What is a subcutaneous

injection?
A subcutaneous injection is given in the fatty
layer of tissue just under the skin.
A subcutaneous injection into the fatty layer of
tissue (pinched up to give the injection) under the
skin.
Why are subcutaneous injections
given?
These injections are given because there is
little blood flow to fatty tissue, and the injected
medication is generally absorbed more slowly,
sometimes over 24 hours. Some medications
that can be injected subcutaneously are
growth hormone, insulin, epinephrine, and
other substances.
Preparing to give medication
Subcutaneous injections are not given if the
skin is burned, hardened,inflamed, swollen,
or damaged by a previous injection.
l. Wash your hands thoroughly. This is the
best way to prevent infection.
2. Assemble your equipment:
medication
May be a multidose vial of liquid or
may be a vial with powder that requires
reconstitution. Follow the manufac-
turers instructions as to what and how
much diluent to use. The diluent is
usually saline (a mixture of salt water)
or sterile water.
syringe and needle:
Depending on the amount of medication
to be given and the size of the child
or adult:
0.5 cc,1.0 cc, or 2 cc with 27-gauge
needle (5/8 of an inch long)
3 cc luer lock syringeused when
solution is more than 1 cc
25-gauge needle (5/8 of an inch long
or 27-gauge needle (5/8 of an inch long)
0.3 mL insulin syringes with 28-gauge
needles (1/2 inch long ) are available
for those who are visually impaired or
for those who need very small doses
of medication.
medication log
container for syringe disposal
sterile 2 x 2 -inch gauze pad
alcohol pads
Patient Information Publications
Warren Grant Magnuson Clinical Center
National Institutes of Health
1 Patient Information Publications Giving a Subcutaneous Injection
Giving a Subcutaneous Injection
Drawing up medication
1. Check the label for correct medication.
2. Remove the soft metal or plastic cap
protecting the rubber stopper of the vial.
3. If the medication vial can be used for
more than one dose, record the date and
time on the label.
4. Clean the exposed rubber stopper using
an alcohol swab.
5. Remove the syringe from the plastic or
paper cover. If necessary, attach the
needle securely.
6. Pull back and forth on the plunger by
grasping the plunger handle. Grasping the
handle end will pre-vent contamination of
the plunger shaft (which is sterile) and
help check for easy movement.
7. With the needle capped, pull back the
plunger, filling the syringe with air
equal to the amount of medication to
be administered.
8. Remove the cap covering the needle and set
it on its side to prevent contamination. Be
careful not to touch the needle. The inside
of the cap and needle is sterile, and the
needle will be covered again with this cap.
9. With the vial in an up-right position, push
the needle through the cleansed rubber
stopper on the vial. Push the needle in at
a 90 degree angle, being careful not to
bend the needle.
10. Inject the air in the syringe into the vial.
Air is injected into a multi-dose vial to
prevent a vacuum from forming. If too
little or no air is injected, withdrawing the
medication may be difficult. If too much
air is injected, the plunger may be forced
out of the barrel causing the medication
to spill.
11. Turn the vial upside down, with the needle
remaining in the vial. The needle will be
pointing upward.
12. Make sure that the tip of the needle is
completely covered by the medication.
This will make it easier to withdraw the
solution (and not air).
13. Pull back on the plunger to fill the syringe
with the correct dose of medication.
14. Keep the vial upside down, with the needle
in the vial pointed upward. Tap the syringe,
or flick it with your fingertips. This helps
move bubbles to the top of the syringe.
15. Once the bubbles are at the top of the
syringe, gently push on the plunger to force
the bubbles out of the syringe and back
into the vial.
Or, you may push all the medication
solution back into the vial, withdraw
again slowly, and repeat steps 14 and 15.
Note: It is important to eliminate large air bubbles
because they take up space needed for the medica-
tion, and they may cause pain or discomfort
when injected.
16. After removing the bubbles, check the dose
of medication in the syringe to be sure
you have drawn up the correct amount.
17. After the medication is correctly drawn
up, carefully replace the needle cap to
prevent contamination.
2 Patient Information Publications Giving a Subcutaneous Injection
Locating injection sites
Subcutaneous injections can be given in the arms, legs, or abdomen. Your nurse or doctor will
help you select the best sites to administer your medication.
1. To locate injection sites
on the arms, fold one arm
across the chest. Place your
hand on the shoulder and
draw an imaginary line
below your hand. Place
another hand on the elbow.
Draw an imaginary line
down the outer side of the
arm and down the center
front of the arm, starting
at the elbow. The area
inside these imaginary
lines is where injections
are given. (If you are
injecting yourself, imagine
the hand placement.)
2. To locate injection sites on the thighs, sit down, place
your hand above the knee, and draw an imaginary line
above it. Place your hand at the uppermost part of the
thigh and draw an imaginary line below your hand.
Draw an imaginary line down the outer side of the leg
and down the center front of the leg. The area within
these imaginary lines is where injections may be given.
3 Patient Information Publications Giving a Subcutaneous Injection
Injection sites on the thighs.
Injection sites on the side of the
arm.
Injection sites on the back of the arm.
3. To locate injection sites on the abdomen, place
your hands on the lower ribs and draw an imagi-
nary line below them. Use this area below your
hands for injections, as far around as you can
pinch up fatty tissue. Do not use a 1-inch area
around the navel.
Rotating injection sites
It is extremely important to rotate sites to keep the
skin healthy. Repeated injections in the same spot
can cause scarring and hardening of fatty tissue
that will interfere with absorption of medication.
Each injection should be about 1 inch apart. Each
injection site can be measured with a small dot
Band-Aid, providing the patient is not sensitive
to the adhesive. Start injections at the highest
point of the area and continue down toward the
point farthest away from the body (for example, upper arm down toward elbow). It is preferable
to use all sites available on one body part (arm or leg) before moving on to another. However,
some parents find that children are more accepting of injections if they are rotated from one
body part to another (arm, leg, arm, leg). Avoid giving injections in areas that are burned, red-
dened, inflamed, swollen, or damaged by prior injections.
Preparing the skin
Since the skin is the bodys first defense against
infection, it must be cleansed thoroughly
before a needle is inserted.
Cleanse the skin in a circular motion using an
alcohol swab. Begin at the center of the site
and progress outward. This motion moves
bacteria away from the injection site. Allow
the alcohol to dry completely either by air or
by using sterile 2x2 gauze.
Giving the injection
1. Take the cover off the needle. Be careful
not to contaminate the needle. Place the
cover on its side.
2. Hold the syringe in one hand like a pencil
or a dart.
3. Grasp the skin between the thumb and
index finger.
4. Quickly thrust the needle all the way into
the skin. Do not push the needle into the
skin slowly or thrust the needle into the
skin with great force. Do not press down
on the top of the plunger while piercing
the skin.
5. Insert the needle at a 90-degree (right)
angle. This angle is important to ensure
that the medications will be injected into the
fatty tissue. However, for small children,
and persons with little subcutaneous fat
on thin skin, you may be taught to use
a 45-degree angle.
4 Patient Information Publications Giving a Subcutaneous Injection
Injection sites on the abdomen
6. After the needle is completely inserted
into the skin, release the skin that you
are grasping.
7. With your free hand, grasp the syringe
near its base to stabilize it.
8. Gently pull back on the plunger and
check for the appearance of blood in the
syringe.
Note: Not all injections require you to
check for blood. Before you are dis-
charged, your nurse will let you know if
you need to do this. If you do not, then
skip down to step 10.
9. If blood appears, remove the needle, discard
it, and start over. Blood in the syringe
means that you may be in a blood vessel,
so discard the syringe with medication.
Do not inject medication into a blood
vessel: the medication is absorbed too
rapidly if it is injected there.
10. If no blood appears, inject the medication
at a slow, steady rate. Medication should
be injected within 5 seconds.
11. As the needle is pulled out of the skin,
gently press a 2x2 gauze onto the needle
insertion site. Pressure over the site while
removing the needle prevents skin from
pulling back, which may be uncomfortable.
The gauze also helps seal the punctured
tissue and prevents leakage.
12. If instructed to do so, press or rub the site
for a few seconds.
13. It is not serious if you notice blood at the
site after the needle is removed. You may
have nicked a surface blood vessel when
you injected, and blood is following the
needle track out to the surface. Simply press
the site with a 2 x 2 gauze pad. Also, a
small amount of clear fluid may appear at
the site. This may be medication that is
following the needle track to the surface.
Again, apply pressure using a 2 x 2 gauze
pad.
Safe needle disposal
Please refer to the Clinical Center pamphlet
Handling Sharp Objects Safely at Home.
5 Patient Information Publications Giving a Subcutaneous Injection
Medication
Dose
Schedule
Primary Nurse
Phone
Physician
Phone
6 Patient Information Publications Giving a Subcutaneous Injection
Where applicable, brand names of commercial
products are provided only as illustrative exam-
ples of acceptable products, and do not imply
endorsement by NIH; nor does the fact that a
particular brand name product is not identified
imply that such product is unsatisfactory.
This information is prepared specifically for
patients participating in clinical research at the
Warren Grant Magnuson Clinical Center at the
National Institutes of Health and is not neces-
sarily applicable to individuals who are patients
elsewhere. If you have questions about the
information presented here, talk to a member
of your healthcare team.
2002
National Institutes of Health
Warren Grant Magnuson Clinical Center
Bethesda, MD 20892
Questions about the Clinical Center?
OCCC@cc.nih.gov