Figure 7.21 Indwelling SC device supplies<\/figcaption><\/figure>\n<\/div>\n\n
If a patient requires frequent SC injections, inserting a device that remains in place can significantly reduce the number of needle pokes (thus discomfort for the patient). Likewise a SC infusion of IV fluids and\/or medications may require the placement of an indwelling device.<\/p>\n
Different brands of indwelling SC devices are on the market. Check your agency for specific directions about insertion, time between changes, and medication administration via an indwelling device.<\/p>\n
Some general considerations for SC indwelling devices include:<\/p>\n
\n- They can promote patient comfort by reducing the number of needle pokes.<\/li>\n
- They reduce risk of needle sticks \/ exposure to BBF by the health care professional (Dawkins et al., 2000, as cited in Becton, Dickinson, 2013<\/span>).<\/li>\n
- They are inserted following principles of asepsis, and the sites dressed according to agency protocol. A semi-permeable transparent dressing allows frequent and accurate assessment of the insertion site.<\/li>\n
- How long an indwelling SC device remains in situ will depend on many factors including patient characteristics, volume of fluid infused, medication, and integrity of the site.<\/li>\n
- Sites should be rotated to prevent tissue damage. This includes:\n
\n- every 7 days and as needed for intermittent medication administration. Some sites advise up to 14 days (RCH, 2014). Check your agency protocol.<\/li>\n
- every 24 to 48 hours or after 1.5 to 2 litres of solution has infused (Saskatchewan Health Authority, 2018).<\/li>\n<\/ul>\n<\/li>\n
- Sites that are red, tender, edematous, bruised, bleeding, burning, leaking, have blood in the tubing and\/or have a displaced cannula need to be removed and re-established.<\/li>\n
- Each site is designated for one particular purpose (i.e., one medication only per site).<\/li>\n
- When used for intermittent medication administration, because there is a small volume associated with the device called the dead space, the initial dose must include a larger volume to account for the volume in the dead space after the first dose is administered. Check your agency protocols to determine this volume (Saskatchewan Health Authority, 2018; RCH, 2014)<\/li>\n
- Each site is labelled with the date it was initiated, the medication name and concentration used, and the nurse\u2019s initials<\/li>\n
- If necessary, change the end cap to one that can be accessed without needles.<\/li>\n<\/ul>\n
![\"\"](\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/subcutaneous-injection-sites-002.jpg\")
<\/a> Figure 7.15 Subcutaneous injection sites[\/caption]\r\n\r\nChoose a site that is free of skin lesions and bony prominences. Rotate sites for most SC medications (see note about insulin below) to prevent the formation of lipohypertrophy or lipoatrophy in the skin. Physical exercise or application of hot or cold compresses influences the rate of drug absorption by altering local blood flow to the tissues. Any condition that impairs that blood flow to the subcutaneous tissue contradicts the use of subcutaneous injections. Examples of subcutaneous medications include insulin, opioids, heparin, epinephrine, and allergy medication (Perry et al., 2018).\r\n\r\nTo administer an SC injection, a 25 to\u00a030 gauge, 3\/8 in to\u00a05\/8 in needle is used. Some subcutaneous injections come prefilled with the syringe attached. Always confirm that the right-size needle is appropriate for the patient before use. Subcutaneous injections are usually given at a 45- to 90-degree angle. The angle is based on the amount of subcutaneous tissue present. Generally, give shorter needles at a 90-degree angle and longer needles at a 45-degree angle (Lynn, 2011).\u00a0SC injections do not need to be aspirated, as the likelihood of injecting into a blood vessel is small. Lynne (2011) suggests that no more than 1 ml of medication is given subcutaneously, as larger amounts may cause discomfort to the patient and may not be absorbed appropriately. Other sources suggest up to 1.5 ml can be injected at once\u00a0 (Perry et al, 2018). Given that, the nurse will have to judge each individual situation.\r\n\r\nThere are varying opinions on\u00a0whether to pinch the skin during administration. Pinching is advised for thinner patients in order to lift the adipose tissue up and away from the underlying muscle and tissue. If pinching is used, release the pinch when the needle is inserted to avoid injecting into compressed tissue. Note, too, that elevating or pinching the skin has been found to increase the risk of injury, as the needle may pierce the opposite side of the skin fold and enter the skin of the health care worker (Black, 2013). The abdomen is the best location for an SC injection if a patient has little peripheral SC tissue. If patient is obese, use a needle that is long enough to insert through the tissue at the base of the skin fold (Perry et al., 2018).\r\n![\"\"](\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Insulin_Delivery_Devices.jpg\")
<\/a> Figure 7.16 Insulin delivery devices[\/caption]\r\n\r\nInsulin pens\u00a0<\/strong>are one method for insulin administration. The pen consists of a syringe (pen), needle, and prefilled cartridge of insulin. It is essential that patients be taught how to use injection pens so they understand the technology. One pen per person to avoid risk of BBF exposure. The needle has to be primed prior to administration. In hospital settings, needles with safety systems must be used. Due to the expense, persons using insulin pens at home can opt for a less expensive needle that doesn't have the safety system in place.\r\n\r\n[caption id=\"attachment_1342\" align=\"aligncenter\" width=\"300\"]![Silhouette d'un humain asexu\u00e9 nu, vue de face et de dos<\/a> by](\"https:\/\/fr.wikipedia.org\/wiki\/Fichier:Silhouette_humain_asexue_anterieur_posterieur.svg\"){kind=link}
![Insulin Delivery Devices<\/a> by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Insulin_Delivery_Devices.png\"){kind=link}
![Priming an insulin pen<\/a> by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0307_Diabetes_PrimingInsulinPen.png\"){kind=link}