This document provides guidance on administering subcutaneous injections using a multi-dose vial. It describes how to check the patient and prescription, select the correct equipment, calculate the dose, draw up the medication avoiding bubbles, administer through subcutaneous injection, and dispose of sharps and waste properly. Safety is emphasized throughout by checking for errors and preventing contamination.

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Sub-cutaneous
Injection Technique
Use of a multi-dose vial

2. Prescription Sheet
Before starting
CHECK
 Patient Details
 Admission Details
 Allergies and Sensitivities
 Drug prescription is
correct and legal
 That the drug has not
already been given
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Multi-dose Vial
Drug name
Preparation
Concentration
Expiry date
Metal cap
surrounding
rubber bung
•Select the correct drug
•Check the expiry date, clarity
•and integrity of the vial
•When satisfied calculate the
dose to be given

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Calculate the amount of fluid to be drawn up
What you want X VOL the drug is in = Volume you need
What you have got
Need to give 75mg Pethidine.
You have 250mg in a 10mL ampoule.
75mg
X 10mL = 3mL
250mg
Volume required for administration = 3mL
* Please see calculating drug dose study guide.

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Preparation
Select Required Equipment
 Alcohol swab x 2
 for cleaning tray and vial /
ampoule
 Clinically clean tray then wash
hands before selecting
remaining equipment
 Gloves
 if fluids are irritant, corrosive or
cytotoxic.
 As per local hospital policy
 For administration
 Vial/ampoule of required drug
 Gauze
 to apply pressure to site if
bleeding

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Preparation
Select Required Equipment
WASH YOUR HANDS
 Sterile syringe.
 size depends on the amount of
fluid to be drawn up
 Sterile filter needle or
‘drawing up’ needle (needs
to be a sharp needle if
piercing a rubber bung)
 if not available no larger than
a green 21 Gauge
 Second sterile needle
 size depends upon method of
administration
 Check all packaging is clean
intact and within expiry date

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Prior to drawing up any injection
 Patient Identity on prescription sheet
 (This will be checked again against patient ID band before administration).
 Prescription
 (the correct fluid/drug).
 Equipment Ready
 (close to hand, packaging intact & clean).
 Ampoule / vial
 drug name – many drugs have similar names,
 concentration, expiry date, may need to note Batch No.
 clarity & colour of contents
 If the vial/ampoule appears discoloured, or cloudy or if particles are
present, discard it and repeat with a new one and inform pharmacy.
 Clean vial / ampoule with alcohol swab and allow to dry.

8. Prior to drawing up any injection
 Clean tray with appropriate solution.
 Wash hands.
 Select and open equipment and assemble
without touching key parts.
 Put gloves on prior to piercing the vial.
 Remove needle sheath (cap) in an
appropriate safe manner
 Draw up solution
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Drawing up - VIAL
 Draw up air into the
syringe (equivalent to
volume to be given)
 Insert unsheathed
needle into vial at a 30-
60o angle (to reduce
coring) whilst it is stood
on work surface. Avoid
holding it with your
other hand.
45-60°

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Drawing UP - VIAL
 Inject the equivalent amount of air into the vial
(this is to break the internal vacuum)
 Pull back on syringe plunger & withdraw fluid as
required, preferably slightly in excess of the
required amount to allow for removal of air
 If you do not have enough fluid in the syringe you
must change the needle for a clean one before
drawing up more fluid. This is to minimise
contamination.

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Removing Air / Excess fluid
When drawing up fluid from the vial/ampoule
air bubbles may be present inside the syringe.
This air needs to be removed before
the fluid is injected.
 To minimise the risk of the needle coming off make
sure it is firmly applied
 Hold the syringe upright by the plunger so the air
will move towards the nozzle of the syringe.
 Draw back a further small amount of air into your
syringe (to create a dead space for air to collect)

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Removing Air / Excess fluid
 Flick the syringe firmly with finger to encourage air
bubbles to float towards the nozzle of the syringe.
 Draw back slightly again on the plunger to remove
any fluid which may now be in the hub of the
needle.
 Carefully depress the plunger of the syringe to
expel the air from the syringe nozzle. Remember to
keep the syringe nozzle upright.
 The fluid should be seen entering the hub of the
needle. This will give you a correct fluid level.

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Removing Air / Excess fluid
 DO NOT SQUIRT EXCESS FLUID INTO AIR DUE
TO RISK OF AEROSOL CONTAMINATION.
 Any excess fluid drawn up in the syringe should be
expelled gently into a procedure tray when using a
multi dose vial or, if using an ampoule excess can
be placed back into the ampoule.
 If adept enough some people choose to leave the
needle in the vial and dispel air and excess.

14. Removing Air / Excess fluid
 Dispose safely of used needle & apply
correct sized needle for administration.
 Do not use the sharps bin to remove the
drawing up needle as it will contaminate
nozzle
 Needles should be an appropriate size for the
route of administration and the condition, age
and size of the patient
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15. Fluid Levels
Fluid Level
This displays 9mL
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DO NOT RESHEATH
 It is good practice NOT TO RESHEATH NEEDLES in
clinical areas.
 This reduces the risk of accidental sharps injury by clean or
‘dirty’ i.e. used needles.
 When the ‘drawing up’ needle is removed it should
immediately be replaced (without contaminating the
nozzle of the syringe) by a clean sheathed ‘giving needle.
 Following administration, the used needle should be
disposed of immediately into a ‘SHARPS BIN’ (which
should be beside the patient).
 However….
* Clean insulin syringes are resheathed to prevent
contamination of needle in transit to the patient

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Principles of administration
 Return to your patient- if you have prepared the injection
within the patients clinical area you only need to wear
one pair of gloves for the entire procedure.
 introduce yourself if you have not done so earlier
 Take with you
 appropriate procedure tray with sharps box. Procedure tray should
contain syringe with correct drug drawn up, relevant ampoule / vial,
and gauze.
 prescription sheet
 Check the patient’s identity verbally and visually, comparing
the wrist band to the prescription sheet if not done earlier
 Explain what you intend to do and gain informed consent
 Offer the patient privacy and expose the optimal available
site

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Administration
 Choose an appropriate site based on
 the type of injection (intra-dermal, sub-cut . or
intramuscular)
 the volume of drug to be administered
 Avoid sites with signs of inflammation, swelling,
open lesions and infection
 Rotate sites to avoid complications such as muscle
atrophy and sterile abscess from poor perfusion
 Administer injection

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Subcutaneous (SC) injection
 Placed in the loose connective tissue
under the dermis.
 Optimum sites include vascular areas
 outer aspect of the upper arms,
 peri-umbilical area of the abdomen
 anterior aspect of the thighs
 Only suitable for small volumes (0.5 –
1mL) of water-soluble medication
 Use a 25G (orange) needle inserted at
90° degrees to the skin
 Pinch up a fold of skin
 Depress plunger slowly and wait for 6
seconds then withdraw needle

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SC Insulin injection
 All insulin preparations in the UK contain 100 units/mL, so
the syringe is delineated in units with no calculation
required.
 Generally there are 2 insulin syringes (50units and 100
units) the delineations are 1 unit for each mark in a 50 units
syringe and 2 units for each mark in a 100 units syringe.
 Insulin syringes have virtually no ‘dead-space’ (amount of
insulin remaining in a syringe after injection is minimal).
 Insulin syringes have correct sized needle pre-attached
 Insulin needles are micro fine to minimise pain
 Inject an equivalent amount of air into the vial as insulin to
make withdrawal of the fluid easier
 Once administered leave the needle in for 6 seconds
 Site should be rotated at each administration

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After administration
 Check injection site
 Cover patient up (if appropriate)
 Dispose of all waste appropriately (see universal
precautions study guide)
 Wash hands
 Sign the prescription sheet (only after
administration)
 If used, return multi dose vial to refrigerator or
cupboard.
 In some instances may be labelled with patient’s details
and used only for that patient

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DISPOSAL of WASTE
Once the correct amount of fluid has been drawn up from
the vial / ampoule, waste should be disposed of safely.
 Sharps Bin (Yellow Plastic Bins):
 needles & syringes (as one).
 Glass ampoules (if separate glass container not provided)
 Contaminated Clinical Waste (Yellow Bag):
 waste that has been or could have been in contact with patient,
 syringe if not attached to needle, alcohol swabs, cotton wool if
used.
 Domestic Waste (Black Bags, Clear bags within
University):
 non-contaminated waste, outer packaging of syringe & needle,
paper, plastic etc.