Administering Subcutaneous Injections: NDIS High Intensity Daily Personal Activities Module

National Disability Insurance Scheme (NDIS) support workers may need to provide assistance with administering subcutaneous injections if an NDIS participant is unable to do so themselves.

What is a Subcutaneous Injection?

Subcutaneous injections are used to administer medicines into the fatty tissue layer between the skin and the muscle (subcutaneous tissue). The subcutaneous tissue has a smaller blood supply, meaning the medicine is absorbed more slowly than if inserted into a vein (Case-Lo 2018; Shepherd 2018).

This type of injection may be beneficial for medicines such as insulin and heparin that require continuous absorption (Shepherd 2018).

Additionally, subcutaneous injections are a less expensive, easier and sometimes more effective way of administering certain medicines (Case-Lo 2018).

The needles used should generally be 16mm long and 25 to 27 gauge (DoH 2018).

What Kinds of Medicines can be Administered Subcutaneously?

• Medicines that can be administered in small doses (less than one to two mL)
• Medicines that need to be administered quickly
• Medicines that need to be administered daily or at home
• Insulin
• Anticoagulant medicines
• Some fertility medicines
• Autoimmune medicines
• Certain hormones
• Analgesics (e.g. morphine)
• Antiemetics
• Some vaccines and allergen immunotherapies.

(Case-Lo 2018; Villines 2018)

Subcutaneous Injection in the NDIS Practice Standards

Subcutaneous injection is a requirement of the NDIS Practice Standards under the High Intensity Daily Personal Activities Module.

Under these standards, NDIS providers must meet the following quality indicators:

• Participants are enabled to engage in the assessment and development of a subcutaneous injection plan that includes dosage measurement and calculation. This plan identifies possible risks, incidents and emergencies, and outlines what actions need to be taken to manage these situations, including the escalation of care, if necessary. The participant’s health status is reviewed regularly (with their consent)
• The participant has been provided with a written prescription or phone order prescribing the medication that will be administered subcutaneously. This prescription must be documented.

(NDIS 2020)

The following skills are required by NDIS workers administering subcutaneous injections:

• Confirming the participant’s identity through three identifiers and confirming their need for subcutaneous injections
• Following the ‘13 Rights of Medication Administration’
• Calculating and measuring medication dosages. If being performed by a support worker, they must be supervised and checked by a clinician
• Understanding the impact of variables such as site location and site rotation
• Understanding and recognising the symptoms of an adverse medication reaction
• Identifying the symptoms of overdose and withdrawal
• Understanding the risks associated with subcutaneous injections and control methods to counter these risks
• Disposing of needles safely
• Maintaining the participant's records
• Following hygiene and infection control procedures
• An understanding of the participant's underlying conditions (e.g. diabetes), if there is one.

(NDIS 2018)

Choosing an Injection Site

The needle must be injected into a site with a layer of subcutaneous tissue. Recommended areas include:

• Umbilical region of the abdomen, about two inches from the navel (avoid the navel)
• Back or side of the upper arm
• Top of the thigh
• Top of the buttocks.

(Villines 2018; Shepherd 2018; Case-Lo 2018)

Avoid areas of skin that have:

• Infection
• Wounds
• Oedema
• Skin lesions
• Scars
• Birthmarks
• Bony prominences
• Large underlying muscles
• Blood vessels or nerves
• Burns
• Bruises
• Broken skin.

(Shepherd 2018; QLD DoH 2020)

It is important to note that different people have varying levels of subcutaneous fat, so each individual should be assessed before you proceed with the injection. Lifting the skin fold can help separate the subcutaneous away from the muscle underneath (which should be avoided) (Shepherd 2018).

If the participant requires frequent injections, you should rotate injection sites to allow each area to heal (Villines 2018).

Method of Injection

1. Perform hand hygiene. While the WHO does not recommend wearing gloves for administering injections, use your own judgement. Wear gloves if bleeding is expected.
2. Prepare an appropriate syringe with the required dosage. Disperse any air bubbles.
3. Place the person into a reclined position.
4. Choose the injection site.
5. Perform hand hygiene.
6. If required, cleanse the chosen injection site and wait for it to dry.
7. Hold the syringe with your dominant hand. With your non-dominant hand, lift a 5 cm fold of skin to separate the subcutaneous layer from the muscle tissue underneath.
8. Using a quick, dart-like technique, insert the syringe at a 45 to 90-degree angle - follow product information for specific guidelines for each medication.
9. Hold the barrel of the syringe firmly and inject the contents for 10 to 30 seconds. The plunger should be pressed all the way down.
10. Wait 10 seconds, then remove the needle and immediately dispose of it into a sharps container.
11. Do not rub the injection site.
12. Apply a dressing if the site bleeds.
13. Record the injection using the required documentation.
14. Monitor for any adverse reactions or complications.

(QLD DoH 2020; Shepherd 2018; John Hopkins Arthritis Center 2012; WHO 2010)

Complications

The participant may experience discomfort at the injection site, such as:

• Pain
• Bleeding
• Redness
• Swelling
• Warmth
• Tenderness
• Haematoma
• Leakage
• Infection.

(Case-Lo 2018; QLD DoH 2020)

Conclusion

While administering subcutaneous injections is considered fairly low-risk, it is still important to ensure providers adhere to correct procedures and manage risks appropriately (ACIA 2018).

Note: This article is intended as a refresher and should not replace best-practice care. Always refer to your organisation’s policy on administering subcutaneous injections.

Additional Resources

• Australian Immunisation Handbook
• NDIS Practice Standards: Skills Descriptors | NDIS
• NDIS Practice Standards: NDIS Practice Standards and Quality Indicators | NDIS
• Medication Administration via the Subcutaneous Route | NSW DoH
• Clinical Practice Procedures: Subcutaneous Drug Administration | QLD DoH

References

• ACIA 2018, Subcutaneous Injections in the Community by Support Workers, ACIA, viewed 18 June 2020, http://acia.net.au/wp-content/uploads/2018/10/ACIA-011-Subcutaneous-Injections-in-the-Community-by-Support-Workers.pdf
• Australian Government Department of Health 2018, Table. Recommended Needle Size, Length and Angle for Administering Vaccines, Australian Government Department of Health, viewed 23 June 2020, https://immunisationhandbook.health.gov.au/resources/handbook-tables/table-recommended-needle-size-length-and-angle-for-administering-vaccines
• Case-Lo, C 2018, What Is a Subcutaneous Injection?, Healthline, viewed 18 June 2020, https://www.healthline.com/health/subcutaneous-injection
• John Hopkins Arthritis Center 2012, How to Give a Subcutaneous Injection, John Hopkins Arthritis Center, viewed 18 June 2020, https://www.hopkinsarthritis.org/patient-corner/how-to-give-a-subcutaneous-injection/
• NDIS Quality and Safeguards Commission 2020, NDIS Practice Standards: NDIS Practice Standards and Quality Indicators, NDIS Quality and Safeguards Commission, viewed 18 June 2020, https://www.ndiscommission.gov.au/sites/default/files/documents/2019-12/ndis-practice-standards-and-quality-indicators.pdf
• NDIS Quality and Safeguards Commission 2018, NDIS Practice Standards: Skills Descriptors, NDIS Quality and Safeguards Commission, viewed 18 June 2020, https://www.ndiscommission.gov.au/sites/default/files/documents/2018-09/high-intensity-skills-descriptors.pdf
• Queensland Government Department of Health 2020, Clinical Practice Procedures: Drug Administration/Subcutaneous, Queensland Government Department of Health, viewed 18 June 2020, https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_Subcutaneous.pdf
• Queensland Government Department of Health 2020, Management of Subcutaneous Infusions in Palliative Care, Queensland Government Department of Health, viewed 18 June 2020, https://www.health.qld.gov.au/cpcre/subcutaneous/section3
• Shepherd, E 2018, ‘Injection Technique 2: Administering Drugs via the Subcutaneous Route’, Nursing Times, vol. 114, no. 9, viewed 23 June 2020, https://www.nursingtimes.net/clinical-archive/assessment-skills/injection-technique-2-administering-drugs-via-the-subcutaneous-route-28-08-2018/
• Villines, Z 2018, Is a Subcutaneous Injection Painful?, Medical News Today, viewed 18 June 2020, https://www.medicalnewstoday.com/articles/322710
• World Health Organisation 2010, WHO Best Practices for Injections and Related Procedures Toolkit, World Health Organisation, viewed 23 June 2020, https://www.who.int/infection-prevention/publications/best-practices_toolkit/en/