At this point in your child’s development, you or your child may be doing the injections. It is a good idea to help your child through the process of giving injections to themselves when you feel they are ready. Learning how to give injections to yourself is a good skill to have for the future. Giving your child independence in their treatment will empower them to take charge of their treatment in the future.
This section of Injection Basics covers:
What is Needed for an Injection
Steps for a Subcutaneous Injection
Tips to Overcome Needle Phobia
Subcutaneous Injections
Medications to treat bleeding disorders are sometimes given through a subcutaneous injection, which means the medication is being injected under your child’s skin. You may hear people say it is a “sub-Q” injection for short. Typically, the first time you perform a subcutaneous injection on your child will be at your child’s HTC (Hemophilia Treatment Center) or with another health care provider. The HTC care team will walk you through how to perform a subcutaneous injection and discuss any other important information with you about your child’s care.
What is Needed for an Injection
When giving your child an injection, it is important to keep the area clean. Remember that anything going into your child’s body needs to be sterile, such as the needle. Sterile means germ free.
Below is a list of items needed to do an injection:
Steps for a Subcutaneous Injection
Here are the steps and tips for a safe and successful injection1. You can also typically find how-to videos and guides as part of the product insert or website.
- Gather all necessary supplies.
- Check the label to make sure you have the correct medication, dose, and type of injection.
- Make sure it has not expired. Check the date.
- Look at the medication to see if seems different than it usually does (different color, texture, or if there is something unusual in the vial). Do not use if it looks different to you.
- Allow medication to come to room temperature before it is injected. This should take about 15 minutes.
- Clean your work area with a sterile alcohol pad. You can also put down a clean cloth or disposable gauze pad.
- Wash your hands and arms up to the elbow with soap and warm water.
- Put on gloves (Gloves are needed when performing an injection on anyone other than yourself).
- Remove the cap from the top of the vial, then clean the top with a sterile alcohol pad.
- Remove the syringe from the packaging. If the transfer needle is not already attached, attach it. This needle is used to fill the syringe with the medication. It will not go into the body. Don’t touch the parts of the needle and syringe that connect.
- Fill the syringe with air that is equal to the amount of medication you will be using.
- Remove the transfer needle cap (place it on its side on a clean area like the inside of the syringe wrapper).
- Insert the needle into the center of the top of the vial.
- Turn the vial upside down with the needle inserted.
- Inject the air with the tip of the needle above the medication to prevent air bubbles.
- Lower the tip of the needle into the medication and gently pull back on the plunger to draw up the prescribed medication dose.
- If there are large air bubbles, flick them to the top of the syringe and push the air back into the vial.
- If the syringe has been over-filled, push the excess back into the vial.
- Check to make sure you have pulled up the correct dose and then remove the needle from the vial.
- a) The vial should be in the upside-down position at this point; flipping the vial right side up before removing the needle may cause loss of some medication from the vial.
- b) If the prescribed dose requires medication from more than one vial, you will need to withdraw all your medication. Check the instruction sheet that came in the package with the medication on how to combine two vials.
- c) If the total dose is greater than 2 mL, you will need to give more than one injection.
- Using one hand, recap the transfer needle by scooping the tip of the needle into the cap. Once it is covered, press down on the cap to secure.
- Remove the transfer needle from the syringe and apply the injection needle.
- a) Both the transfer and injection needles must remain sterile. It is provided in sterile packaging. If it touches anything nonsterile (even a tabletop that has been cleaned), you must discard it and use a new sterile needle instead. Never reuse or share needles.
- Choose the injection site.
- a) The most common injection sites are the side or back areas of the upper arms and thighs, and the area of your stomach near the navel (belly button). Avoid scars, moles, skin lesions, areas with redness, bruised, tender, or hardened areas, and areas over bony prominences, blood vessels and nerves.
- b) Avoid the 2-inch area around the navel.
- c) Sites should be rotated, at least 1 inch from the last injection to prevent irritation or scarring.
- Clean the area with a sterile alcohol wipe and allow to air dry.
- Lift the part of skin where the injection will be given by using your fingers to gently pinch the skin. Inject the needle with the angled surface up, at a 45–90-degree angle. Your HTC team can recommend to you what specific angle to use.
- Let go of the lifted skin, being careful that the needle does not accidentally exit the body.
- Slowly inject the medication.
- Withdraw the needle at the same angle.
- a) You may want to wait a few seconds before taking the needle out so there is no medication leak.
- Push the safety shield on to the needle until you hear a click.
- Dispose of all needles in your sharps container.
- Do not massage the skin after injection.
- Check for any bleeding or adverse reactions and apply a bandage or gauze as needed.
- If you have bruising, an ice pack can be applied with gentle pressure.
- Any medication left in the vial must be thrown away, and vials should not be reused.
- If you spilled any medication or if there is blood on your work area, use chlorine bleach to clean it.
- Make sure to log your treatment in your treatment log.
You can download and print the Steps for Sub-Q Injections to have with you when you inject.
Tips to Overcome Needle Phobia
Kids at various ages may be afraid of needles. This is normal. It is important you stay calm and confident when using needles for your child’s treatment. For more information on overcoming needle phobia, check out this video:
- NHF Nursing Working Group. (2021). Nurses’ Guide to Bleeding Disorders: Emicizumab Subcutaneous Injection Guidelines. National Hemophilia Foundation (NHF). Retrieved March 1, 2023, from https://www.hemophilia.org/healthcare-professionals/allied-healthcare/nursing/nurses-guide-to-bleeding-disorders