ARELLANO UNIVERSITY-PASIG

Andres Bonifacio Campus

Pag-asa St., Caniogan, Pasig City
COLLEGE OF NURSING

PROCEDURES CHECKLIST
GIVING SUBCUTANEOUS INJECTIONS
PERFORMANCE
STEPS Excellent V.Good Good Fair Poor
96-100% 91-95% 86-90% 80-85% 75-79%
5 4 3 2 1
Assessment
1. Review medication record to determine the medications to /
be administered.
2. Check medication listed against physician’s or nurses /
order.
3. Review information about medications to be administered. /
4. Assess patient’s size and build. /
5. Assess need for assistance. /
Planning
6. Determine appropriate needle and syringe needed. /
1-5ml syringe with gauge 25- 23 needle
7. Wash your hands /
8. Gather equipment needed. /
Equipment
❏ Proper size syringe with engineered sharps injury protection
(SESIP) needle:
• Subcutaneous: syringe (1- to 3-mL) and needle (25- to 27-
gauge, 3/8 - to 5/8-inch)
• Subcutaneous U-100 insulin: insulin syringe (1 mL) with
preattached needle (28- to 31-gauge, 5/16- to 1/2 -inch) •
Subcutaneous U-500 insulin: 1 mL tuberculin (TB) syringe with
needle (25- to 27-gauge, 1/2 - to 5/8 -inch)
❏ Small gauze pad (optional)
❏ Alcohol swab
❏ Medication vial or ampule
❏ Clean gloves
❏ Medication administration record (MAR) or computer
printout
❏ Puncture-proof container
Implementation
9. Read name of medication from the record. /
10. Check the label on the medication before picking it up. /
11. Check label again before calculating and preparing dosage. /
12. Draw up medication /
13. Check label of vial or ampule and dosage. /
14. Place MAR or identification card with medication. /
15. Carry prepared medication to bed side. /
16. Approach and identify patient. /
17. Explain what are you going to do. /
18. Provide privacy /
19. Give the subcutaneous injection.
a. Put on clean gloves /
b. Select the appropriate site and clean it using circular /
motion.
c. Allow site to dry /
d. Place swab between fingers on non dominant hand. /
e. Remove needle guard. /
f. Pinch skin between thumb and index finger /
To elevate subcutaneous tissue.
 g. Use 45 degrees angle /
h. Insert needle at appropriate depth. /
i. Inject medication slowly /
j. Withdraw needle after introducing the medication /
k. Cover the site with sterile cotton and tape to secure /
20. Discard syringe and needle in “sharps” container /
21. Leave patient in a comfortable position. /
22. Wash your hands. /
Evaluation
23. Return to room in 15 to 30 minutes and ask if patient /
feels any acute pain, burning, numbness, or tingling at
injection site. Inspect site.
24. Observe patient’s response to medication. Review /
laboratory results as appropriate (e.g., blood glucose,
partial thromboplastin).
Documentation
25. Document medication, dosage, route, time and signature. /

CRITERIA FOR GRADING:

TOTAL RAW Score X 50 + 50 = 175 X 50 + 50 = 100%

Highest Score 175

Grade in Percent Description Interpretation

96-100% Performed and explained accurately, Excellent
completely and clearly.
91-95% Performed well, There are 1 or 2 points not Very Good
fully done and explained.
86-90% Performed adequately, There are 3 or 5 Good
points not explained accurately and clearly.

80-85% Performed adequately, There are more than Fair

5 points not done and explained accurately

75-79% Performance not acceptable and explanation Poor

not accurate and clear.

GRADE: 100% (EXCELLENT)

Recommendations: ______________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________

Student Signature/Acknowledgement:

(Name over signature) Date:

Evaluated by:

Date:
INOCENCIA P. MARQUEZ RN, MAN