Its easy for patients and caregivers to learn how to perform a subcutaneous, or “under-the-skin” injection.
This type of injection is often called a subq injection, pronounced as “sub Q” (“sub cue”).
Check out our video below to watch Dr. Andy Thompson, a rheumatologist, demonstrate how to perform an injection using a 2mL vial of methotrexate and a 1cc insulin syringe.
The video lesson is applicable a variety of medications used in rheumatology that must be taken by subcutaneous injection.
A subcutaneous injection involves poking a small needle just under the skin to deliver medicine into the “fatty tissue” below. The medicine is absorbed by the small blood vessels under the skin.
The way the body absorbs medication under the skin is similar to when you take a pill or tablet. In that case, small blood vessels in the stomach or bowel absorb the medication.
A subcutaneous injection is a different type of injection than those that deliver medicine into a muscle (an intramuscular injection) or directly into the blood (an intravenous injection).
Parts of a syringe
Each syringe has 4 basic parts:
- A needle cap (which is removed)
- A needle
- A barrel which contains the medicine
- And a plunger.
Step-by-Step: How to Inject
There are five basic steps to performing a subcutaneous injection:
Step 1: Gather your supplies
Step 1: Gather your Supplies
We’ve prepared a special “injection placemat” that you can download and print to help make sure that you’ve got all of the necessary supplies:
Place your “injection placemat” on a clean table or surface.
Gather your supplies, you’ll need:
- Your syringe
- A vial of medication
- A clean gauze or tissue
- A puncture proof “sharps container” to dispose of the used syringe.
If you are missing any of the required supplies, talk to your local pharmacist.
Step 2: Choose an injection site
It’s important to start by washing your hands thoroughly with soap and water.
A subcutaneous injection can be given into the thigh, the abdomen, or the upper arm. It’s best to choose a different site for each injection at least a few centimetres (an inch) away from a previous injection.
You can easily inject into your abdomen or thighs on your own, but you’ll probably need help from another person if you want to inject into your upper arms.
It’s a good idea to rotate your injection sites. For example, if you had to take weekly injections, this week you might place the injection in your thigh, and next week to your abdomen. If someone else is performing the injection on you, you can also use your upper arms.
If you’re injecting into your abdomen stay away from the 2 inches around your belly button.
Don’t inject into an area that is tender, bruised, red, hard, or one that has scars or stretch marks.
Step 3: Prepare the medication
- Remove the protective cap from the top of the vial of medication to expose the rubber stopper.
- Remove the needle cap and draw air into the syringe to the amount of methotrexate you are injecting. For example if you are taking 15 mg you’ll draw the syringe back to 0.6 cc’s and if you’re taking 20 mg you’ll draw back to 0.8 cc’s.
- Insert the needle through the centre of the rubber stopper. Push the plunger down to push the air into the vial.
- Slowly pull back on the plunger to draw up the right amount of medicine. Remove the needle from the vial.
Be careful not to touch the needle or allow it to touch anything else.
Step 4: Inject the medicine
- Pinch a fold of skin at the injection site.
- Gently insert the needle into the fold at a 45-degree angle under the skin.
- Release the skin and slowly inject the medicine. When the syringe is empty remove the needle.
- Apply pressure with a cotton gauze or tissue for about 10 seconds.
It’s normal to see a tiny drop of blood.
Step 5: Dispose of the syringe
It’s important to dispose of used sharp syringes in a proper container, often called a Sharps Container. These containers can be found at your local pharmacy.
Don’t ever put the needle cap back on a needle as you or someone else may accidentally poke themselves with it. Simply take the used needle and place it in the Sharps Container.
Store your Sharps Container in a safe place out of reach of small children. When the container is 2/3 full, tape the lid closed and discard of it as instructed by your local pharmacist.
Giving a small injection under the skin is really just that easy. If you have any questions or concerns please talk to your doctor or your nurse.
Methotrexate Injection Sheet
If you are injecting methotrexate, you might be interested in printing off step-by-step instructions for this medication: