SC injection sites with ascites

[tsm007]

I took care of a pt last night who had ascites and needed 2 SC injections. I gave both in the back of his arm because it just didn't seem like the meds would be really going into SC tissue in the abdomen with that much ascites. After I was done though I started wondering about that whether the abdomen is contraindicated with ascites and couldn't find much info on it searching the topic. Can anyone tell me if there are rules on this?

[Double-Helix, BSN, RN]

Ascites is build up of fluid between the peritoneum (the protective membrane of the abdominal cavity) and the abdominal organs, so this fluid accumulates underneath whatever layers of subcutaneous tissue the patient may have on the abdomen. However, severe ascites may cause the skin (and fat) of the abdomen to be stretched thin, making it difficult or even more painful to correctly inject into the subcutaneous tissue there.

So really, it's not immediately contraindicated and if you have decent subcutaneous tissue, ascites likely won't affect absorption of an injected medication. It depends on the severity of the ascites and how much subcutaneous tissue is present on the abdomen to begin with. I'd agree with your decision to use an alternative injection site, though, especially if you're questioning it or the abdomen is distended. Keep in mind that the thighs are also appropriate for subcutaneous injections as well.