Droplet oozing from subcutaneous administration?

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Hi all!

I am in my first month of nursing. This week I was giving a subQ insulin-R shot (8 units) and when I withdrew the needle, a droplet of insulin came out with it. I wondered if I got the insulin in the wrong type of tissue (I pinched skin behind the arm and injected at a 90 degree angle). The patient is a young adult of average or slightly above weight, admitted for DKA.

The same day, I gave a 70 unit lovenox shot in the "love handle" (left abdoment, lateral to umbilicus) of an older adult who is a bit on the heavy side, and I noticed the exact same thing. If the answer is using the z-track method for insulin, I shouldn't do this for lovenox, right, or I risk bruising or hematoma?

I've given subq shots in school clinicals and on the job, and never noticed this before. Am I doing something wrong? I talked to my preceptor and she didn't seem concerned, but she was busy, too.

Thanks,

Greg

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I wouldn't be concerned either. Just make sure you have completely depressed the plunger before withdrawing the needle.

Note: Lovenox is only supposed to be injected in the abdominal area.

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Specializes in LTC, Med-Surg, IMCU/Tele, HH/CM.

This is a normal occurance ( I *think* but correct me if I'm wrong) if you withdraw the needle right after you depress the plunger. I was taught in nursing school to depress the plunger and count to three silently before withdrawing the needle. This allows the medication to absorb a bit so that it doesn't follow the path of least resistance out through the puncture site.

I thought Z-track was an IM method for irritant meds like Iron and so? I didnt think you could use it with sub-q. . .

Also, in the hospital I did clinicals in Lovenox could be injected in either the abdominal area or the "love handles" or the upper thighs (if there was enough fat) with about 9 or 10 different rotating sites. Perhaps each hospital has a different policy?

Would like to see more imput about this from experianced nurses :) Not sure if I'm correct since I am a new grad as well!

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Specializes in med/surg, telemetry, IV therapy, mgmt.
http://www.drugs.com/pro/lovenox.html
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Specializes in LTC, Med-Surg, IMCU/Tele, HH/CM.

Thanks for the link!

I just wanted to post the guidelines for sub-q injections. . . This website says:

"Subcutaneous Injection Technique: Patients should be lying down and Lovenox administered by deep SC injection. To avoid the loss of drug when using the 30 and 40 mg prefilled syringes, do not expel the air bubble from the syringe before the injection. Administration should be alternated between the left and right anterolateral and left and right posterolateral abdominal wall. The whole length of the needle should be introduced into a skin fold held between the thumb and forefinger; the skin fold should be held throughout the injection. To minimize bruising, do not rub the injection site after completion of the injection."

So that clears it up pretty well :)

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Hi all!

I am in my first month of nursing. This week I was giving a subQ insulin-R shot (8 units) and when I withdrew the needle, a droplet of insulin came out with it. I wondered if I got the insulin in the wrong type of tissue (I pinched skin behind the arm and injected at a 90 degree angle). The patient is a young adult of average or slightly above weight, admitted for DKA.

The same day, I gave a 70 unit lovenox shot in the "love handle" (left abdoment, lateral to umbilicus) of an older adult who is a bit on the heavy side, and I noticed the exact same thing. If the answer is using the z-track method for insulin, I shouldn't do this for lovenox, right, or I risk bruising or hematoma?

I've given subq shots in school clinicals and on the job, and never noticed this before. Am I doing something wrong? I talked to my preceptor and she didn't seem concerned, but she was busy, too.

Thanks,

Greg

Hi Greg,

Just had an in service regarding adminstering insulin. You should hold the plunger down and count 123. Apparently for insulin it does matter......Counting 123 insures that the patient is getting the proper coverage. ( you should not see any drops after counting)

Hope that helps:)

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Specializes in ER, Med/Surg.

Z-track is only for IM, not SQ. Lovenox can be given in the "love handles", that is covered in the link above.

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Thanks so much for the help. I will definitely count to 3 after giving insulin.

Regarding the lovenex, my hospital's policy is to only give it in the love handles, not in the anterior abdomen around (but away from) the umbilicus. The nursing management says that in their study of best practices, only using the love handles reduces the risk of hematomas and bruising.

I don't know where they got that or if there is any conflicting evidence based practice!

Thanks again,

Greg

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