 The purpose of a subcutaneous injection is to place medication between the skin and the muscle tissue in a tissue layer that is rich in blood vessels. This causes the medication to be quickly distributed throughout the body. This program will show you how to administer the familiar shot in the arm to provide a subcutaneous injection. After you've washed your hands, assembled, checked, and loaded your equipment, you begin by locating a suitable injection site. Actually, there are many suitable injection sites. The most commonly selected are the outer part of the thigh and the upper arm. During this program we'll use the posterior area of the upper arm, here toward the back of the patient's arm. Now, clean the area of your patient's arm to be injected. Use an antiseptic sponge and scrub in a circular motion, spiraling outward from the injection site. Now, pick up the syringe and remove the needle guard. Pull it straight off. Don't touch the guard to the needle. With your other hand, pinch the skin of your patient's arm and hold it firm. Hold the barrel of the syringe with your right hand between your thumb and index finger. Check to see that the cutting edge or bevel of the needle is pointing up toward you. Now move the needle up toward the cushion of skin you're pinching between your fingers. Hold the needle at about a 45-degree angle upwards. Straight in is 90 degrees. 45 degrees is halfway. Insert the needle at this 45-degree angle into the skin. Insert it with a firm, quick forward thrust. When the needle has penetrated the skin, you can release your pinch and move your free hand to the plunger of the syringe. Now comes a very important precaution. As we explained, the purpose of this type of injection is to introduce medication to the blood-rich tissue under the protective skin. But you never want to inject medication directly into a blood vessel. The effect of medication might injure the blood vessel. It could even cause shock. Therefore, you need to check yourself. Draw the plunger back a bit or aspirate. If you have hit a blood vessel, some blood will appear in the syringe. If blood appears in the syringe, withdraw the needle and start again. If no blood appears in the syringe when you aspirate, press the plunger into the barrel slowly and steadily until all the medication is injected. Then put an alcohol sponge over the site and quickly remove the needle. Massage the site with the antiseptic sponge. Use a gentle circular motion to help disperse the medication throughout the tissue so that it will absorb readily. Then discard the syringe and needle in the appropriate container. The process of injection takes a very short time. We stretched out this process to make our teaching points. Now practice this task yourself. Intradermal injections are commonly used for various skin tests for sensitivity to disease or allergies. This lesson will show you how to administer an intradermal injection. The purpose of an intradermal injection is to introduce very small quantities of a solution between the layers of the skin. Intradermal means within the layers of the skin. Since very small quantities of solution are administered, you use a much smaller syringe than you would use for other kinds of injections. And you would use a smaller needle too. Here you can see the difference between the kind of syringe which might be used for an intramuscular injection and the smaller needle in syringe for intradermal injections. You prepare the needle in syringe in the same manner as you would for other injections except that you should use the smaller tuberculin syringe. When your syringe is prepared, apply these principles to administer the intradermal injection. Select an injection site and cleanse it with a firm circular motion. Recheck your syringe and expel any air bubbles that may still be in the syringe. While pulling the skin tight, insert the needle. Then slowly inject the solution and withdraw the needle, being careful to avoid pressure over the injected skin. For an intradermal injection, select a site on the inside of the patient's forearm, the side which would be exposed when the hand is palm up. With a sponge wet with disinfectant like ether or acetone, cleanse the injection site using a firm, gentle circular motion, cleaning outward in a spiral. Now pick up your syringe. Remove the needle guard and hold the syringe around the barrel. The bevel or cutting edge of the needle should be facing up. Next stretch the skin tight across the forearm at the injection site. Hold the syringe so that the needle is at a flat angle, almost parallel to the skin, about 15 degrees. Insert the needle only enough so that the cutting edge or bevel penetrates the skin. When the needle has penetrated the skin, you can use your other hand to operate the plunger. Inject a small amount of solution. If you have inserted the needle correctly, a small white circular bump will appear on the skin. Inject the remainder of solution slowly. The small amount of solution you ordinarily inject will remain in the circular bump under the skin. Withdraw the needle and blot the site with a dry sterile sponge. Don't massage the circular bump and caution your patient not to rub or scratch it. You don't want to disperse any of the solution into the underlying tissues. When finished, dispose of your needle and syringe in the appropriate place. Now practice the whole task.