Administering subcutaneous injections to children: what does the evidence say?

Abstract

The administration of subcutaneous injections to babies, children and adolescents is a fundamental nursing task and one that should be underpinned by an evidenced-based practice. The subcutaneous route is used routinely with children to administer a wide variety of pharmacological preparations including vaccinations, anticoagulants, analgesics, insulin, growth hormones and some anti-carcinogen agents (Torben et al, 2006). These medications are predominantly administered via injection or continuous infusion. Subcutaneous injection technique varies greatly among nurses and children who self-administer, ranging from the angle of insertion (a 45-degree angle to a 90-degree angle) to the use of an elevated skin-fold or not. The variation in the selection of needle lengths may also result in the possibility of intramuscular injections rather than achieving a true subcutaneous injection (Prettyman, 2005). Paediatric nursing text books (Trigg and Mohammed, 2006), journal articles (Annersten and Willlman, 2005; Tubiana-Rufi et al, 1999) and patient instruction leaflets often give conflicting or inconsistent advice regarding subcutaneous injection technique. The administration of subcutaneous injections can cause stress, anxiety and pain to children (Trigg and Mohammed, 2006) often leaving them apprehensive about receiving future medications, or even becoming noncompliant with medical care (Ellis and Bentz, 2007). Injection pain is often the result of injury to the nerve fibre endings located in the skin and tissue from mechanical trauma caused by the needle puncture. Kuzu and Ucar (2001) have noted that site-pain causes the patient physical and psychological discomfort and bruising often limits possible sites for subsequent injections. This article examines the literature that guides clinical practice and considers recent changes in relation to the administration of subcutaneous injection in children, while acknowledging that there is little evidence-based practice to support the formulation of recommendations regarding the technical aspects of subcutaneous administration (Annersten and Willman, 2005). This paper examines the nurse’s role in administration of subcutaneous medications.