BARTOLABA, LYCA R.

PREPARING AND ADMINISTERING SUBCUTANEOUS INJECTION

Purpose:
1. To provide a medication a client requires.
2. To allow slower absorption of a medication compared with either the intramuscular or
intravenous route.

Equipment / Materials Needed

1. Vial or ampule of the correct medication
2. Sterile syringe (3ml) with needle gauge #25 (3/8 to 5/8 inch long)
3. Withdrawing needle gauge # 21 0r 22
4. Alcohol swab or cotton with alcohol
5. Clean gloves (according to agency protocol)
6. Medication Card / ticket
7. Kardex
8. Patient’s Chart

EXPECTED BEHAVIOR RATIONALE

ASSESSMENT
Assess Assessment is a prerequisite for every
1. Allergies to medication medication given. Subcutaneous injection
sites need to be rotated in an orderly
2. Specific drug action, side effects fashion to minimize tissue damage, aid
and adverse reactions absorption and avoid discomfort.
3. Client’s knowledge and learning
needs about the medication
4. Status and appearance of
subcutaneous site for lesions,
erythema, swelling, ecchymosis,
inflammation and tissue damage
from previous injections
5. Ability of client to cooperate
during the injection.
6. Previous injection site used.
PLANNING
7. Determine the appropriate size of Appropriate needle size and syringe
needle and syringe to be used. should be used during the injection.
IMPLEMENTATION
Preparation of the drug:
8. Check the MAR.
a. Check the label on the To make sure that the correct medication
medication carefully against is being prepared.
the MAR.
b. Follow the three checks for Properly identifying medication decreases
administering medications (1) risk of inadvertently administering the
when it is taken from the wrong medications.
BARTOLABA, LYCA R.

medication cart/box (2) before

withdrawing the medication
and (3) after withdrawing the
medication.
c. Organize the equipment. To save time and effort.

Performance
9. Perform hand hygiene and observe Hand hygiene prevents the spread of
other appropriate infection microorganisms.
prevention procedures (e.g. clean
gloves).
10. Prepare the medication from the Double checking the dosage avoids
ampule or vial for drug medication errors.
withdrawal. If the medication is
heparin or insulin, the dosage
needs to be verified by another
nurse.

Note: refer to drug preparation from

ampule / vial
11. Provide for client privacy. This is to ally patient’s anxiety and to gain
cooperation throughout the procedure.
12. Prepare the client.
a. Prior to performing the This ensures that the right client receives
procedure, introduce self and the right medication.
verify the client’s identity.
b. Explain the purpose of the Explaining the procedure allays anxiety
medication and how it will and enhance cooperation of client during
help, using language that the injection.
client can understand. Include
relevant information about Information can facilitate acceptance of
effects of the medication. and compliance with the therapy.
c. Assist the client to a position A relaxed position of the site minimizes
in which the arm, leg, or discomfort.
abdomen can be relaxed,
depending on the site to be
used.
13. Select and clean the site.
a. Select a site free of tenderness, These conditions could hinder the
swelling, scarring, itching, absorption of the medication and may also
burning, or localized increase the likelihood of injury and
inflammation. Select a site that discomfort at the injection site.
has not been used frequently.
b. Apply clean gloves. to avoid contaminating the nurse from
liquid medications used and fluids from
client.
BARTOLABA, LYCA R.

c. Locate the exact site for the To ensure patient safety while
injection. administering the medication and to
administer medications properly.
d. As the agency protocol The mechanical action of swabbing
indicates, clean the site with an removes skin secretions, which contain
antiseptic swab. Start at the microorganisms.
center of the site and clean in a
widening circle to about 5cm
(2 inches). Allow the area to
dry thoroughly.
e. Place and hold the swab/cotton Using this technique keeps the swab or
balls with alcohol between the cotton ball with alcohol readily accessible
third and fourth fingers of the when the needle is withdrawn.
nondominant hand, or position
the swab on the client’s skin
above the intended site.
14. Prepare the syringe for injection. The needle will become contaminated if it
a. Remove the needle cap while touches anything but the inside of the cap
waiting for the antiseptic to is sterile.
dry. Pull the cap straight off to
avoid contaminating the needle
by the outside edge of the cap.
15. Inject the medication.
a. Grasp the syringe in your This is to properly administer the
dominant hand by holding it medications on the subcutaneous tissues
between your thumb and and needle won’t go beyond it and
fingers. With palm facing to damaging or irritating other tissues.
the side or upward for a 450
angle insertion, or with the
palm downward for a 900 angle
insertion, prepare to inject.
b. Using the nondominant hand, *Recommendations vary about whether to
pinch or spread the skin at the pinch or spread the skin and at what angle
site, and insert the needle using to administer subcutaneous injections. The
the dominant hand and a firm most important consideration is the depth
steady push. of the subcutaneous tissue in the area to
be injected. If the client has more than ½
inch of adipose tissue in the injection site,
it would be safe to administer the injection
at a 900 angle with skin spread. If the
client is thin or lean and lacks adipose
tissue, the subcutaneous injection should
given with the skin pinched and at a 450 to
600 angle.
*One way to check that the pinch of skin
is subcutaneous tissue is to ask the client
BARTOLABA, LYCA R.

to flex and extend the elbow. If any

muscle is being held in the pinch, you will
feel it contract and relax. If so, release the
pinch and try again.
c. When the needle is inserted, This is to easily hold the needle and the
move your nondominant hand syringe steadily and facilitate injection of
to the end of the plunger. Some fluids smoothly on the subcutaneous
nurses find it easier to move tissues.
the nondominant hand to the
barrel of the syringe and the
dominant hand to the end of
the plunger.
d. Inject the medication by Holding the syringe steady and injecting
holding the syringe steady and the medication at an even pressure
depressing the plunger with a minimizes discomfort for the client.
slow, even pressure.
*It is recommended that with
many subcutaneous injections,
especially insulin, the needle
should be embedded within the
skin for 5 seconds after complete
depression of the plunger to ensure
complete delivery of the dose.
16. Remove the needle.
a. Remove the needle smoothly, Depressing the skin places countertraction
pulling along the line of on it and minimizes the client’s
insertion while depressing the discomfort when the needle is withdrawn.
skin with your nondominant
hand.
b. If bleeding occurs, apply Applying pressure on the bleeding site
pressure to the site with dry makes the bleeding stop.
sterile gauze until it stops.
Bleeding rarely occurs after
subcutaneous injection.
17. Dispose of supplies appropriately. Proper disposal protects the nurse and
a. Activate the needle safety others from injury and contamination. The
device or discard the uncapped CDC recommends not capping the needle
needle and put syringe into before disposal to reduce the risk of
designated receptacles. needlestick injuries.
b. Remove and discard gloves For infection control.
18. Perform hand hygiene. For infection control.
19. Do after care. To avoid unnecessary injuries such as
needle-stick injury and cross
contamination.
20. Assess the effectiveness of the To makes sure that the medication is
medication at the time it is suitable to the patient.
BARTOLABA, LYCA R.

expected to act and document it.

EVALUATION The patient will need to be evaluated for
21. Conduct appropriate follow-up therapeutic and adverse effects of the
such as desired effect, any adverse medication or solution.
effects and clinical signs of side
effects.
22. Relate to previous findings if To know the if there are adverse or
available. therapeutic reaction of the medicine that
occurs to the patient.
23. Report deviations from normal to To apply necessary interventions needed
the primary care provider. by the patient.
DOCUMENTATION
24. Some medications require Proper documentation helps ensure patient
documentation of lot numbers per safety.
agency policy
25. Document the medication given,
dosage, time, route and any
assessments and your signature.
26. Do not document before giving the
drug; do not document for anyone
else; do not ask another nurse to
document a drug you have given.
27. Chart any therapeutic or adverse
effects of the medication.
28. If the client is unable or refuses to
take the medication, document on
the MAR that the medication was
not administered, along with the
reason, and inform the physician.
BARTOLABA, LYCA R.

RETURN DEMONSTRATION EVALUATION TOOL FOR:

INTRADERMAL INJECTION

Name: _____________________________________ Grade: _____________

Time started:____________ Time ended:________Date of RD:________________________

RATING COMMENTS
AREA FOR EVALUATION
5 4 3 2 1 0
SKILLS (35%)
ASSESSMENT
Assesses
1. Allergies to medication
2. Specific drug action, side effects
and adverse reactions
3. Client’s knowledge and learning
needs about the medication
4. Status and appearance of
subcutaneous site for lesions,
erythema, swelling, ecchymosis,
inflammation and tissue damage
from previous injections
5. Ability of client to cooperate
during the injection.
6. Previous injection site used.
PLANNING
7. Determine the appropriate size of
needle and syringe to be used.
IMPLEMENTATION
Preparation of the drug:
1. Checks the label on the
medication carefully against the
MAR.
2. Follows the three checks for
administering medications
3. Organizes the equipment.
Performance
4. Performs hand hygiene and
observes other appropriate
infection prevention procedures.
5. Prepare the medication from the
ampule or vial for drug
withdrawal.
BARTOLABA, LYCA R.

Ampule:
a. Flicks the upper stem of the
ampule several times with a
fingernail.
b. Uses an ampule opener or places a
piece of sterile gauze or alcohol
wipe between your thumb and the
ampule neck or around the
ampule neck, and breaks off the
top by bending it toward you to
ensure the ampule is broken away
from yourself and away from
others.
c. Disposes of the top of the ampule
in the sharps container.
d. Withdraws the medication.
- Places the ampule on a flat
surface.
- Attaches the fwithdrawing
needle to the syringe.
- Removes the cap from the
needle and inserted the
needle into the center of
the ampule. Did not touch
the rim of the ampule with
needle tip or shaft.
e. Replaces the withdrawing needle
with a regular needle, tighten the
cap at the hub of the needle, and
push solution into the needle to
the prescribed amount.
f. Disposes the withdrawing needle
by placing in a sharp containers.
Vials
a. Attaches withdrawing needle, to
draw up premixed liquid
medications from multidose vials.
b. Ensures that the needle is firmly
attached to the syringe.
c. Removes the cap from the needle,
then draw up into the syringe the
amount of air equal to the volume
of the medication to be
withdrawn.
d. Inserts the needle into the upright
vial through the center of the
BARTOLABA, LYCA R.

rubber cap (maintaining the

sterility of the needle).
e. Injects air into the vial, keeping
the bevel of the needle above the
surface of the medication.
f. Withdraws the prescribed amount
of medication using either of the
following methods:
Method 1:
Holds the vial down (i.e. with the base
lower than the top), move the needle tip
so that it is below the fluid level, and
withdraw the medication. Avoid drawing
up the last drops of the vial.

Method 2:
Inverts the vial, ensure the needle tip is
below the fluid level, and gradually
withdraw the medication
g. Holds the syringe and vial at eye
level to determine that the correct
dosage of drug is drawn into the
syringe. Eject air remaining at the
top of the syringe into the vial.
h. Withdraws the needle from the
vial, and replace the cap over the
needle using the scoop method,
thus maintaining its sterility.
i. Taps the syringe barrel to
dislodge any air bubbles present
in the syringe.
j. Replaces the withdrawing needle,
if used, with a regular needle of
the correct gauge and length.
Eject air from the new needle and
verify correct medication volume
before injecting the client.
6. Provides client privacy.

7. Introduces self and verify the

client’s identity.
8. Explains the purpose of the
medication and how it will help,
using language that the client can
understand. Included relevant
information about effects of the
BARTOLABA, LYCA R.

medication.
9. Assisst the client to a position in
which the arm, leg, or abdomen
can be relaxed, depending on the
site to be used.
10. Selects a site free of tenderness,
swelling, scarring, itching,
burning, or localized
inflammation. Selects a site that
has not been used frequently.
11. Applies clean gloves.
12. Cleans the site with an antiseptic
swab. Starting at the center of the
site and clean in a widening circle
to about 5cm (2 inches). Allows
the area to dry thoroughly.
13. Places and holds the swab/cotton
balls with alcohol between the
third and fourth fingers of the
nondominant hand, or position the
swab on the client’s skin above
the intended site.
14. Removes the needle cap while
waiting for the antiseptic to dry.
Pulls the cap straight off to avoid
contaminating the needle by the
outside edge of the cap.
15. Grasps the syringe with the
dominant hand by holding it
between your thumb and fingers.
With palm facing to the side or
upward for a 450 angle insertion,
or with the palm downward for a
900 angle insertion, prepare to
inject.
16. Using the nondominant hand,
pinches or spreads the skin at the
site, and insert the needle using
the dominant hand and a firm
steady push.
17. When the needle is inserted,
moves the nondominant hand to
the end of the plunger.
18. Injects the medication by holding
the syringe steady and depressing
the plunger with a slow, even
BARTOLABA, LYCA R.

pressure.
19. Removes the needle smoothly,
pulling along the line of insertion
while depressing the skin with
nondominant hand.
20. If bleeding occurs, apply pressure
to the site with dry sterile gauze
until it stops. Bleeding rarely
occurs after subcutaneous
injection.
29. Performs hand hygiene.
30. Does after care.
31. Assesses the effectiveness of the
medication at the time it is
expected to act and document it.
EVALUATION
32. Conducts appropriate follow-up
such as desired effect, any adverse
effects and clinical signs of side
effects.
21. Relates to previous findings if
available.
22. Reports deviations from normal to
the primary care provider.
DOCUMENTATION
23. Some medications require
documentation of lot numbers per
agency policy.
24. Documents the medication given,
dosage, time, route and any
assessments and your signature.
33. Charts any therapeutic or adverse
effects of the medication.
34. If the client is unable or refuses to
take the medication, document on
the MAR that the medication was
not administered, along with the
reason, and inform the physician.
KNOWLEDGE (15%)
1. Gives rationale of the procedure.
2. Explains the elements and
mechanics of the procedure.
3. Knows the elements of nursing
process as applied
4. States Principles applied in the
BARTOLABA, LYCA R.

procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________

Clinical Instructor’s signature: ____________________________________