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clinical patient care

Subcutaneous (SubQ) Injection

A subcutaneous (SubQ) injection puts medication into the fatty layer between the skin and the muscle.

15 steps4 criticalLimit 4 minAlways tested

Steps

  1. 1Check the order and clarify anything that is unclear
  2. 2Critical stepPerform hand hygiene
  3. 3Critical stepVerify the medication against the order, including the expiration date, using the rights of medication administration
  4. 4Confirm the patient's identity with two identifiers, ask about allergies, and explain the procedure
  5. 5Put on nonsterile gloves if contact with blood or body fluids is likely or skin is not intact
  6. 6Choose a site: outer upper arm, abdomen (more than 2 inches from the navel), or front of the thigh
  7. 7Clean the site with an alcohol swab in a circular motion and let it dry
  8. 8Critical stepGrasp and pinch up the tissue at the site
  9. 9Insert the needle quickly at 45 to 90 degrees, depending on the patient's size and amount of fat tissue
  10. 10After the needle is in, release the pinched tissue and inject all of the medication without moving the syringe; for heparin or an insulin pen, keep pinching during the injection and release just before withdrawing
  11. 11Wait 10 seconds before withdrawing the needle, then withdraw at the same angle
  12. 12Critical stepAssess the site and apply gentle pressure with gauze; do not massage
  13. 13Activate the needle safety feature and place the needle and syringe straight into a sharps container without recapping
  14. 14Remove gloves and perform hand hygiene
  15. 15Document the medication given, including the site used, and anything else your facility requires

What graders are watching for

Tips
  • For insulin, use one body region and rotate the specific spots within it.
  • Insulin pens and heparin: keep the skin fold pinched during the injection and release it just before withdrawing.
  • Heparin: do not massage the site afterwards; massage can contribute to a hematoma.

Common mistakes

  • Using 90 degrees on a thin patient.
  • Massaging the site afterward, especially after heparin.
  • Recapping the needle.
  • Injecting too close to the navel.
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