before administering a subcutaneous injection perform hand hygiene and prepare the medication using aseptic technique check the medication label twice against the medication administration record or ma R take the medication to the patient at the correct time according to your agency's policy give time critical medications such as stat and now doses at the exact time specified in the order after performing hand hygiene and ensuring privacy introduce yourself to the patient identify him using to identify errs and can you tell me your name bill Ramirez and your birthday 927 of 62 and ask him if he has any allergies then access the electronic ma are at the bedside again compare the medication label with the MA our discuss the purpose of each medication its action and possible adverse effects allow the patient to ask questions find out where the last injection was given by checking the MA our and or asking the patient then determine which site you'll use shift the patient's bed linen to expose only the potential injection site and surrounding area inspect the area for bruising inflammation and edema if the skin is bruised or show signs of infection use a different site the best sites for subcutaneous injection include the outer aspect of the upper arm the abdomen from below the costal margin to the iliac crest and the anterior aspect of the thigh these areas are easily accessible and large enough to allow multiple injections palpate the site and avoid any area that's tender or in which you feel a mass beneath the skin to make sure you have the right size needle use your thumb and forefinger to grasp a skin fold of tissue at the injection site measure the fold from top to bottom and check to ensure that the needle is about half as long give preference to abdominal injection sites when your administering insulin or heparin specifically the best subcutaneous site at which to administer low molecular weight heparin is at least 2 inches or 5 centimeters to the right or left of the umbilicus if the abdominal area isn't available look for a site on the thigh for insulin systematically rotate injection sites within one anatomical region either the abdomen or thigh help the patient find a comfortable position and ask him to relax the area you're about to inject apply clean gloves clean the site with an antiseptic swab remember to begin at the center and move out in a two inch radius cleaning in a circular pattern remove the needle cap or protective sheath on the syringe by pulling it straight off hold the syringe between the thumb and forefinger of your dominant hand as though you are holding a dart if your patient is of average size hold the skin across the site or pinch a fold of skin with your non-dominant hand insert the needle quickly and firmly at a 45 to 90 degree angle release the pinched skin rest your non-dominant hand on the patient and use it to stabilize the syringe if you're using an injection pen or giving heparin continue to pinch the skin during the injection if your patient is obese pinch the skin and inject the needle below the tissue fold at a 90 degree angle move your dominant hand to the end of the plunger and slowly inject the medication over several seconds retain your grasp on the syringe to keep it still quickly withdraw the needle place a swab or gauze pad on the site and apply gentle pressure but don't massage the site if you've just given heparin hold the pad on the site for 30 to 60 seconds activate the needle safety and help the patient into a comfortable position discard the needle and syringe in a puncture proof leak-proof container remove and discard your gloves and use gauze or an antiseptic swab perform hand hygiene document the injection immediately in the MA are including the medication name the dose given and the site at which it was injected as part of your follow-up care remain with the patient for several minutes to watch for signs of an allergic reaction then return to the patient's room in fifteen to thirty minutes to see if the patient has any acute pain tingling burning or numbness at the injection site