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 ADMINISTRATION OF
PARENTERAL
MEDICATIONS:
Subcutaneous & Intradermal
Prepared by: Asst. Prof. Noyme Lour Abegil L Laviste, MN RN
DON’T FORGET TO DO THE 3 CHECKS
WHEN PREPARING MEDICATIONS
SUBCUTANEOUS INJECTION (SQ)
Involves injecting a small amount of
liquid drug usually 0.5 to 1ml into the
subcutaneous (SQ) tissue

Drug is absorbed slowly into the

nearby capillaries.

Can have a longer duration of action

compared to the intramuscular route.
Potter & Perry, 2017
SUBCUTANEOUS INJECTION (SQ)

Absorbed completely if circulatory

status is normal.

The client may experience some

discomfort because of some pain
receptors.
SUBCUTANEOUS INJECTION (SQ)

 Only small doses of water-soluble

medication should be given by the SQ
route.

 Collection of medication within the tissues

can cause sterile abscess that appears as
hardened painful lumps under the skin.
SUBCUTANEOUS INJECTION (SQ)

Preferred needle length is half of the skin fold.

With this method the angle of insertion maybe

45 - 90 degree.
SUBCUTANEOUS INJECTION (SQ)

 Generally, adults of normal weight:#25-gauge

 5/8-inch needle = 45° angle of insertion
 3/8-inch needle = 90° angle of insertion
 1/2-inch needle = 90° angle of insertion (Potter & Perry, 2017)

 Child:

 1/2-inch needle = 45° angle of insertion

SUBCUTANEOUS INJECTION (SQ)

 If obese, the nurse pinches the tissue & uses

a needle long enough to insert through
fatty tissue & the
base of the skin fold.
SUBCUTANEOUS INJECTION (SQ)

Body weight indicates the depth of the

SQ layer.

 choose the needle length and angle of insertion

on the basis of:

- patient's weight
- estimation of the amount of subcutaneous
tissue
The angle of needle insertion
will depend on the length of
the needle used for the
subcutaneous injection
SUBCUTANEOUS INJECTION (SQ)

Needle sizes and lengths are

selected based on:

 body mass
 intended angle of insertion
 planned site
SUBCUTANEOUS INJECTION SITES

Most common sites:

1. outer posterior aspect of the upper

arms
2. the anterior aspects of the thighs

3. abdomen from below the costal margins to the iliac crests

Alternative subcutaneous sites:

4. scapular areas of the upper back
5. upper ventral or dorsal gluteal
areas
What is the SQ route that allows the
fastest absorption of medications?
SUBCUTANEOUS INJECTION SITES
INSULIN PEN

INSULIN SYRINGE
Here are links to the videos on:

Administration of Subcutaneous injection:

https://www.youtube.com/watch?v=R5jd4SDEcsA (upper arm)

https://www.youtube.com/watch?v=o8-2zz1ASKk (abdomen)

Administering insulin using an Insulin pen:

https://www.youtube.com/watch?v=fJPzkzyuMZ8

Administering insulin using an insulin syringe:

https://www.youtube.com/watch?time_continue=82&v=C0coWZbO-
_E&feature=emb_logo
Read on rules in rotating sites for those
receiving regular SQ injections?

Why is there a need to rotate injection sites?

INTRADERMAL ROUTE (ID)

• An intradermal (ID) injection

is the administration of a
drug into the dermal layer of
the skin just beneath the
epidermis.
• Injection of a small amount of
liquid (0.5 ml / less) into the
outer layers of the client’s
skin.

Berman et al., 2016

INTRADERMAL ROUTE (ID)

• Usually for skin testing

*** Why is the intradermal route chosen for

skin testing?

◦ e.g. TB screening, allergy testing, vaccines, anesthetics, antibiotics

Berman et al., 2016

INTRADERMAL ROUTE (ID)
Anaphylactic reaction may occur if the medication
enters the circulation rapidly.

Skin testing is performed for clients with history of

numerous allergies.

The nurse uses a tuberculin syringe with a 25 G to

27 G, ¼ to5/8 inch needle.
Choose skin-testing sites that allow you to
easily assess for changes in color and
tissue integrity

ID sites need to be:

1. lightly pigmented
2. free of lesions
3. relatively hairless

***The inner forearm and upper back are

ideal locations.

Potter & Perry, 2017

 INTRADERMAL SITES

***What are the intradermal sites?

1. inner lower forearm

2. Upper back
3. ____________________
 In choosing a site for intradermal injection,
we should AVOID sites that are:

1. ______________
2. ______________
3. ______________
 What is the angle of insertion
in an intradermal route?

Before introducing the needle into

the skin, the patient’s skin is to be
pulled until it is TAUT.

- How is this technique done?

- What is the rationale for this?

INTRADERMAL INJECTION (ID)

A small bleb resembling a mosquito bite

should appear on the skin’s surface.
What is a BLEB?

If a bleb does not appear or if the site

bleeds after needle withdrawal, you’ve
probably injected the medication too deeply.

Give another dose at least 2” (5 cm) away

from the first site.
INTRADERMAL INJECTION (ID)

After a bleb is produced, the nurse

encircles the bleb with ink….

What is the rationale?

What ink color is ideally used?

Why do you think the ink color
matters?
Here are links to the videos on:

Intradermal injection:

https://www.youtube.com/watch?v=1mvZDM0v-Hs
https://www.youtube.com/watch?v=IQNXQWqTf8k

*** OBSERVE THE TECHNIQUES USED IN MAKING THE SKIN

TAUT. They differ in the technique, but both serve the same
purpose.
What is the direction of cleansing an
injection site?

Is the disinfected site wiped with dry

cotton ball or is it allowed to dry by
itself?
What should be included in the
documentation of medications given as
injections?