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Subcutaneous Injections. NURS128 Instructor: Marilyn Gilbert Winter: 2006 Thank you to Sherrie Bade and Susan Ross and Laura Ford. Routes of Medication Administration. Parenteral medication: administration of a medication by injection into body tissues

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Subcutaneous injections l.jpg
Subcutaneous Injections

NURS128

Instructor: Marilyn Gilbert

Winter: 2006

Thank you to Sherrie Bade and Susan Ross and Laura Ford


Routes of medication administration l.jpg
Routes of Medication Administration

  • Parenteral medication: administration of a medication by injection into body tissues

    • Subcutaneous (SC) – into tissue below dermis of skin

    • Intramuscular (IM) – into the body muscle

    • Intravenous (IV) – into a vein

    • Intradermal (ID)– into the dermis just under the epidermis

    • Can you give examples of above?


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Syringes

  • Three main parts:

    • Barrel – chamber that holds the medication

    • Plunger – part within the barrel that moves back and forth to withdraw and instill medication

    • Tip – part that the needle is attached to

  • Calibration:

    • Syringe sizes from 1 ml to 50 ml

    • Measure to a 1/10th or 1/100th depending on calibration


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Needles

  • Shaft of the needle

    • Length 3/8th of an inch – 1 ½ inches

    • Length chosen depends on the depth to which medication will be instilled

    • Tip of shaft is beveled or slanted to pierce the skin more easily

  • Gauge: width of the needle (18 – 27 gauge) – a smaller number indicates a larger diameter and larger lumen inside the needle


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Considerations when choosing a syringe and needle

  • Type of medication

  • Depth of tissue penetration required

  • Volume of medication

  • Viscosity of medication

  • Size of the client


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Asepsis: Sterile technique

  • Sterile technique: method of creating and maintaining an area free of all pathogens (microorganisms; spores)

  • Used for all parenteral injections including subcutaneous injections

  • The primary purpose of asepsis for injections is to prevent infection


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Asepsis related to the syringe and needle

  • Follow principles to keep needle and syringe parts sterile:

    • Shaft of the needle

    • Inside the hub of the needle

    • Tip of the syringe

    • Inside the barrel of the syringe

    • The part of the plunger entering the barrel of the syringe


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Asepsis of Medication Containers

  • Vials: have a rubber stopper are glass or plastic - single and multidose

    • Must be cleansed with alcohol prior to inserting needle through it

    • Self sealing when needle withdrawn

    • Date outside of container when first used

  • Ampoules: glass and plastic – narrow neck that is broken – single dose

    • Neck cleansed with alcohol and broken away from you

    • Needle inserted only into opening into ampoule


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Assessments prior to administration of subcutaneous injection

  • Use Clinical Decision Making (CDM) process:

    • Assessment – collect data (follow with analysis & synthesis of data).

    • Planning – what actions to take?

    • Implementation – carry out actions/ interventions.

    • Evaluation – did the interventions work?


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Pharmacokinetics injection

  • The study of how drugs:

    • Enter the body- absorption

    • Reach their site of action-distribution

    • Are metabolized-metabolism

    • Exit the body-excretion

  • Pharmacokinetics necessary influences:

    • Choice of medications for a specific client

    • Timing of drug administration

    • Selection of route for administration


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Dosage Calculations injection

  • Dose Ordered X Unit/Volume = Amount

  • Dose Available (ml, tab, cap) to give

  • D/A X unit= dose to give


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The 7 Rights of Drug Administration injection

  • Right client

  • Right medication

  • Right dose

  • Right route

  • Right time

  • Right reason

  • Right documentation


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Administration of Medication injection

  • Wash hands

  • Compare MAR with order or note RN initials present indicating order checked

  • Three checks of client name, allergies, date and time and medication

  • Calculate correct dose

  • PREPARE MEDICATION

  • Confirm right client by checking name band, asking to state name or alternatives depending on agency

  • Document on MAR [document on chart if needed]


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Preparing Medication: Withdrawing from an Ampoule injection

  • Tap top of ampoule to move liquid down

  • Place alcohol pad around neck of ampoule

  • Snap neck of ampoule away from you

  • Insert needle into opening – may hold upside down or on a flat service but keep needle tip under liquid

  • Remove needle – tap syringe remove air bubbles – establish dosage – may have to discard some med in sink

  • Put cap back on needle ( only cap a needle that has not been used) NEVER RECAP A USED NEEDLE


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Preparing Medication: Withdrawing from a Vial injection

  • Select appropriate syringe and needle

  • Remove cover from rubber stopper

  • Clean a pre-opened vial by swabbing it firmly with an alcohol swab - circular motion from inside to outside

  • Fill syringe with volume of air equal to volume to be withdrawn from vial

  • Insert needle – invert vial and hold/brace it while pulling on end of plunger

  • Tap barrel to remove air

  • Push on plunger to move medication to tip of needle

  • Replace cap


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Insulin injection

  • A hormone – regulates glucose metabolism - only given parenterally (SC, IV)

  • Prescribed in units – insulin syringe calibrated in units (100 u/ml) 100 units = 1ml or 100units=1cc

  • Two sizes of syringes

    • 0.5 ml = 50 units

    • 1.0 ml = 100 units

  • Clients generally require one or more injections daily

  • Blood glucose monitoring (BGM) – A ‘normal’ range is 4 - 7


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Insulins: injection

  • Rapid-acting:

    • Humalog: Onset – 5 minutes, Peak – 1 hour, Duration – 2-4 hours

    • Regular (Humulin R – clear): Onset – 1 hour, Peak – 2-4 hours, Duration – 5-7 hours

      - Regular insulin is CLEAR

  • Intermediate-acting:

    • NPH (Humulin N – cloudy): Onset – 1 – 2.5 hours, Peak – 6-12 hours, Duration – 18-24 hours


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Insulins: injection

  • Long-acting Insulin (cloudy):

    • Ultralente: Onset – 4-8 hours, Peak – 12-20 hours, Duration – 24-48 hours

    • Mixed Insulins:

      • 30/70 most usual one

      • 20/80

      • 50/50

        Onset – 30-60 minutes then 1-2 hours, Peak – 2-4 hours then 6-12 hours, Duration – 6-8 hours then 18-24 hours


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Mixing Insulins injection

  • Roll cloudy vial to mix

  • Cleanse rubber stoppers of both vials of insulin

  • Instill an amount of air equal to the volume that will be withdrawn from the cloudy vial

  • Repeat with clear insulin and withdraw required amount

  • Pierce cloudy vial – withdraw required units

  • Always CLEAR before CLOUDY


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To Ensure Safe Drug Administration injection

  • Focus: Don’t carry on a conversation

  • Always Check physician orders for insulin in patient`s chart

  • If uncertain ALWAYS check PRIOR to administration of a drug

  • Check for client allergies

  • Keep medications within your sight at all times

  • Withhold a medication if client demonstrating an undesirable reaction – Report and Record this

  • Record drug administration as soon as possible after medication administration

  • If an error is made, record it IMMEDIATELY so measures may be taken to minimize effects of the error – an agency incident report and TRU incident report filled out


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Injection technique for SC injection

  • Locate site for injection

  • Cleanse with an alcohol swab cleaning from center outward in a circular motion – 5 cm

    (2 in) circle

  • Clean gloves

  • Pinch up skin or spread taut depending on site and size of client

  • Dart needle quickly and firmly into tissue at either a 45° or 90° angle – stabilize by resting hand doing injection on skin surface

  • Inject medication

  • Withdraw needle quickly and immediately into sharps container – DO NOT RECAP


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Administration of controlled substances i.e. narcotics injection

  • All narcotics in locked cabinet – RN carries keys

  • When narcotic taken from cabinet documentation on ledger of:

    • Client’s name and Dr.’s name

    • Time taken from cabinet

    • The count of drug remaining

    • Signature of nurse administering – cosign for wastage

  • At change of shift oncoming and nurse completing shift do a count of all controlled substances in locked cabinet

  • Any drug discrepancies are reported immediately


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Common Medication Errors injection

  • Errors in mathematical calculation of doses – check decimal point

  • Incorrect reading of labels on medications

  • Lack of knowledge about med administered

  • Failure to properly identify client before administering med or failure to listen to client – double check when a client raises questions about a medication

  • Administration of medications without critically thinking ( CT)


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