EMS providers need to be well-versed in subcutaneous (SC) medication administration to ensure effective and safe patient care. Here are the key points they should know:
1. Indications and Contraindications
Indications:
Medications that require slow, sustained absorption such as insulin, heparin, and certain vaccines.
Situations where IV or IM routes are not appropriate or available.
Contraindications:
Allergy to the medication
Presence of infection or injury at the injection site
Conditions causing poor blood flow or perfusion to the skin, such as shock or severe edema.
2. Anatomy and Site Selection
Common SC Injection Sites:
Upper outer arm
Abdomen (avoiding a 2-inch radius around the navel)
Anterior thighs
Upper buttocks or hips
Site Selection Criteria:
Rotating sites to avoid tissue damage
Considering the patient's preference and comfort
Avoiding areas with scars, bruises, or inflammation
3. Preparation and Technique
Medication Preparation:
Verify the medication, dose, and expiration date.
Use aseptic technique to draw up the medication.
Injection Technique:
Clean the injection site with an antiseptic wipe.
Pinch the skin to lift the subcutaneous tissue away from underlying muscle.
Insert the needle at a 45-degree angle (or 90 degrees if using a short needle or for thicker subcutaneous tissue).
Inject the medication slowly and steadily.
Withdraw the needle and apply gentle pressure to the site with a sterile gauze.
4. Needle Selection
Needle Length: Typically 3/8 to 5/8 inches.
Needle Gauge: Usually 25 to 30 gauge, depending on the viscosity of the medication and the patient's subcutaneous tissue.
5. Medication Administration
Dosage and Volume: Adhere to recommended dosage and volume limits (generally up to 1 mL for subcutaneous injections).
Rate of Administration: Inject the medication slowly to reduce discomfort and ensure proper absorption.
6. Complications and Management
Pain and Discomfort: Techniques to minimize pain include using a quick, smooth insertion, and injecting the medication slowly.
Bleeding and Bruising: Applying gentle pressure post-injection can prevent these.
Infection: Use aseptic technique and proper site selection to prevent infection.
Lipodystrophy: Rotate injection sites to avoid lipodystrophy (abnormal distribution of fat tissue).
7. Special Considerations
Patient Age and Size: Adjust needle size and injection site based on the patient’s age, size, and subcutaneous tissue thickness.
Medication Properties: Some medications may cause irritation or require specific injection techniques.
Patient Positioning: Position the patient comfortably to ensure relaxation and reduce the risk of complications.
8. Training and Proficiency
Simulation Training: Regular practice using simulation models to maintain proficiency in SC injection techniques.
Continuing Education: Stay updated on best practices, new medications, and techniques.
9. Legal and Ethical Considerations
Scope of Practice: Adhere to the legal scope of practice for their certification level and local regulations.
Informed Consent: Obtain informed consent from the patient or guardian whenever possible.
Documentation: Accurate documentation of medication name, dose, route, site of injection, time of administration, and any adverse reactions.
Conclusion
Effective SC medication administration requires EMS providers to combine theoretical knowledge with practical skills.
Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.
Further Reading:
Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education
Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson
Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.
Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.
Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education
Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell
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