Pediatrics – Medication: Subcutaneous Injection SECTION: 20.20

Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

PURPOSE:

To inject a prescribed medication into subcutaneous tissue between the fat and the muscle.

CONSIDERATIONS:

1. This route is commonly used for insulin, heparin, some narcotics, some chemotherapy, hormone replacement, allergy desensitization and some vaccines.

2. Common subcutaneous sites are outer aspects of arms and thighs.

3. Rotate injection sites to avoid trauma to same site.

4. Since infants and children move unexpectedly, have an extra needle available in case of contamination.

5. If the patient is a child, encourage him/her to help with the procedure by putting on the self-adhesive bandage.

6. A filter needle must be used to draw medication from an ampule and then replaced with appropriate-sized needle for injection.

7. Use at least two patient identifiers prior to administering medications.

EQUIPMENT:

Medication

Alcohol swabs/wipes

Gauze

Syringes with 24-30-gauge needles

19-gauge filter needle (optional)

Gloves

Impervious trash bag

Puncture-proof container

PROCEDURE:

1.  Adhere to Standard Precautions.

2.  Check doctor's order for dosage, frequency and route of administration.

3.  Identify the patient and explain procedure to caregiver and patient, if age appropriate.

4.  Draw medication. Recheck medication dosage.

5.  Select injection site.

6.  Clean site with alcohol swabs, cleaning center first and moving outward in circular motion.

7.  Pinch up skin gently to elevate subcutaneous tissue.

8.  Insert needle at 45-degree angle for child with little subcutaneous tissue or 90-degree angle for child with more subcutaneous tissue.

9.  Once needle is inserted, skin can be released.

10.  Inject medication.

11.  Withdraw needle. Hold gauze over site and apply pressure for a few seconds.

12.  Discard soiled supplies in appropriate containers.

AFTER CARE:

1. Encourage caregiver to comfort the patient, if necessary.

2. Utilize play opportunities to help the patient master his/her feelings about injections.

3. Document in patient's record:

a. Medication administered, dose, time, route and site.

b. Patient's response to procedure, side effects and management.

c. Instructions given to caregiver.

d.  Communication with the physician.