SUBCUTANEOUS AND INTRAMUSCULAR INJECTIONS
The Irish physician Francis Rynd (1811–1861) invented the hollow needle in 1844,
patented in the Irish patents office. Charles Gabriel Pravaz (1791–1853), a French
physician, created the first hypodermic tubular needle and syringe in 1853, made
entirely from silver. Soon after, the Scottish physician Alexander Wood (1817–1884)
went on to develop a method for subcutaneous injection. Not without an unfortunate
sense of irony, the first recorded fatality from an overdose administered by Wood’s
invention was that of his wife who had become addicted to intravenous morphine.
INTRODUCTION
Subcutaneous and intramuscular injections provide routes for medication delivery that
do not require intravenous access. This may be advantageous in either an emergency
situation (e.g. intramuscular epinephrine) or electively (e.g. subcutaneous insulin).
INDICATIONS
Subcutaneous injections, e.g. insulin, tetracosactide, growth hormone, morphine
Intramuscular injections, e.g. haloperidol, epinephrine, metoclopramide, cyclizine.
CONTRAINDICATIONS
• Local contraindications to injection include:
— cellulitis
— haematoma
— lipoatrophy
— lipohypertrophy
— lymphoedema.
• Bleeding diatheses – coagulopathy or thrombocytopaenia may increase the risk of
subcutaneous or intramuscular haematoma formation.
• Lack of consent.
EQUIPMENT
•Gloves.
• Sterile hypodermic needles
— 25 gauge needle (orange: length 16 mm, inner diameter 0.241 mm) for subcutaneous delivery
— 21 gauge (green: length 40 mm, inner diameter 0.495 mm) to 23 gauge needle
(blue: length 30 mm, inner diameter 0.318 mm) for intramuscular delivery
— 21 gauge needle for drawing up the drug.
• Syringe (of required volume for the medication +/– volume of dilutant required to
reconstitute the medication).
•Sterile alcohol swabs.
•Gauze.
•Plaster.
•Vial of medication to be administered. Always read the instructions to check the
correct dosage, route of delivery and solution required to reconstitute the powder
form of the medication.
•Sharps bin.
PRACTICAL PROCEDURE
PREPARATION
•Explain the procedure to the patient and gain consent.
• Position the patient and expose the area for injection.
•Wash your hands and wear gloves.
• Perform the following checks prior to administering any medication:
— Confirm the patient’s personal details and check that they correspond with their
drug chart and name band.
— On the drug chart confirm the patient’s drug allergies, the drug to be given, the
dose required, the timing of the dose and the route of administration.
— Check the drug itself together with the dosage and expiry date in the presence
of a colleague.
• Draw up the required volume of specified dilutant (see information accompanying
the medication) into the syringe using a green needle.
•Open the vial of medication for injection. Insert the syringe containing the dilutant
attached to the green needle. Insert a second green needle into the vial to allow air
to escape when adding dilutant.
• Reconstitute the medication in the vial and aspirate into the syringe when complete. Discard the vial and green needles into a sharps bin.
•Expel any excess air or air bubbles from the syringe by gently tapping the side of
the syringe whilst holding it upright.
•Clean the area of skin for injection with sterile alcohol swabs and allow to dry.
SUBCUTANEOUS INjECTION
•Attach the 25 gauge (orange) needle to the syringe.
•Choose a site for injection. Suitable sites include the triceps area, anterior thigh
area or the abdomen.
• Pinch and lift the skin overlying this area gently into a fold between the thumb
and index finger of your non-dominant hand, thereby separating the subcutaneous
adipose tissue layer from the muscle
• Warn the patient of a sharp scratch.
• Gently insert needle into the skin at a 30–45 degree angle.
•Slowly inject the medication.
INTRAMUSCULAR INJECTION
•Attach the 23 gauge (blue) or 21 gauge (green) needle to the syringe.
• Choose a site for injection taking into account the individual’s muscle mass. Suitable muscles include the deltoids, the gluteal muscles and the lateral thigh muscles.
•Pull the skin taught over the underlying muscle layer and insert the needle in one
swift motion.
Pinch and lift the skin into a fold, separating the subcutaneous adipose tissue
layer from the muscle.
• Aspirate the syringe to ensure that the needle is not in a blood vessel.
• Slowly inject the medication at a rate of approximately 1 mL every 10 seconds.
FINISHINGOFF
• Remove the needle and apply pressure to the puncture site with gauze or cotton
wool to prevent haematoma formation.
•Dispose of the syringe and needle into a sharps bin.
•Attach a plaster if needed.
•Observe for any adverse drug reactions.
•Record the date and time of injection on the patient’s drug chart.
COMPLICATIONS
•Local infection – either superficial (cellulitis) or deep (abscess formation).
•Bleeding – either superficial or deep haematoma formation. This may predispose to
infection.
• Lipoatrophy.
•Lipohypertrophy.
•Injection fibrosis – if injections are delivered with an incorrect technique or too
frequently to that site.
The Irish physician Francis Rynd (1811–1861) invented the hollow needle in 1844,
patented in the Irish patents office. Charles Gabriel Pravaz (1791–1853), a French
physician, created the first hypodermic tubular needle and syringe in 1853, made
entirely from silver. Soon after, the Scottish physician Alexander Wood (1817–1884)
went on to develop a method for subcutaneous injection. Not without an unfortunate
sense of irony, the first recorded fatality from an overdose administered by Wood’s
invention was that of his wife who had become addicted to intravenous morphine.
INTRODUCTION
Subcutaneous and intramuscular injections provide routes for medication delivery that
do not require intravenous access. This may be advantageous in either an emergency
situation (e.g. intramuscular epinephrine) or electively (e.g. subcutaneous insulin).
INDICATIONS
Subcutaneous injections, e.g. insulin, tetracosactide, growth hormone, morphine
Intramuscular injections, e.g. haloperidol, epinephrine, metoclopramide, cyclizine.
CONTRAINDICATIONS
• Local contraindications to injection include:
— cellulitis
— haematoma
— lipoatrophy
— lipohypertrophy
— lymphoedema.
• Bleeding diatheses – coagulopathy or thrombocytopaenia may increase the risk of
subcutaneous or intramuscular haematoma formation.
• Lack of consent.
EQUIPMENT
•Gloves.
• Sterile hypodermic needles
— 25 gauge needle (orange: length 16 mm, inner diameter 0.241 mm) for subcutaneous delivery
— 21 gauge (green: length 40 mm, inner diameter 0.495 mm) to 23 gauge needle
(blue: length 30 mm, inner diameter 0.318 mm) for intramuscular delivery
— 21 gauge needle for drawing up the drug.
• Syringe (of required volume for the medication +/– volume of dilutant required to
reconstitute the medication).
•Sterile alcohol swabs.
•Gauze.
•Plaster.
•Vial of medication to be administered. Always read the instructions to check the
correct dosage, route of delivery and solution required to reconstitute the powder
form of the medication.
•Sharps bin.
PRACTICAL PROCEDURE
PREPARATION
•Explain the procedure to the patient and gain consent.
• Position the patient and expose the area for injection.
•Wash your hands and wear gloves.
• Perform the following checks prior to administering any medication:
— Confirm the patient’s personal details and check that they correspond with their
drug chart and name band.
— On the drug chart confirm the patient’s drug allergies, the drug to be given, the
dose required, the timing of the dose and the route of administration.
— Check the drug itself together with the dosage and expiry date in the presence
of a colleague.
• Draw up the required volume of specified dilutant (see information accompanying
the medication) into the syringe using a green needle.
•Open the vial of medication for injection. Insert the syringe containing the dilutant
attached to the green needle. Insert a second green needle into the vial to allow air
to escape when adding dilutant.
• Reconstitute the medication in the vial and aspirate into the syringe when complete. Discard the vial and green needles into a sharps bin.
•Expel any excess air or air bubbles from the syringe by gently tapping the side of
the syringe whilst holding it upright.
•Clean the area of skin for injection with sterile alcohol swabs and allow to dry.
SUBCUTANEOUS INjECTION
•Attach the 25 gauge (orange) needle to the syringe.•Choose a site for injection. Suitable sites include the triceps area, anterior thigh area or the abdomen.
• Pinch and lift the skin overlying this area gently into a fold between the thumb
and index finger of your non-dominant hand, thereby separating the subcutaneous
adipose tissue layer from the muscle
• Warn the patient of a sharp scratch.
• Gently insert needle into the skin at a 30–45 degree angle.
•Slowly inject the medication.
INTRAMUSCULAR INJECTION
•Attach the 23 gauge (blue) or 21 gauge (green) needle to the syringe.
• Choose a site for injection taking into account the individual’s muscle mass. Suitable muscles include the deltoids, the gluteal muscles and the lateral thigh muscles.
•Pull the skin taught over the underlying muscle layer and insert the needle in one
swift motion.
Pinch and lift the skin into a fold, separating the subcutaneous adipose tissue
layer from the muscle.
• Aspirate the syringe to ensure that the needle is not in a blood vessel.
• Slowly inject the medication at a rate of approximately 1 mL every 10 seconds.
FINISHINGOFF
• Remove the needle and apply pressure to the puncture site with gauze or cotton
wool to prevent haematoma formation.
•Dispose of the syringe and needle into a sharps bin.
•Attach a plaster if needed.
•Observe for any adverse drug reactions.
•Record the date and time of injection on the patient’s drug chart.
COMPLICATIONS
•Local infection – either superficial (cellulitis) or deep (abscess formation).
•Bleeding – either superficial or deep haematoma formation. This may predispose to
infection.
• Lipoatrophy.
•Lipohypertrophy.
•Injection fibrosis – if injections are delivered with an incorrect technique or too
frequently to that site.
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