection (Procedure, sites and complications)

BSc. Nursing Fourth Year, TU,IOM,MNC, Kathmandu, Nepal

1. SUBCUTANEOUS INJECTION Presented by: Ganga Tiwari BSc. Nursing Fourth year, Teaching Learning TU,IOM,MNC, Kathmandu, Nepal

2. Different gauge of needle:

3. Subcutaneous injection: Subcutaneous injection involves injecting medication into the adipose tissue (sub cutaneous layer of fat) below dermis and above the muscle tissue. This tissue has few blood vessels, so drug administered here have slow and sustained absorption into the capillaries.

4. Introduction contd … Only small dose (0.5 ml to 1 ml) of water soluble medications is given subcutaneously because tissue is sensitive to irritating solution and large volume of medication

5. Common sites: Outer aspect of upper arm. Posterior chest wall below the scapula. Anterior abdominal wall.(2 inches around the umbilicus) Anterior and lateral aspects of thigh.  

6. Common sites:

7. Articles Medication cardex . Medication tray Kidney tray Spirit swab Sterile syringe and needle Prescribed medications in ampule or vial Disposable gloves Medicine cutter/ opener Puncture proof container

8. Procedure Check medication instructions. Identify the patient carefully. Explain procedure to the patient the drug that is to be administer, site and how to co-operate. Wash hands Set up medication tray with necessary articles. Assemble all articles including loaded syringe near the patient bed side.

9. Contd.. Maintain privacy. Help the patient to assume the position depending upon the site selected. -anterior thigh: sitting or lying down with muscle relaxed - Abdomen: patient should lie on semi recumbent position. -Scapular: patient may be prone, lateral or sitting position. -Outer aspect of upper arm: arm relaxed at the side of the body

10. Contd.. Assess the area. Check for lumps, nodules, tenderness, hardness, swelling, scaring, itching, burning sensation and localized inflammation in the area. Wear gloves Clean the area around the injection site with spirit swab. Use firm circular motion while moving outward (about 5 cm in diameter).allow antiseptic to dry.

11. Contd.. Remove the needle cap with non- dominant hand pulling it straight off. Grasp and pinch the area around the injection site (obese and normal person) or spread skin at site( thin person). Hold the syringe in dominant hand between thumb and fore finger. Inject the needle quickly at an angle 45 to 90 degree.

12. Contd.. After insertion, release the tissue immediately moves your non-dominant hand to steady the lower end of the syringe. Slide your dominant hand to top of the barrel. Aspirate by holding the barrel steady with non-dominant hand. Withdraw the needle if blood appears in the syringe, discard and prepare new injection. Do not aspirate heparin is anticoagulant and causes bruising on aspiration.

13. Contd.. Inject medication slowly if no blood appears. Withdraw the needle quickly at the same angle as it was inserted while applying counter traction around the injection site with non-dominant hand. After withdrawing the needle apply gentle pressure.

14. Contd.. Do not massage the heparin and insulin injection site. Massaging heparin site can lead to bruising. Massaging insulin site can lead to unpredictable absorption

15. Contd.. Assist the patient to comfortable position. Discard the syringe and the needle in puncture proof container and discard gloves and other soiled articles in an appropriate container. Wash hands. Document the administration of medication with date, time, route, sites and nurse signature.

16. Complications Fat necrosis Erythema Abscess Cellulitis Formation of nodule.

17. C ellulitis

18. Complications of sub cut injection

19. References B asvanthappa,B.T .(2004). Fundamentals of Nursing. New Delhi : Jaypee Brothers. Perry, A.G. and Potter, P.A. (2007).Basic Nursing Essentials For Practice .(sixth edition): Mosby Giri , M. and Sharma,P . (2013). Essential Fundamental Of Nursing.(first edition).Kathmandu: Medhavi Publication. Pathak , S.and Devkota ,R.(2011).A Textbook Of Fundamentals of Nursing.(second edition). Kathmandu:Vidyarthi Prakashan . Taylor,C.R . and Lillis,C .(2008). Fundamental Of Nursing.(Volume1): Lipincott William and Willikins Health learning material center. Institute Of Medicine,Tribhuvan University.Fundamental Of Nursing (Second Edition ,reprint,2010).Kathmandu Dillibazar . Heidel Press.  

20. THANK YOU !!