Subcutaneous injections

Seite 1

Before you start

Make sure you know the following about the medication:

What is the medication?

Why is the patient having it?

What is the normal dose?

Do you know the general side effects

Are there any precautions/contra-indications?

How do you give it? Over what time/rate?

Check prescription is correct on patient's drug chart

Check allergy status is recorded on drug chart

Be able to tell patient what you intend to do and why

Be able to discuss risks and benefits of the procedure

Understand how to gain informed consent

Introduction

1. Wash hands

2. Introduce yourself to patient

"Hi, I'm Aleda and I'm a 3rd year medical student"

3. Confirm 3 point of identification

Name, DOB, NHS Number

4. Ask about allergies

"Do you have any allergies?"

5. Check past medical history, symptoms and previous exposure

"Do you have any medical conditions or past procedures I should know about?"

"Are you on any current medications?"

Be aware of clotting disorders/use of anti-coagulants

"Have you had a SC injection before?"

"Are you currently feeling well?"

6. Explain the procedure

"I'm going to provide a dose of medication into the tissue just under your skin using a small needle. This may be slightly uncomfortable, you will feel a sharp scratch but it shouldn't be painful."

Indications for SC

Pt unable to take oral meds

Meds unavailable in oral form

Rapid action not required

Meds altered by intestinal secretions

Meds not absorbed in GI system

7. Explain risks and how you will avoid these happening

Side effects of meds

Infection

Handwashing

Observe ANTT

PPE

Adverse reaction/allergy

Asked about allergies

Monitor patient

Pain = Sharp scratch

Inject slowly

Stop if increased level of pain

Won't massage area post insertion

Bleeding & bruising

Use of appropriate injection site and needle

8. Assess patient's understanding

"Do you understand everything I've just said to you?"

"Would you feel comfortable repeating it back to me in your own words?"

9. Gain consent

"Are you happy to go ahead with the procedure?"

Seite 2

Equipment

PPE (Gloves & apron)

Equipment tray & trolley

Patient's prescription

Medication (Checked)

Blunt filter/drawing up needle

Injecting needle

Orange = Longer

Brown = Shorter

Length depends on patient & site of injection

Syringe - Smallest syringe that will accomodate medication volume

Gauze/cotton swab

Sharps bin

Seite 3

The 7 Rights

Right person

Check the patient/patient's wristband against the name on the prescription

If possible use 2 identifiers (patient & the wristband)

Right drug

Check labelled drug against prescription

Check expiry date

Right dose

Check against prescription

Right time

Confirm when last dose was given

Right route

Right to refuse

Ensure patient has consented

Right documentation of prescription & allergies

Does patient have any allergies?

Seite 4

Administering a SC injection

1. Wash hands

2. Don gloves

3. Draw up required amount of appropriate medication into syringe using drawing up needle

4. Remove drawing up needle & dispose of it into sharps bin

5. Open injection needle and attach it to syringe using ANTT

6. Choose an appropriate injection site

Lower abdomen

Preferred for low molecular weight heparin injections

Lateral aspect of upper arm

Lateral aspect of upper thigh

Upper buttock

Consider:

Size of the patient

Muscle bulk

The position & mobility of the patient

Previous subcutaneous injections

Ask the patient if they have frequent subcutaneous injections - if so, rotate sites

If multiple injections are given, use diff sites for each subsequent injection

DO NOT use a site that is inflamed, red, bruised or scarred.

7. Expose the skin at the selected site & position the patient to provide optimal access to the site

8. Clean the area if necessary using a alcohol wipe or soap & water if visibly soiled

9. Pull back orange safety cap & expose needle

10. Pinch subcutaneous tissue

11. Insert needle at 45-90 degree angle with bevel facing upwards, aiming to stay in subcutaneous layer

Angle depends on patient's BMI & size of needle

"SHARP SCRATCH"

DO NOT aspirate

12. Slowly administer med

13. Gently remove needle while maintaining pinch

14. Release pinch & place cotton wool on site

DO NOT rub the site

Check for bruising & bleeding

15. Make needle safe on hard surface and dispose of in sharps bin

16. Ensure patient is decent before leaving bed

17. Dispose of all waste appropriately

Seite 5

Completing the procedure

Thank patient

Wash hands

Provide aftercare advice

"It may be sore for 1-2 days, but this is normal"

"If there's any swelling, redness or pain, they should alert a member of staff"

Inform relevant staff that medication has been given

Documentation

Sign the patient's drug chart