Sub Q injections - Exam notes PDF

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Injections: Subcutaneous 1. Prepare medications in a No Interruption Zone according to facility policy. Obtain the medication. Verify that the label of the medication matches the medication administration record (MAR), perform any dosage calculation, and check the expiration date of the medication: a. If using an automated dispensing system, enter the appropriate information, and remove the medication. Verify the correct dose. b. If using bar coding, scan the MAR and medication. Verify the correct dose. c. If using a medication cart, unlock the cart, locate the correct patient drawer, remove the medication, and verify the correct dose. Avoid possible medication errors by adhering to the Six Rights of Medication Administration and by checking the medication with the MAR three times. 2. Perform hand hygiene. Frequent hand hygiene prevents the spread of microorganisms. 3. Check the medication label against the MAR a second time. Verify that the correct medication and dosage have been obtained, and draw up the medication in an appropriate syringe with an appropriate needle (see Skill 35-3). a. An appropriate fluid amount is 0.5 to 1 mL. b. Some syringes are prefilled (multidose-unit pens) (see the Nursing Care Guideline: Medication Administration With Multidose Insulin Pens box). Avoids possible medication errors by adhering to the Six Rights of Medication Administration and by checking the medication with the MAR three times. 4. Assess the patient's knowledge, and educate the patient about the procedure as needed. Communication with the patient eases anxiety and facilitates cooperation. 5. Perform premedication assessments as indicated. Evaluation of the patient before administering medication promotes safe, quality patient care and provides baseline assessment data to evaluate the effectiveness of the medication and interventions.

6. If using bar coding, scan the medication and the patient identification. Enter pertinent information. Recheck the label on the medication with the MAR a third time before returning the medication to its storage place or before opening the package at the bedside. Avoid possible medication errors by adhering to the Six Rights of Medication Administration and by checking the medication with the MAR three times. 7. Determine an appropriate injection site: a. Does the medication require that a specific injection site be used? b. Should the injection site be rotated on a schedule? c. Assess the skin and tissue of the selected site to be sure the site is acceptable.

d. Allow patient choice or input if possible. Some medications absorb better in certain sites. The injection sites for routine medications are rotated to prevent tissue damage. Obvious skin or tissue integrity issues such as scars, moles, or rashes require avoidance of the site. Permitting patient input promotes compliance and gives the patient control. 8. Site locations, beginning with the most common (see Figure 35-13). a. Lateral aspect of the upper arm b. Abdomen, below the costal margin to the iliac crests (avoid injections within 2 inches of the umbilicus) c. Lateral anterior thigh d. Upper ventrodorsal gluteal area e. Upper back or scapular areas Subcutaneous injection areas are not bony, muscular, or dense with nerves or blood vessels. Correct anatomic placement of the injection prevents injury. 9. Position the patient for optimal access to the chosen site. Proper patient position promotes optimal administration and technique for ultimate safe, quality care and promotes patient comfort during administration. 10. Perform hand hygiene, and apply clean gloves. Frequent hand hygiene and proper glove use prevent the spread of microorganisms. 11. Clean the site with an alcohol swab, using a circular motion that moves from the center outward 2 inches, or follow facility policies and procedures. Allow the site to air-dry. Proper antiseptic procedures should be used to prevent the spread of microorganisms. 12. Administer the injection: a. Have the patient relax. b. Hold a piece of gauze in the third and fourth fingers of the nondominant hand. c. Pull the needle cap straight off, and set the cap aside. d. Hold the syringe as you would a pen or dart, with the thumb and tips of one or two (forefinger and middle) fingers of the dominant hand and with the palm of the hand directed downward. . Pinch or stretch the tissue at the site with the nondominant hand. f. Insert the needle quickly, with the bevel up at a 45- to 90-degree angle. The nondominant hand releases the pinched tissue and stabilizes the syringe. g. Use the dominant hand to slowly depress the plunger and inject the medication. Relaxing the muscles facilitates injection into the subcutaneous tissue rather than inadvertent injection into muscle. Proper technique promotes minimal discomfort and easy manipulation of supplies. Taking proper precaution to remove the needle cap prevents the spread of microorganisms. Pinching the skin allows smooth injection. Keeping the bevel up and using the appropriate needle angle promote proper medication administration into subcutaneous tissue rather than into muscle (avoiding possible errors) and promote safe, quality patient care.

13. Perform the following steps in quick succession: a. With the dominant hand, withdraw the syringe. b. With the dominant hand, activate the needle safety protection device. c. With the nondominant hand, apply the gauze and slight pressure to the site; do not massage the site. d. Apply an adhesive bandage as needed. Following this procedure minimizes discomfort and tissue damage. Massage can damage tissue by pushing the medication into surrounding tissues and may cause the medication to be absorbed faster than intended. The needle safety device protects caregivers from injury. 14. Dispose of the needle and syringe in a sharps container according to facility policy. Proper disposal of waste reduces the spread of microorganisms and protects caregivers from injury. 15. If the medication requires follow-up assessment, return to obtain information within an appropriate time frame. Educate the patient on the expected effect of the medication. Performing a follow-up assessment can prevent adverse effects and provides information regarding the effectiveness of the medication administered. Communication with the patient eases anxiety and facilitates cooperation....