home Drugs Subcutaneous injection. Injections What does it mean for subcutaneous injection

Subcutaneous injection. Injections What does it mean for subcutaneous injection

Often, medical necessity requires the introduction of drugs into the body as quickly as possible or directly into the blood. This is necessary to achieve a faster, higher-quality effect, to avoid harm and stress on the digestive system, or if it is impossible to administer the drug in other ways (for example, orally). Any doctor would say that the simplest and most effective way to use this approach is an injection - that is, the introduction of drugs into the body using a hollow needle. To many, this process will seem painful and barbaric; they will remember the unsuccessful experience of very painful injections. However, by following all the rules for vaccinations, you can save yourself from pain or unpleasant side effects.

If possible, get vaccinated in the treatment room of your clinic. If this is not possible, consult your doctor in detail about the nuances of the procedure.

People who are far from medicine or simply from going to clinics often mistakenly believe that the types of injections are limited to two: into a vein in the arm or the buttock. In fact, there are six of them, and they are classified based not at all on the place of injection:

intravenous is the most common injection that directly introduces medicine into the blood. In addition, all types of IVs are placed intravenously, with rare exceptions;
intramuscular is the most popular method of administering drugs, due to its simplicity. The injection and administration of the drug is carried out into the muscle tissue, where it is easiest to reach;
subcutaneous is a slightly more complex procedure that requires minimal concentration and skill. The needle is inserted into the subcutaneous fat layer, where there are many thin blood vessels;
intradermal - an injection that does not involve widespread distribution of the drug through the blood, for the purpose of local anesthesia or diagnostics. Not everyone can give such an injection - a very thin needle is inserted into the stratum corneum of the skin, the dosage is very strict;
intraosseous - used only in special cases (anesthesia, patients with high degrees of obesity) only by qualified personnel;
intra-arterial - an even rarer type of injection, very complex, often dangerous with complications. Performed during resuscitation efforts.

The article will describe in detail the rules of only the first three types of injections - the rest should be done only by qualified medical personnel, and the need to do them arises extremely rarely.

The most important principle of any medical procedure, including vaccinations, is sterility. Neglect or poor sanitation can often result in pathogens being introduced into, or even along with, the injection site. This not only does not contribute to recovery, but can also lead to serious complications. Therefore, before injection, the injector’s hands should be thoroughly washed, the injection site should be treated with alcohol, and the syringe and needle should be sterile (at best, disposable).

After use, be sure to throw away the syringe, needle and ampoule of the medicine, as well as the consumables used for treatment.

All types of injections have many small nuances and their own technique of execution. Unfortunately, even in hospitals, patients' comfort and health are often neglected by not following proper procedures or using the wrong needles. Below are small reminders that minimize pain and the risk of complications after common types of medical injections.

Everyone has seen scenes in feature films where characters inject something into their veins on their own. This is indeed possible, but is highly not recommended. It is unlikely that you will be able to maintain sterility and all the conditions for a high-quality intravenous injection alone, so it is worth enlisting someone’s support. In addition to the person and the medicine itself, you will need:

disposable, hermetically sealed syringe of the required volume;
sterile needle with a thickness of 0.8, 0.9 or 1.1 millimeters;
rubber venous tourniquet;
any antiseptic, cotton wool or clean rags;
optional: elbow pad, rubber gloves.

Be careful! There should be no air bubbles in the syringe at the time of drug administration!

First of all, the patient should be seated or laid down - it is not uncommon for people to lose consciousness during vaccinations from fear of pain or blood. It is recommended to place a small pillow or simply a rolled-up rag under the elbow; this will ensure fuller extension of the arm and additional comfort. Apply a tourniquet just above the shoulder (preferably on top of a clean cloth rag or clothing). We ask the patient to clench and unclench his fist, during which you can fill the syringe with the medication solution, after washing and treating your hands with an antiseptic. It is important to make sure that there is no air in the syringe and needle: to do this, squeeze a few milliliters of medicine out of the syringe, pointing it with the needle up. Afterwards, we find the most convenient place for the needle to penetrate, and slightly stretch the skin at the grafting site downwards, towards the hand. Do this with the right hand free from the syringe; it also additionally fixes the patient’s limb, clenched into a fist.

Before vaccination, try to warm the medicine to the temperature of the human body in your hands or warm water - this will reduce the discomfort from the vaccination.

We take the syringe in our hand closer to the front edge, so that the tip of the needle is at the bottom and the cut is facing up. Pressing the needle with your finger, we pierce the vein and skin at the same time, inserting the needle a third of its entire length. In this case, the needle is almost parallel to the vein itself, a deviation of several degrees is allowed. A sign that the needle has entered the vein can be its slight advancement, the appearance of blood in the syringe and direct visibility (it is permissible to slightly move the inserted needle to make sure that it has hit the right place). You should take some blood into the syringe by pulling the plunger towards you. If everything is done correctly, the tourniquet must be removed, and the patient must be asked to work with his fist again. Only now can you slowly inject the medicine, pull out the syringe, holding the skin at the injection site with a cotton swab moistened with alcohol.

Intramuscular method

A much simpler technique for administering vaccinations, here you won’t need to get anywhere and aim - muscle tissue on the human body is always easy to find, at least on the buttock. We will analyze this type of injection. You will need a little:

A couch, a trestle bed or a comfortable straight-shaped sofa to give the patient a horizontal position;
a syringe and a needle with a diameter of at least 1.4 mm, but no more than 1.8 (it is important to keep in mind that if there is an impressive subcutaneous fat layer, you will need a needle of a larger diameter and longer length);
disinfectants;

First of all, the patient will need to lie on his stomach on a trestle bed or couch and clear the area for vaccinations from clothing. Next, follow the standard procedure to treat the injection site and hands, open the disposable syringe and draw the required amount of medicine and proceed to the operation. The needle should be inserted into the upper right quadrant of the buttock (visually divided into four parts by a horizontal and vertical line to make four parts), strictly perpendicular to the skin. After administering the medicine, the needle can be pulled out by immediately applying alcohol-soaked cotton wool for a few minutes. It should be remembered that the drug must be warmed, and the administration must be carried out very smoothly - then the patient will receive much less painful sensations.

Subcutaneous administration

Also, a method that is not difficult for an attentive person - the drug is injected into the subcutaneous fat layer, to a depth of no more than one and a half centimeters. The most convenient places are: the space under the shoulder blade, the outer part of the shoulder, the outer side of the thigh, the axillary region. A needle with a diameter of 0.6 mm is best suited for this type of procedure. As usual, the first step is to disinfect the selected injection site. Afterwards, the skin is folded with the hand free from the syringe. The needle is inserted at an angle of 30-45° relative to the surface of the skin at 1–1.5 cm, then the medicine is injected into the fat layer.

Any type of vaccination will be much more painless if you warm the medicine with your hands immediately before administration.

People who have no idea what vaccines, injections, needles, and so on are, often make the same mistakes. Failure to comply with the technique of performing medical vaccinations can, at best, bring very unpleasant painful sensations to the patient, and at worst, give rise to serious complications. Follow the injection rules and such troubles as abscesses, painful papules, hematomas will bypass you!

A subcutaneous injection is an injection given directly into the fat layer under the skin (as opposed to an intravenous injection, which is given directly into a vein). Because subcutaneous injections distribute medications more evenly and slowly than intravenous injections, subcutaneous injections are commonly used to administer vaccines and medications (for example, type 1 diabetics often administer insulin this way). A prescription for medications that must be administered subcutaneously usually contains detailed instructions on how to properly administer the subcutaneous injection.

Note: Please note that the instructions in this article are provided as an example only. Before injecting yourself at home, consult a healthcare professional.

Steps

Preparation

Prepare everything you need. Giving a hypodermic injection properly requires more than just a needle, syringe and medication. Before you begin, make sure you have:

A dose of medication in a sterile container (usually in a small ampoule with proper labeling)
Sterile syringe of the required size. Depending on the amount of medication and the patient's weight, you may choose the following syringe sizes or other sterile administration method:
- volumes of 0.5, 1 and 2 ml with a 27 gauge needle (0.40 × 10 mm 27G × 1/2);
- syringe with Luer lock, 3 ml volume (for large doses);
- refilled disposable syringe.
Container for safe disposal of the syringe.
Sterile gauze pad (usually 5 x 5 cm).
Sterile adhesive tape (make sure your patient is not allergic to the adhesive of the tape, as this may cause irritation around the wound).
Clean towel.

Taking a dose of medication

Remove the stopper insert from the medication ampoule. Place it on a towel. If the stopper has already been opened, if the ampoule contains multiple doses, wipe the rubber stopper of the ampoule with a clean alcohol wipe.

If you are using an already filled disposable syringe, skip this step.

We give a subcutaneous injection

Prepare the syringe in your dominant hand. Hold the syringe the same way you would hold a pencil or dart. Make sure you can easily reach the plunger of the syringe.

Gather the skin at the injection site. Using your non-dominant hand, gather approximately 2.5 to 5 cm of skin between your thumb and index finger, creating a small fold. Do everything carefully so as not to bruise or damage surrounding tissue. Skin harvesting is necessary to increase the thickness of the subcutaneous fat at the injection site, which will allow the medicine to be administered into the fat layer rather than into the muscle tissue.

When harvesting the skin, do not harvest the muscle underneath. You will be able to feel the difference between the soft fat layer and the hard muscle tissue underneath.
Subcutaneous medications are not designed for intramuscular administration and may cause bleeding in muscle tissue, especially if the medication has blood-thinning properties. However, intramuscular injection needles are usually small enough that administering the medication is unlikely to cause any difficulty.

Insert the syringe into the skin. With a slight acceleration of the hand, insert the entire length of the needle under the skin. Typically, the needle is inserted into the skin at a 90-degree angle (vertically downward relative to the surface of the skin) to ensure that the medication is completely injected into the subcutaneous fat layer. Sometimes, for muscular or very thin people who have very little subcutaneous fat, the needle is inserted at a 45-degree angle (diagonal) to avoid the medication getting into the muscle tissue.
- Act quickly and confidently, but not too harshly. Slow down and the needle may pop out of the skin, causing increased pain.
Press the plunger of the syringe firmly and evenly. Press the plunger without additional force until all the medicine has been injected. Use the same constant and confident movement.

Gently place a piece of gauze next to the injection site. The sterile material will absorb some of the blood that will be released after the needle is removed. The pressure you apply to the surface of the skin through the gauze pad or cotton wool will prevent the needle from pulling on the skin as the needle is withdrawn, which can also be painful.

Remove the needle from the skin in one smooth motion. You can ask the patient to hold gauze or cotton wool over the injection site, or do it yourself. Do not rub or massage the injection site, as this may cause subcutaneous bleeding or bruising.

Put the needle and syringe in a safe place. Carefully place the needle and syringe in a durable sharps container. It is very important not to throw away used needles with your regular trash - they may contain potentially dangerous bacteria.

Place gauze over the injection site. With the syringe and needle removed, you can apply adhesive tape to the patient's skin using gauze or cotton wool. Most likely, there will be minimal bleeding, so securing the bandage is not necessary - tell the patient to hold the gauze or bandage for a couple of minutes at the injection site. If using adhesive tape, make sure the patient is not allergic to adhesives.

Put away all tools. You have successfully performed a subcutaneous injection.

Give your child an age-appropriate task, such as holding a needle cap after you remove it. And tell him that "when he's old enough" you'll let him take it off. Children love to take an active part in these kinds of things.
For minor pain relief, you can use an ice cube.
To prevent a bruise or small scar from forming at the injection site, apply pressure to the injection site with gauze or cotton wool for 30 seconds after removing the needle. If we are talking about giving an injection to a child, tell him that he can control the degree of pressure - the main thing is that he does not press too hard.
Also alternate injection sites between injections on the legs, arms, or body (left and right, front and back, bottom and top), so that you do not inject in the same place more than once every two weeks. Just stick to the same order for the 14 locations and the injection sites will rotate automatically! Children love predictability. Or give them the opportunity to choose the injection sites themselves - write a list and cross out the injection sites.
Apply pressure to the injection site with gauze or cotton wool, this will avoid tension on the skin when you remove the needle, and the pain from the injection will be less.
Go to the manufacturer's website for exact instructions.
If you are giving an injection to a child and he is afraid of pain, use Emla as an anesthetic. Apply it to the injection site half an hour before the injection.

From a medical point of view, an injection means the introduction of a drug into the body using a syringe with a needle. As a rule, injections are used for precise dosing of a drug, its increased concentration in a certain place, or to accelerate the effect of medications. Let's look at how intradermal and subcutaneous injection is done.

Types of injections

Doctors distinguish several types of injections: subcutaneous, intramuscular, arterial, venous and injections directly into organs. They all have their own characteristics and administration techniques. So, let's look at the first two types.

What is a subcutaneous injection?

Injections under the skin are used to safely administer the drug precisely to those areas of the body where there are no large vessels and nerves (the shoulder, subscapularis, interscapular region, inner thigh, and abdomen.) For this method, both watery and oily solutions are used. For watery ones, thinner needles are used, for oily ones, thicker ones, which makes it easier for the drug to enter the tissue. To ensure that the subcutaneous oil injection does not require significant force, it is recommended to first warm up the ampoule with the medicine in warm water, and inject the solution itself more slowly. Such injections can be given with the patient lying down, sitting or standing. So, let's look at how to do subcutaneous injections.

Subcutaneous injection: technique

Doctors distinguish between two methods of administering medication subcutaneously:

1. The syringe is taken in the right hand so that the little finger holds the needle cannula, then you need to make a small fold of skin and inject the medicine. The peculiarity of this method is that the needle is inserted perpendicular to the injection site.

2. The same position of the syringe in the hand involves inserting the needle from bottom to top or top to bottom at an angle of 30-45 degrees (often used for subscapular or interscapular areas).

It is worth emphasizing that the future injection site must first be treated with a sterile, preferably alcohol, solution, and after administering the medicine this procedure should be repeated. It is also worth paying attention: if some time after the injection a lump forms in its place, you can no longer inject medications into this area.

What is an intradermal injection?

Intradermal injections, in turn, are used to identify a patient’s allergy to a drug. They are often a biological test (such as the Mantoux test) or are used for local anesthesia of a small area. Injections of this type are made into the upper and middle parts of the forearm if the patient does not suffer from respiratory diseases at the time of injection and does not have problems with the skin at the site of the biological test.

Technique for performing intradermal injection:

treat the surface of your hands, put on sterile gloves;
prepare an ampoule with medicine;
draw the medicine into the syringe;
change the needle, eliminate the presence of air in the syringe;
treat the future injection site with an alcohol solution;
slightly stretch the skin at the test site;
insert a needle under the skin parallel to the middle or upper part of the forearm;
introduce the solution. When administered correctly, a subcutaneous bubble is formed, which must be treated with alcohol without pressing on it. If the technique is followed, both intradermal and subcutaneous injection will not lead to serious consequences, but, on the contrary, will help in diagnosis or become the most important weapon in the treatment of the disease.

In ordinary life, the ability to perform subcutaneous injections is not as important as the ability to perform intramuscular injections, but the nurse must have the skills to carry out this procedure (know the algorithm for performing a subcutaneous injection).
Subcutaneous injection is performed on depth 15 mm. The maximum effect from a subcutaneously administered drug is achieved on average 30 minutes after injection.

The most convenient areas for subcutaneous administration of drugs:

upper third of the outer surface of the shoulder,
subscapular space,
anterolateral surface of the thigh,
lateral surface of the abdominal wall.

In these areas, the skin is easily caught in the fold, so there is no danger of damage to blood vessels and nerves.
Do not inject medications into areas with swollen subcutaneous fat or into lumps from poorly absorbed previous injections.

Required equipment:

sterile syringe tray,
disposable syringe,
ampoule with drug solution,
70% alcohol solution,
pack with sterile material (cotton balls, swabs),
sterile tweezers,
tray for used syringes,
sterile mask,
gloves,
anti-shock kit,
container with disinfectant solution.

Procedure to complete:

The patient should take a comfortable position and free the injection site from clothing (if necessary, help the patient with this).
Wash your hands thoroughly with soap and warm running water; Without wiping with a towel, so as not to disturb the relative sterility, wipe your hands well with alcohol; put on sterile gloves and also treat them with a sterile cotton ball soaked in a 70% alcohol solution.
Prepare a syringe with medicine (see article).
Treat the injection site with two sterile cotton balls soaked in a 70% alcohol solution, widely, in one direction: first a large area, then with the second ball directly at the injection site.
Remove the remaining air bubbles from the syringe, take the syringe in your right hand, holding the needle sleeve with your index finger, and the cylinder with your thumb and other fingers.
Form a fold of skin at the injection site by grasping the skin with the thumb and index finger of your left hand so as to form a triangle.

Insert the needle with a quick movement at an angle of 30-45°, cut upward, into the base of the fold to a depth of 15 mm; At the same time, you need to hold the needle sleeve with your index finger.

Release the fold; make sure that the needle does not fall into the vessel by slightly pulling the piston towards you (there should be no blood in the syringe); If there is blood in the syringe, the needle should be inserted again.
Place your left hand on the piston and, pressing on it, slowly introduce the medicinal substance.

Press the injection site with a sterile cotton ball soaked in a 70% alcohol solution and quickly remove the needle.
Place the used syringe and needles in the tray; Place used cotton balls in a container with a disinfectant solution.
Remove gloves, wash hands.
After the injection, the formation of a subcutaneous infiltrate is possible, which most often appears after the introduction of unheated oil solutions, as well as in cases where the rules of asepsis and antisepsis are not followed.

Hacharacteristics of the methodology for performing a simple medical service

Algorithm for performing subcutaneous drug administration

I. Preparation for the procedure.

Introduce yourself to the patient, explain the process and purpose of the procedure.
Help the patient find a comfortable position: sitting or lying down. The choice of position depends on the patient's condition; of the administered drug. (if necessary, fix the injection site with the help of junior medical personnel)
Treat your hands hygienically, dry them, put on gloves and a mask.
Prepare a syringe.

Check the expiration date and tightness of the packaging.

Draw up the medicine into the syringe.

A set of medicine into a syringe from an ampoule.

- Shake the ampoule so that all the medicine is in its wide part.

— Treat the ampoule with a ball moistened with an antiseptic.

— File the ampoule with a nail file. Use a cotton ball moistened with an antiseptic to break off the end of the ampoule.

— Take the ampoule between your index and middle fingers, turning it upside down. Insert a needle into it and draw out the required amount of medication.

Ampoules with a wide opening should not be inverted. Make sure that when drawing the medicine, the needle is always in the solution: in this case, air cannot enter the syringe.

— Make sure there is no air in the syringe.

If there are air bubbles on the walls of the cylinder, you should slightly pull back the syringe plunger and “turn” the syringe several times in a horizontal plane. The air should then be forced out by holding the syringe over a sink or into the ampoule. Do not push the medicinal product into the air in the room; this is hazardous to health.

- Change the needle.

If using a reusable syringe, place it and cotton balls in the tray. When using a single-use syringe, put a cap on the needle, place the syringe with the needle and cotton balls in the syringe packaging.

A set of medicine from a bottle closed with an aluminum cap.

— Using non-sterile tweezers (scissors, etc.), bend off the part of the bottle cap covering the rubber stopper. Wipe the rubber stopper with a cotton ball moistened with an antiseptic.

— Draw a volume of air into the syringe equal to the required volume of the drug.

— Insert the needle at an angle of 90° into the bottle.

- Inject air into the bottle, turn it upside down, slightly pulling the piston, draw the required amount of the drug from the bottle into the syringe.

— Remove the needle from the bottle.

- Change the needle.

— Place the syringe with a needle in a sterile tray or package of a single-use syringe into which the drug was drawn.

Store an opened (multi-dose) bottle for no more than 6 hours.

Select and examine/palpate the area of the intended injection to avoid possible complications.

II. Executing the procedure

Treat the injection site with at least 2 balls moistened with an antiseptic.
Gather the skin with one hand into a triangular fold, base down.
Take the syringe with your other hand, holding the needle cannula with your index finger.
Insert the needle and syringe with a quick movement at an angle of 45° to 2/3 of the length.
Pull the plunger towards you to ensure that the needle is not in the vessel.
Slowly inject the drug into the subcutaneous fat.

III. End of the procedure.

Remove the needle, press the ball with skin antiseptic to the injection site, without lifting your hand with the ball, lightly massage the injection site.
Disinfect consumables.
Remove gloves and place them in a container for disinfection.
Treat hands hygienically and dry.
Make an appropriate entry about the results of the implementation in the medical documentation.

Additional information about the features of the technique

Before injection, individual intolerance to the drug should be determined; lesions of the skin and fatty tissue of any nature at the injection site

When administering heparin subcutaneously, it is necessary to hold the needle at an angle of 90°, do not aspirate for blood, and do not massage the injection site after the injection.

When prescribing injections for a long course, 1 hour after it, apply a heating pad to the injection site or make an iodine mesh.

15-30 minutes after the injection, be sure to ask the patient about his well-being and his reaction to the injected medicine (identifying complications and allergic reactions).

Places for subcutaneous injection are the outer surface of the shoulder, the outer and anterior surface of the thigh in the upper and middle third, the subscapular region, the anterior abdominal wall; in newborns, the middle third of the outer surface of the thigh can also be used.