Lydia, a student nurse, is assigned to assist a staff nurse who is caring for a diabetic patient. According to the patient’s chart, the patient is due to receive an insulin injection in 15 minutes. Since it will be her first time to observe such procedure, she couldn’t help but feel both excited and anxious.

Excited because this means she could learn more about the procedure better upon seeing it getting performed right before her eyes (she learns best through observing). And anxious since she doesn’t know what to expect. Yup, she has heard about it, and she even encountered the procedure once or twice when reading nursing books, but she didn’t really pay that much attention.

 With just a little background on what the procedure is all about, she doesn’t know what will happen or how the procedure is done. She knows that there are several types of insulin, but will they all be administered just the same? Or are there certain considerations one must take?

Below are the steps on how to give an insulin injection as well as steps on how to fill the syringe with one/two types of insulin:

Filling the Syringe – One Type of Insulin

• Wash your hands with soap and water. Dry them well.
• Perform assessment. Check the insulin bottle label and make sure it is the right insulin. Also make sure it is not expired.
• The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle.
• Intermediate-acting insulin is cloudy, and must be rolled between your hands to mix it. DO NOT shake the bottle. This can make the insulin clump.
• Clear insulin does not need to be mixed.
• If the insulin vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. DO NOT blow on it.
• Know the dose of insulin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of medicine you want.
• Put the needle into and through the rubber top of the insulin bottle. Push the plunger so the air goes into the bottle.
• Keep the needle in the bottle and turn the bottle upside down.
• With the tip of the needle in the liquid, pull back on the plunger to get the right dose of insulin into the syringe.
• Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the right dose.
• When there are no bubbles, take the syringe out of the bottle. Put the syringe down carefully so the needle does not touch anything.

Filling the Syringe – Two Types of Insulin

• Never mix two types of insulin in one syringe unless you are told to do this. You will also be told which insulin to draw up first. Always do it in that order.
• There will be a doctor’s order on how much of each insulin the patient will need. Add these two numbers together. This is the amount of insulin you should have in the syringe before injecting it.
• Wash your hands with soap and water. Dry them well.
• Check the insulin bottle label. Make sure it is the right insulin.
• The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle.
• Intermediate-acting insulin is cloudy, and must be rolled between your hands to mix it. DO NOT shake the bottle. This can make the insulin clump.
• Clear insulin does not need to be mixed.
• If the vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. DO NOT blow on it.
• Know the dose of each insulin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of the longer-acting insulin.
• Put the needle into the rubber top of that insulin bottle. Push the plunger so the air goes into the bottle. Remove the needle from the bottle.
• Put the air in the short-acting insulin bottle the same way as the previous two steps above.
• Keep the needle in the short-acting bottle and turn the bottle upside down.
• With the tip of the needle in the liquid, pull back on the plunger to get the right dose of insulin into the syringe.
• Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the right dose.
• When there are no bubbles, take the syringe out of the bottle. Look at it again to make sure you have the right dose.
• Put the needle into the rubber top of the longer-acting insulin bottle.
• Turn the bottle upside down. With the tip of the needle in the liquid, slowly pull back on the plunger to exactly the right dose of long-acting insulin. DO NOT draw extra insulin in the syringe, since you should not push the mixed insulin back into the bottle.
• Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Remove the needle from the bottle before you push out the air.
• Make sure you have the right total dose of insulin. Put the syringe down carefully so the needle does not touch anything.

Giving the Injection

Choose where to give the injection. Check the chart for places that have been previously injected, so you do not put the insulin in the same place all the time.

• Keep your shots 1 inch away from scars and 2 inches away from your navel.
• DO NOT put a shot in a spot that is bruised, swollen, or tender.

The site you choose for the injection should be clean and dry. If the skin is visibly dirty, clean it with soap and water. DO NOT use an alcohol wipe on your injection site.

The insulin needs to go into the fat layer under the skin.

• Pinch the skin and put the needle in at a 45º angle.
• If the tissues are thick enough, you may be able to inject straight up and down (90º angle).
• Push the needle all the way into the skin. Let go of the pinched skin. Inject the insulin slowly and steadily until it is all in.
• Leave the syringe in place for 5 seconds after injecting.

Pull the needle out at the same angle it went in. Put the syringe down. There is no need to recap it. If insulin tends to leak from the injection site, press the injection site for a few seconds after the injection.

Dispose needle properly. Place the needle and syringe in a safe hard container. Never reuse needles or syringes.

 

Sources:

• https://medlineplus.gov/ency/patientinstructions/000660.htm
• https://www.webmd.com/diabetes/type-1-diabetes-guide/give-yourself-insulin-shot