Subcutaneous (S.C.) injections are delivered into the adipose (fatty) tissues beneath the skin. The result is a slower and more sustained drug administration than intramuscular injections. Small doses of medication less than 2 mL are given by this route. There's also less trauma to tissue and less risk of striking large blood vessels and nerves. Drugs and solutions are injected through short needles; common sites are the upper arms, anterior thigh, abdomen, upper hips, buttocks, and upper back. (See Subcutaneous injection sites.)
Patient's medication record and chart 
prescribed medication 25G to 27G 5/8'' to ½'' needle gloves 1- or 3-mL syringe alcohol pads.
Verify the order on the patient's medication record by checking it against the doctor's order. Also note whether the patient has any allergies, especially before the first dose.
Check the prescribed medication for color, clarity, and the expiration date. Choose equipment appropriate to the prescribed medication and injection site and make sure it works properly. Check for allergies to the medication.
If you use ampules . . .
- Perform hand hygiene.
- Wrap an alcohol pad around the ampule's neck and snap off the top, directing the force away from your body.
- Attach a filter needle to the needle and withdraw the medication.
- Tap the syringe to clear air from it.
- Before discarding the ampule, check the medication label against the patient's medication record, then discard the filter needle and the ampule.
- Attach the appropriate needle to the syringe.
But for vials . . .
- Perform hand hygiene
- Reconstitute powdered drugs according to instructions, making sure all crystals have dissolved in the solution.
- Warm the vial by rolling it between your palms to help the drug dissolve faster.
- Wipe the stopper with an alcohol pad and draw up the prescribed amount of medication.
- Read the medication label as you select the medication, as you draw it up, and after you've drawn it up to verify the correct dosage.
- Confirm the patient's identity using two patient identifiers.
- Provide privacy, explain the procedure to the patient, and perform hand hygiene.
- Select an appropriate injection site and rotate sites for repeated injections using different areas of the body unless contraindicated.
- Don gloves; position and drape the patient.
- Clean the injection site with an alcohol sponge, beginning at the center of the site and moving outward in a circular motion. Allow the skin to dry.
Grasp and lift
- Loosen the protective needle sheath. With your nondominant hand, grasp the skin around the injection site firmly to elevate the subcutaneous tissue.
- Holding the syringe in your dominant hand, insert the loosened needle sheath between the fourth and fifth fingers of your other hand while still pinching the skin around the injection site. Pull back the syringe with your dominant hand to uncover the needle.
- Position the needle with its bevel up and tell the patient he'll feel a needle prick.
- Insert the needle quickly in one motion at a 45- or 90-degree angle. (See Technique for subcutaneous injections.)
Check and inject
- Pull back the plunger slightly to check for blood return; if none appears, inject the drug slowly.
- After injection, remove the needle gently but quickly at the same angle used for insertion.
- Cover the site with an alcohol pad and apply a gauze dressing (delete massage gently); check the site for bleeding and bruising.
- Dispose of equipment according to your facility's policy.
- Never use medication that's cloudy or discolored or contains a precipitate unless the manufacturer's instructions allow it. If in doubt, check with the pharmacist.
- If blood appears on aspiration, withdraw the needle, prepare another syringe, and repeat the procedure.
- Don't aspirate for blood return when giving insulin or heparin. It isn't necessary with insulin and may cause a hematoma with heparin.
- To avoid needlestick injuries, don't resheath the needle.
Adjust for length
- When using prefilled syringes, adjust the angle and depth of insertion according to needle length.
- When combining insulins in a syringe, follow the facility's policy regarding which insulin to draw first. Remember to roll and invert the bottle gently when administering insulin.
Heparin hints
- The preferred site for heparin injection is the lower abdominal fat pad, 2'' (5 cm) beneath the umbilicus, between the right and left iliac crests.
- When injecting heparin, leave the needle in place for 10 seconds and then withdraw it; apply ice for 5 minutes if the patient bruises easily. Also, to prevent hemorrhages and bruising, don't rub or massage the site after the injection. (See Documenting subcutaneous injection.)
- If giving heparin in a prefilled syringe, do not expel the air bubble.
Outline