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Subcutaneous Administration

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By Paul Martin, BSN, R.N.

Subcutaneous administration or subcutaneous injection is a method of delivering medication into the tissue layer between the skin and the muscle. This technique is commonly used for medications that require slow, sustained absorption, providing a convenient and effective means of drug delivery for various conditions.

Table of Contents

What is a Subcutaneous Administration?

Subcutaneous administration (also known as “SubQ”) involves the injection of medication into the subcutaneous tissue, which is the layer of fat and connective tissue just beneath the skin. This method allows for the gradual absorption of the medication into the bloodstream, making it suitable for drugs that need to be released slowly over time. It is less invasive than intramuscular or intravenous injections and can often be performed by patients independently at home.

Advantages

Subcutaneous injections are advantageous due to the following:

  • Easy to administer. SubQ injections are relatively easy to administer, making them suitable for home use and self-administration by patients.
  • Slower Absorption. Provides a slow and steady release of medication, which is beneficial for drugs that need to be absorbed gradually.
  • Decreased Pain. Generally less painful than intramuscular injections as it avoids deeper muscle tissues.
  • Cost-effective. Typically less expensive compared to intravenous routes. It lessens the need for healthcare resources and professional administration.

Disadvantages

While subcutaneous injections have many benefits, it’s important to consider factors that may affect their use in certain situations.

  • Limited Dosage. Only small volumes (up to 1-2 ml) can be administered, which limits the dosage.
  • Delayed Onset. Medications typically take longer to produce effects compared to intravenous injections.
  • Potential for tissue damage. Improper technique can lead to tissue damage, including lipodystrophy or localized infection.
  • Absorption Variability. Absorption rates can vary based on the site of injection, temperature, and patient’s body composition.

Indications

Subcutaneous administration is indicated for a variety of medications and conditions:

  • Diabetes Management. Insulin and GLP-1 receptor agonists.
  • Anticoagulation Therapy. Heparin and low-molecular-weight heparins.
  • Hormone Replacement. Growth hormone, certain contraceptives.
  • Vaccinations. Some vaccines require subcutaneous administration.
  • Biologics and Monoclonal Antibodies. Used in chronic conditions such as rheumatoid arthritis or psoriasis.
  • Pain Management. Certain analgesics and palliative care medications.

Common Injection Sites

The choice of injection site can influence the absorption rate and patient comfort:

  • Abdomen. The area around the belly button, avoiding a 2-inch radius. This site is commonly used for insulin and anticoagulants.
  • Thighs. The front or outer part of the thigh. Suitable for self-administration.
  • Upper Arms. The outer part of the upper arm. Often used for vaccinations and hormone injections.
  • Buttocks. The upper outer quadrant of the buttocks. Used for larger volume injections or when other sites are not suitable.

Side Effects

While generally safe, subcutaneous injections can have side effects:

  • Local Reactions such as redness, swelling, and pain at the injection site.These are common and usually mild, resulting from the injection process itself.
  • Risk of localized infection at the injection site. Proper aseptic technique is needed to minimize this risk.
  • Lipodystrophy (fat tissue changes, including lumps or dents at the injection site). Rotating injection sites helps prevent this condition.
  • Allergic Reactions. Rare but possible reactions to the medication or its components.

How to Administer Subcutaneous Injection?

Nurses can achieve safe and effective subcutaneous injections by following these steps:

1. Wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer. Decreases the risk of infection.

2. Collect all necessary supplies and equipment:

  • Medication: Correct dosage as prescribed.
  • Syringe: Appropriate size (usually 1 mL or 3 mL).
  • Needle: Typically 25 to 30 gauge, 3/8 to 5/8 inch.
  • Alcohol Swabs: For cleaning the injection site.
  • Gauze Pad: To apply pressure after injection.
  • Sharps Container: For safe disposal of needles and syringes.
  • Gloves: To maintain aseptic technique.

3. Verify medication order. This ensures that the right patient receives the right medication.

4. Draw the prescribed amount of medication into the syringe, making sure there are no air bubbles. Accurate dosage ensures effective treatment and minimizes adverse effects.

5. Choose an appropriate injection site (e.g., abdomen, thigh, upper arm). Select a site that has not been used often.
Decreases the risk of tissue damage and allows consistent medication absorption.

6. Cleanse the site with an antiseptic swab and wait for complete drying of the area. Minimize the risk of infection and ensure aseptic technique during subcutaneous injections.

7. Explain the procedure to the patient, ensure they are comfortable, and position them appropriately. Increases patient understanding, cooperation, and comfort.

8. Select the appropriate needle gauge (25-30 gauge) and length (3/8 to 5/8 inch), and use a suitable syringe size (1 mL or 3 mL). Ensures proper delivery of the medication and minimizes discomfort.

9. Use the nondominant hand to pinch or spread the skin at the site. With the dominant hand, insert the needle at a 90-degree angle for patients with more than 5 cm of adipose tissue, or at a 45- to 60-degree angle for lean patients with less adipose tissue. Ensures the medication is delivered into the subcutaneous tissue for proper absorption.

10. Inject the medication with steady, even pressure while keeping the syringe stable. Keeping the syringe steady and applying even pressure while injecting helps alleviate the patient’s discomfort.

11. Remove the needle quickly and apply gentle pressure to the injection site with a gauze pad. Do not massage the site. Minimizes bleeding and promotes comfort.

12. Place the needle and syringe in a sharps container. Prevents needlestick injuries and ensures safe disposal.

13. Record the medication, dose, site, time of administration, and any patient observations. Timely recording enhances patient safety.

14. Observe the patient for any immediate adverse reactions. Allows for prompt intervention if necessary.

Nursing Considerations

Following these guidelines provides a safe and effective subcutaneous injection administration:

1. Examine the skin for any signs of infection, bruising, or other abnormalities before choosing an injection site. Injecting into compromised skin can increase the risk of infection and further tissue damage. Choosing a healthy site ensures safer administration.

2. Choose a site on the abdomen at least 5-10 cm away from the umbilicus and above the level of the iliac crests. This will minimize the risk of bleeding or accidental medication administration into the umbilical veins.

3. Do not aspirate during subcutaneous injection. Aspiration is not advisable in subcutaneous injections because it can cause tissue damage and discomfort. Subcutaneous tissue lacks large blood vessels, so the risk of injecting into a blood vessel is minimal.

4. Allow the refrigerated medication to sit at room temperature for 15-30 minutes before proceeding with a subcutaneous injection. Promotes patient’s comfort and helps prevent vasoconstriction, which can affect the absorption of the medication and increase discomfort at the injection site.

5. Rotate injection sites to prevent tissue damage and ensure consistent absorption. Repeated use of the same site can cause lipodystrophy, which can interfere with medication absorption and cause discomfort. Rotating sites helps maintain tissue integrity and absorption rates.

Sources and References

Paul Martin R.N. brings his wealth of experience from five years as a medical-surgical nurse to his role as a nursing instructor and writer for Nurseslabs, where he shares his expertise in nursing management, emergency care, critical care, infection control, and public health to help students and nurses become the best version of themselves and elevate the nursing profession.

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