subcutaneous injection technique

05/03/2023 © Clinical Skills Resource Centre, University of Liverpool, UK 1

Sub-cutaneous Injection Technique

Use of a multi-dose vial

Prescription SheetBefore starting

CHECK Patient Details Admission Details Allergies and Sensitivities Drug prescription is

correct and legal That the drug has not

already been given



Multi-dose Vial

Drug namePreparationConcentrationExpiry date

Metal capsurroundingrubber bung

• Select the correct drug• Check the expiry date, clarity • and integrity of the vial• When satisfied calculate the dose to be given


Calculate the amount of fluid to be drawn up

What you want X VOL the drug is in = Volume you needWhat you have got

Need to give 75mg Pethidine. You have 250mg in a 10mL ampoule. 75mg X 10mL = 3mL 250mg

Volume required for administration = 3mL

* Please see calculating drug dose study guide.


Preparation Select Required Equipment

Alcohol swab x 2 for cleaning tray and vial / ampoule

Clinically clean tray then wash hands before selecting remaining equipment

Gloves if fluids are irritant, corrosive or

cytotoxic. As per local hospital policy For administration

Vial/ampoule of required drug Gauze

to apply pressure to site if bleeding


PreparationSelect Required Equipment

WASH YOUR HANDS Sterile syringe.

size depends on the amount of fluid to be drawn up

Sterile filter needle or ‘drawing up’ needle (needs to be a sharp needle if piercing a rubber bung)

if not available no larger than a green 21 Gauge

Second sterile needle size depends upon method of

administration Check all packaging is clean

intact and within expiry date


Prior to drawing up any injection Patient Identity on prescription sheet

(This will be checked again against patient ID band before administration).

Prescription (the correct fluid/drug).

Equipment Ready (close to hand, packaging intact & clean).

Ampoule / vial drug name – many drugs have similar names, concentration, expiry date, may need to note Batch No. clarity & colour of contents

If the vial/ampoule appears discoloured, or cloudy or if particles are present, discard it and repeat with a new one and inform pharmacy.

Clean vial / ampoule with alcohol swab and allow to dry.

Prior to drawing up any injectionClean tray with appropriate solution.Wash hands.Select and open equipment and assemble

without touching key parts.Put gloves on prior to piercing the vial.Remove needle sheath (cap) in an

appropriate safe mannerDraw up solution



Drawing up - VIAL

Draw up air into the syringe (equivalent to volume to be given)

Insert unsheathed needle into vial at a 30-60o angle (to reduce coring) whilst it is stood on work surface. Avoid holding it with your other hand.

45-60°


Drawing UP - VIAL

Inject the equivalent amount of air into the vial (this is to break the internal vacuum)

Pull back on syringe plunger & withdraw fluid as required, preferably slightly in excess of the required amount to allow for removal of air

If you do not have enough fluid in the syringe you must change the needle for a clean one before drawing up more fluid. This is to minimise contamination.


Removing Air / Excess fluid When drawing up fluid from the vial/ampouleair bubbles may be present inside the syringe.

This air needs to be removed before the fluid is injected.

To minimise the risk of the needle coming off make sure it is firmly applied

Hold the syringe upright by the plunger so the air will move towards the nozzle of the syringe.

Draw back a further small amount of air into your syringe (to create a dead space for air to collect)


Removing Air / Excess fluid

Flick the syringe firmly with finger to encourage air bubbles to float towards the nozzle of the syringe.

Draw back slightly again on the plunger to remove any fluid which may now be in the hub of the needle.

Carefully depress the plunger of the syringe to expel the air from the syringe nozzle. Remember to keep the syringe nozzle upright.

The fluid should be seen entering the hub of the needle. This will give you a correct fluid level.



DO NOT SQUIRT EXCESS FLUID INTO AIR DUE TO RISK OF AEROSOL CONTAMINATION.

Any excess fluid drawn up in the syringe should be expelled gently into a procedure tray when using a multi dose vial or, if using an ampoule excess can be placed back into the ampoule.

If adept enough some people choose to leave the needle in the vial and dispel air and excess.


Dispose safely of used needle & apply correct sized needle for administration.

Do not use the sharps bin to remove the drawing up needle as it will contaminate nozzle

Needles should be an appropriate size for the route of administration and the condition, age and size of the patient


Fluid Levels

Fluid Level

This displays 9mL

05/03/2023 15© Clinical Skills Resource Centre, University of Liverpool, UK


DO NOT RESHEATH It is good practice NOT TO RESHEATH NEEDLES in

clinical areas. This reduces the risk of accidental sharps injury by clean or

‘dirty’ i.e. used needles. When the ‘drawing up’ needle is removed it should

immediately be replaced (without contaminating the nozzle of the syringe) by a clean sheathed ‘giving needle.

Following administration, the used needle should be disposed of immediately into a ‘SHARPS BIN’ (which should be beside the patient).

However…. * Clean insulin syringes are resheathed to prevent

contamination of needle in transit to the patient


Principles of administration Return to your patient- if you have prepared the injection

within the patients clinical area you only need to wear one pair of gloves for the entire procedure.

introduce yourself if you have not done so earlier Take with you

appropriate procedure tray with sharps box. Procedure tray should contain syringe with correct drug drawn up, relevant ampoule / vial, and gauze.

prescription sheet Check the patient’s identity verbally and visually, comparing

the wrist band to the prescription sheet if not done earlier Explain what you intend to do and gain informed consent Offer the patient privacy and expose the optimal available

site


Administration Choose an appropriate site based on

the type of injection (intra-dermal, sub-cut . or intramuscular)

the volume of drug to be administered Avoid sites with signs of inflammation, swelling,

open lesions and infection Rotate sites to avoid complications such as muscle

atrophy and sterile abscess from poor perfusion Administer injection


Subcutaneous (SC) injection Placed in the loose connective tissue

under the dermis. Optimum sites include vascular areas

outer aspect of the upper arms, peri-umbilical area of the abdomen anterior aspect of the thighs

Only suitable for small volumes (0.5 –1mL) of water-soluble medication

Use a 25G (orange) needle inserted at 90° degrees to the skin

Pinch up a fold of skin Depress plunger slowly and wait for 6

seconds then withdraw needle


SC Insulin injection All insulin preparations in the UK contain 100 units/mL, so

the syringe is delineated in units with no calculation required.

Generally there are 2 insulin syringes (50units and 100 units) the delineations are 1 unit for each mark in a 50 units syringe and 2 units for each mark in a 100 units syringe.

Insulin syringes have virtually no ‘dead-space’ (amount of insulin remaining in a syringe after injection is minimal).

Insulin syringes have correct sized needle pre-attached Insulin needles are micro fine to minimise pain Inject an equivalent amount of air into the vial as insulin to

make withdrawal of the fluid easier Once administered leave the needle in for 6 seconds Site should be rotated at each administration


After administration Check injection site Cover patient up (if appropriate) Dispose of all waste appropriately (see universal

precautions study guide) Wash hands Sign the prescription sheet (only after

administration) If used, return multi dose vial to refrigerator or

cupboard. In some instances may be labelled with patient’s details

and used only for that patient


DISPOSAL of WASTEOnce the correct amount of fluid has been drawn up from

the vial / ampoule, waste should be disposed of safely. Sharps Bin (Yellow Plastic Bins):

needles & syringes (as one). Glass ampoules (if separate glass container not provided)

Contaminated Clinical Waste (Yellow Bag): waste that has been or could have been in contact with patient, syringe if not attached to needle, alcohol swabs, cotton wool if

used. Domestic Waste (Black Bags, Clear bags within

University): non-contaminated waste, outer packaging of syringe & needle,

paper, plastic etc.

subcutaneous injection technique

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