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Subcutaneous injection

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TOPIC :
Subcutaneous
Injection

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INTRODUCTION
The administration of subcutaneous injection is an important part of
drug administration and a common nursing...

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DEFINITION
Subcutaneous injection is administered into the
fatty layer of skin directly below the dermis and
epidermis. Su...

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Subcutaneous injection

Details about subcutaneous injection. We know about subcutaneous injection but do we know about the right information? Maybe you know, I here try to upgrade your current knowledge about the topic. Here, we discuss about the indications, contraindications, precautions, procedure, nursing care plan of subcutaneous injection, complications and many more. Feel free to learn.
Thanks

Details about subcutaneous injection. We know about subcutaneous injection but do we know about the right information? Maybe you know, I here try to upgrade your current knowledge about the topic. Here, we discuss about the indications, contraindications, precautions, procedure, nursing care plan of subcutaneous injection, complications and many more. Feel free to learn.
Thanks

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Subcutaneous injection

  1. 1. TOPIC : Subcutaneous Injection
  2. 2. INTRODUCTION The administration of subcutaneous injection is an important part of drug administration and a common nursing intervention in clinical practice. Among the different drug injection methods, subcutaneous injection is the one which is applied to the fatty layer of subcutaneous tissue just beneath the skin. As subcutaneous tissue has few blood vessels, the injected drug is diffused very slowly at a sustained rate of absorption. Therefore, it is highly effective in administering vaccines, growth hormones and insulin, which require continuous delivery at a low dose rate. It is often part of nurse’s role to administer medicine and educate the patient in injection technique. A skilled injection technique can make the patients experience less painful and avoid unnecessary complications. Giving a subcutaneous injection safely is considered to be a routine nursing activity. However, it requires knowledge of anatomy and physiology, psychology, communication skills and practical expertise.
  3. 3. DEFINITION Subcutaneous injection is administered into the fatty layer of skin directly below the dermis and epidermis. Subcutaneous injections are highly effective in administering vaccines such as measles, mumps, rubella and medications such as insulin, morphine, di-acetyl morphine and goserelin.
  4. 4. TYPES OF SYRINGE FOR SUBCUTANEOUS INJECTION Two types of syringe : I. Insulin syringe: This holds maximum of 1 ml of medicine . The syringe has markings from 10 to 100.The marking at 100 is the same as 1 ml
  5. 5. II.TUBERCULIN SYRINGE : This syringe holds up to 1ml of medicine . It has a needle that is slightly longer than an insulin syringe . The syringe is marked every 0.1 ml.
  6. 6. NEEDLE SIZE WITH SITE AND VOLUME ACCORDING TO AGE OF PATIENTS Patient’s age Injection Site Needle size Volume of drugs Infants (Birth-1 year) • Fatty area of the thigh • 3/8 inches • 31 G 0.1 ml Toddlers (1-3 years) • Fatty area of the thigh or outer aspect of upper arm • 3/8 inches • 29-31 G 0.5 ml Children (3-11 years) • Fatty area of the thigh or outer aspect of upper arm • 5/8 inches • 28-31 G 1 ml Adolescents / adults(11years- olders) • Abdomen(abou t 2 inches away from the navel) or upper buttock • 5/8 inches • 28-31 G 0.5-1 ml
  7. 7. SITES OF SUBCUTANEOUS INJECTION:  Abdomen: At or under the level of the belly button, about 2 inches away from the navel.  Arm: Back or side of the upper arm.  Thigh: Front of the thigh.  Buttock: Imagine a line that runs across the back just above the crack between the buttocks . An injection may be given below the waist and above this line
  8. 8. INDICATIONS OF SUBCUTANEOUS INJECTION  Severe dysphagia/swallowing difficulties  Mouth, throat and esophageal lesions  Intestinal obstruction  Profound weakness  Poor absorption of oral drugs  Unacceptable number of oral medications  Unconscious patient
  9. 9. ADVANTAGES OF SUBCUTANEOUS INJECTION 1. Safe and easy route. 2. Slow and sustained absorption. 3. Self medication is possible. 4. Prolonged duration of action. 5. Foul smelling & irritating drugs can be given.
  10. 10. DISADVANTAGES OF SUBCUTANEOUS INJECTION 1. Painful 2. Skin pigmentation 3. Hypersensitivity reaction may occur. 4. Large volume of drug can not be given. 5. Discoloration of skin may occur. 6. Irritation , infection , tissue necrosis to the site of injection may occur.
  11. 11. COMPLICATIONS:  Severe pain  Redness  Swelling or bruising  Skin irritation  Thrombus formation  Pulmonary embolism  Allergic reaction  Restlessness  Tenderness  May be experience soreness or bleeding
  12. 12. PRECAUTION FOR SUBCUTANEOUS INJECTION Subcutaneous injection are inserted at 45 to 90 degree angles , depending on amount of subcutaneous tissue present and length of needle. i. Do not aspirate . It is not necessary to aspirate because the epidermis and dermis is relatively without vessels. ii. Review lab values and assessment data prior to injection. (e.g –insulin) iii. Avoid sites that are bruised, tender, hard or swollen. iv. Be careful when preparing and administering high alert medications.
  13. 13. ESSENTIAL STEPS FOR ADMINISTERING SUBCUTANEOUS INJECTION Cheek for administration rights . These are :  Right drug/Medication  Right client/Patient  Right Route  Right Dose  Right Time  Right Assessment  Right Approach
  14. 14. Continue..  Right Education  Right Prescription  Right Nurse Clinician  Right Principle of Care  Right Evaluation  Right Documentation
  15. 15. EQUIPMENT NEEDED FOR SUBCUTANEOUS INJECTION  Syringe appropriate for the medication being given.  Needle (3/8 or 5/8 inch)  Alcohol pad  Medication ampoule or vial  Disposable gloves  Kidney tray  One sterile gauze or cotton piece  One tray
  16. 16. PROCEDURE  Wash hands to minimize risk of infection to the patient.  Don gloves  Check the patient’s identification.  Position patient either sitting or lying down  Check the drug , formulation, indication, route, volume and side effects.  Assess the skin and the patient’s condition.  Prepare the patient:  Clean the area with the an alcohol pad in a spiral motion, clean outward 3 inches.  Assist the client into a comfortable position:  Relax the arm, leg, or abdomen.  Distract client by talking about an interesting subject or explaining what we are doing step by step
  17. 17. CONTINUE..  Injection Administration procedure:  Consider rotation of injection sites and assess those that are repeatedly used for injection  Hold the syringe between thumb and forefinger of dominant hand like a dart  Pinch skin with non dominant hand  Inject needle quickly and firmly (like a dart) at a 45 degree to 90 degree  Ensure the fold of skin is injected into and released only when the needle is removed .
  18. 18. CONTINUE..
  19. 19. CONTINUE..  Wait at least 10 seconds before withdrawing the needle.  Do not massage or rub the site afterwards unless otherwise indicated.  Re-assess for therapeutic effects and/or any side effects.  Assist the client to a comfortable position.  Discard the uncapped needle and syringe in a disposable needle receptacle.  Remove gloves ; wash hands.  Document accurately and appropriately.
  20. 20. NURSING CARE PLAN Nursing diagnosis Goal Nursing intervention Evaluation 1.Fear and anxiety due to administration of subcutaneous injection To reduce fear and anxiety • Explain the procedure to the patient about subcutaneous injection • Provide emotional and psychological support • Allow the time for questions and answers Gradually minimize fear and anxiety
  21. 21. Nursing diagnosis Goal Nursing intervention Evaluation 2.Risk for developing complication To prevent complication • Maintain aseptic technique during procedure • Use of disposable needle and syringe • Use the needle of appropriate size and length according to age • Maintain rotation of injection site Gradually reduce the complication
  22. 22. Nursing diagnosis Goal Nursing intervention Evaluation 3.Deficite knowledge about subcutaneous injection Provide information about subcutaneous injection to promote knowledge • Explain the patient about the procedure • Explain the importance of taking prescribed medication • Provide information of subcutaneous injection encourage to maintain cleanliness and hygiene • Provide knowledge to prevent complication Gradually demonstrate the knowledge about subcutaneous injection
  23. 23. SUMMARY The subcutaneous injection technique requires skill, knowledge and a good understanding of the indications for the injection. Although the subcutaneous route is relatively pain- free , over injection can lead to these sites being more painful. Poor injection technique can lead to adverse outcomes for the patient: site pain and bruising can occur from local tissue trauma. Rotation of sites is therefore recommended to avoid irritation, scarring of tissue and pain.
  24. 24. REFERENCE  Dr. Md. Mokbul Hossain MBBS;M phil (pharmacology), A handbook of easy pharmacology  Hunter J (2008) Subcutaneous injection technique. Nursing Standard.22,21,41-44.  In Jamieson EM, Whyte LA, McCall JM (Eds) Clinical Nursing Practices. Fifth Edition. Churchill Livingstone Elsevier, Edinburgh, 5-9.  Sherri Ogston -Tuck Senior lecturer, adult nursing, Institute of Health and Society, University of Worcester, Worcester. Correspondence to : S.ogston-tuck@worc.ac.uk  http://en.wikipedia.org/wiki/subcutaneous injection  www.healthline.com/health/SC injection
  25. 25. THANKS

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