Emergency Medicine Book

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Subcutaneous Injection

Aka: Subcutaneous Injection, SQ Injection
  1. Indications: Medications
    1. Insulin
    2. Morphine
    3. Heparin or Enoxaparin
  2. Technique
    1. Administered beneath Dermis and Epidermis
    2. Locations (typical Insulin injection sites)
      1. Upper arm
      2. Abdomen (sparing the peri-umbilical area in ~2 cm radius)
      3. Buttock
      4. Thigh (Anterolateral, at least 10 cm distal from top)
    3. Needle Sizes
      1. Length: 1/2 to 5/8 inch (regardless of age)
      2. Needle gauge
        1. Insulin: 28 to 32 gauge
        2. Other aqueous medications: 22 to 25 gauge
        3. Thick solutions: 21 to 23 gauge
    4. Technique: General
      1. Prep area (e.g. Alcohol swab)
      2. "Pinch an inch" of skin
      3. Inject at 45 to 90 degrees
    5. Technique: Insulin needles
      1. Typically shorter (4 to 5 mm long)
      2. Avoid pinching skin
      3. Inject at 90 degrees
    6. Reducing injection pain
      1. Allow medication dose to warm to room Temperature before infection
      2. Apply ice to the skin area for 10 min prior to injection
  3. Precautions
    1. Rotate injection sites (risk of Lipodystrophy with frequent repeat use)
    2. Patients should dispose of needles in sharps container (NOT the trash)
    3. Avoid rubbing injection area after injection

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