Subcutaneous injection

Key points

• 01Hand hygiene and supply preparation. CDC hand-hygiene guidance is applied before any parenteral procedure. Supplies, single-use syringe, alcohol prep pad, sharps container, and the prescribed medication, are laid out before the vial or pen is opened.
• 02Injection-site selection within the three documented zones. The abdomen (avoiding a two-inch radius around the umbilicus), the anterolateral thigh, and the posterior upper arm are the three subcutaneous sites described in nursing-education literature (Perry & Potter; Frid et al. 2016).
• 03Skin antisepsis. A 70% isopropyl alcohol prep pad is applied in a single outward spiral. The site is allowed to air-dry before needle insertion, per CDC injection-safety guidance.
• 04Pinch versus stretch. The skin-pinch technique raises the subcutaneous layer away from the underlying muscle. Frid et al. 2016 (Mayo Clinic Proceedings) describe this as the default approach for short (5/16") insulin needles in lean individuals. The same paper describes stretching for sites with abundant subcutaneous tissue and shorter needles.
• 05Needle angle. A 90-degree angle is described in nursing-education literature for 5/16" (8 mm) needles. A 45-degree angle is described in the same literature for longer needles in individuals with reduced subcutaneous tissue.
• 06Plunger depression and needle dwell. The plunger is depressed at a steady rate. A five-to-ten-second dwell after plunger completion is described in pen-manufacturer package inserts (Novo Nordisk; Eli Lilly) to reduce incomplete dose delivery.
• 07Needle withdrawal and sharps disposal. The needle is withdrawn at the insertion angle and placed directly into an FDA-cleared sharps container. Recapping is not performed, per OSHA bloodborne-pathogen guidance.

Pre-injection checklist

• ✓Wash hands with soap and water for at least 20 seconds (CDC injection-safety guidance).
• ✓Confirm the medication name, strength, expiration date, and prescribed dose against the original prescription.
• ✓Inspect the medication: clear and colourless for most peptide solutions. Cloudy, discoloured, or particulate-containing solutions are not used; the prescriber is contacted.
• ✓Confirm the medication has reached the temperature specified in the package insert. For Ozempic, Wegovy, and Mounjaro the cartridge may be at refrigerated or room temperature; cold injections are reported as more uncomfortable but are not contraindicated.
• ✓Lay supplies on a clean flat surface within reach. Do not open the syringe / pen needle until immediately before use.
• ✓If using a pre-filled pen, dial the dose specified by the prescriber. Confirm the dose window reads the intended dose before each injection.
• ✓Position the sharps container within reach of the dominant hand.

Step-by-step guide

1. 1

   Prepare a clean work surface and wash hands

   Wash hands with soap and water for at least 20 seconds. Lay supplies on a clean flat surface: medication, syringe or pen needle in original packaging, alcohol prep pad, sharps container within reach.

   Pro tip

   Always check the fluid is clear and colourless before injection.
2. 2

   Inspect the medication

   Confirm the medication name, dose, and expiration date. Inspect the solution: clear and colourless for most peptide products. If cloudy, discoloured, or particulate-containing, do not use and contact the prescriber.

   Pro tip

   Always check the fluid is clear and colourless before injection.
3. 3

   Select an injection site

   Choose one of the three documented subcutaneous zones: the abdomen (outside a 2-inch radius around the umbilicus), the anterolateral thigh, or the posterior upper arm. Rotate sites systematically, use a different site than the previous injection.

   Pro tip

   Always check the fluid is clear and colourless before injection.
4. 4

   Clean the site with the alcohol prep pad

   Apply the prep pad in a single outward spiral, covering a roughly 2-inch circle. Allow the alcohol to dry fully before needle insertion (CDC injection-safety guidance). Do not blow on or fan the site.

   Pro tip

   Always check the fluid is clear and colourless before injection.
5. 5

   Pinch the skin and insert the needle

   Pinch a fold of skin and subcutaneous tissue between thumb and index finger, lifting it away from underlying muscle. Insert the needle at a 90-degree angle for short (4–6 mm) needles in most adults, or at 45 degrees for longer needles in lean individuals. The needle is fully seated.

   Pro tip

   Always check the fluid is clear and colourless before injection.
6. 6

   Inject the medication

   Depress the plunger or pen button at a steady, even rate. The injection should feel like firm pressure, not sharp pain. If sharp pain is felt, stop and remove the needle without injecting.

   Pro tip

   Always check the fluid is clear and colourless before injection.
7. 7

   Hold for 5 to 10 seconds

   After the dose dial on a pen returns to zero, or when the syringe plunger is fully depressed, keep the needle in place for 5 to 10 seconds (per Ozempic, Wegovy, Mounjaro, Zepbound prescribing information). This reduces incomplete dose delivery.

   Pro tip

   Always check the fluid is clear and colourless before injection.
8. 8

   Withdraw and dispose

   Withdraw the needle at the insertion angle. Release the skin pinch. Place the used needle directly into the sharps container without recapping (OSHA 29 CFR 1910.1030). Apply gentle pressure with clean gauze if a bead of blood or fluid appears; do not rub.

   Pro tip

   Always check the fluid is clear and colourless before injection.

After the injection

• Do not rub the injection site. Gentle pressure with clean gauze for ten to twenty seconds is acceptable if a small bead of fluid or blood appears (Frid et al. 2016).
• Replace the outer needle cover only if the package insert specifies; otherwise dispose of the needle directly into the sharps container without recapping (OSHA bloodborne-pathogen guidance).
• Record the injection: date, time, dose, site (left vs right, abdomen vs thigh vs upper arm). Site logs are described in Forum for Injection Technique recommendations as the primary tool for systematic rotation.
• Wash hands again. Return medication to the storage condition described in the package insert (refrigerated for unopened pens; ambient for in-use pens within the manufacturer-specified window).
• Mild soreness, a small bruise, or a 1 cm patch of pinkness at the injection site that resolves within 24 hours is consistent with normal injection response and does not warrant prescriber contact (Frid et al. 2016).

Common mistakes

Frequently asked questions

Sources

1. Frid AH et al., 2016. New Insulin Delivery Recommendations, Mayo Clinic Proceedings
2. CDC. Injection Safety: Safe Injection Practices
3. OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030
4. Wilding JPH et al., 2021. Semaglutide STEP-1, NEJM (injection administration protocol)
5. Jastreboff AM et al., 2022. Tirzepatide SURMOUNT-1, NEJM (injection administration protocol)
6. Ozempic (semaglutide) Prescribing Information. Novo Nordisk
7. Wegovy (semaglutide) Prescribing Information. Novo Nordisk
8. Mounjaro (tirzepatide) Prescribing Information. Eli Lilly
9. Zepbound (tirzepatide) Prescribing Information. Eli Lilly
10. Stevens DL et al., 2014. IDSA Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections
11. Forum for Injection Technique (FIT). Recommendations for Best Practice in Injection Technique
12. Perry AG, Potter PA. Clinical Nursing Skills & Techniques (Elsevier). Subcutaneous injection chapter.