Teaching: Subcutaneous Heparin injection

Casebank Combined
1

\Where are you:
You are an FY2 in Medicine Department.

Who is the Patient:
Jamie Watson, a 2nd year medical student who is undergoing a rotation in your department. He has been on the ward for weeks and he would like to learn how to perform subcutaneous injection

What you must do:
Teach the student the basics of subcutaneous injection.

Special Note:
None

  1. Introduction / ID check as like the structure
  2. Build rapport
  3. Main concern ( how can I help you )
  4. Assess knowledge ( 4 w )
  • What do you know about it ( past )
  • What do you want to know (future )
  • Why do you want to know
  • Why we do it (for colleague )
    Common route of delivery for medications such as insulin and low molecular weight heparin (LMWH) and palliative medications

Before we do the test

Collect Materials

  • Gloves & apron: Be sterile and To prevent cross
    contamination
  • Equipment tray
  • Syringe (smallest syringe that will accommodate the medication volume)
  • 2 needle
    – Injecting needle (26–30 gauge)
    – Drawing-up needle (when drawing up medications from ampoules)
  • Gauze or cotton swab
  • Sharps container/ Bin
  • The medication to be administered ( Heparin)
  • The patient’s prescription
  • Injection Site chart

Checks Before the procedure

  • Introduce yourself to the patient including your name and role
  • Briefly explain what the procedure
  • Gain consent ( Right to refuse )
  • Do check List :
  1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription
  2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired.
  3. Right dose: check the drug dose against the prescription to ensure it is
    correct.
  4. Right time: confirm the appropriate time to be
    administering the medication
  5. Right route: check the planned route of administering
    drugs.
  6. Right to refuse: ensure that valid consent has been gained
    prior to medication administration.
  7. Right documentation of the prescription and allergies

How to do it (Show and do)

  1. Wash your hands and wear your gloves
  2. Wipe the top of the medicine bottle with alcohol pad
  3. Choose the injection site
  4. Open syringe package and put on a clean surface
  5. Insert the drawing needle into the top of the bottle at angle of 90 degrees
  6. Pull back the plunger to fill the medication
  7. Remove the needle and replace it with theinjecting needle one
  8. Hold needle upward , tap it gently and then push the plunger
  9. Use you non-dominant hand (pinching the skin increases the depth of the subcutaneous tissue available).
  10. Warn the patient of a sharp scratch.
  11. Inject the contents of the syringe whilst holding the barrel firmly. Aspiration is not recommended for subcutaneous injections, as there are no major blood vessels in the subcutaneous tissue and the risk of inadvertent intravenous administration is minimal,however, always follow your local guidelines.
  12. Remove the needle and immediately dispose of it into a sharps container.
  13. Apply gentle pressure over the injection site with a cotton swab or gauze and avoid rubbing the site.
  14. Replace the gauze with a plaster. Dispose of your equipment into
    an appropriate clinical waste bin.

What to do next

  • Explain to the patient that the procedure is now complete.
  • Thank the patient for their time.
  • Discuss post-injection care and Safety Netting
    Warn the patient that it is normal for the injection site to be sore for one or two days.
    Advise that if they experience worsening pain after 48 hours they should seek medical review.
    Reiterate the potential complications of subcutaneous injections including
    haematoma formation, persistent nodules, local irritation and rarely anaphylaxis.
  • Document the details of the procedure and the medication
    administered.

Appropriate injection site:

  • Abdomen: avoid injecting within a 2-inch radius around the umbilicus (this is the preferred site if administering low molecular weight heparin).
  • Upper outer aspect of the arm
  • Outer aspect of the upper thigh
  • Upper buttock
  • Do NOT use a site that is scarred, inflamed, irritated or bruised.

Figure below denotes the injection site chart:

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https://geekymedics.com/subcutaneous-sc-injection-osce-guide/

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