Subcutaneous Injections: how?
April 1, 2020 2:22 PM   Subscribe

I have to give myself a subcutaneous injection in the stomach from a prepared needle twice a day for the next little while. I think I'm doing it wrong. You've done it before. Walk me through it please?

It's a blood thinner - Enoxaparin, to be specific. The syringes are all preloaded from the pharmacy. The RN at the doctor's office said the pharmacist would tell me how to do it but not to worry, it was perfectly simple, safe and fast. The pharmacist said, no big deal, just pinch some stomach fat, dab it with rubbing alcohol, slide the needle in from a 45 degree angle, it won't hurt. OK well it hurts. Am I supposed to put the needle all the way in to the hilt? It's long! I'm scared! And when I did it this morning it formed a bubble in my skin! I didn't put it in all the way, I got too freaked out.

Is that normal? I would call the doctor's office but they are so swamped with really important things, please, could someone who has done this before walk me gently through the whole process? I watched some youtube videos but they didn't help much. Honestly I'm not sure I can do it again, it was so awful the first time. I am not a needle person, I really am not. Help!
posted by mygothlaundry to Health & Fitness (21 answers total) 2 users marked this as a favorite
Best answer: 'slide the needle' is the problem. you want to take a pinch of stomach and lightly JAB the needle in. quick delivery is less painful than slow just like taking off a bandaid (I did many subq injections when I was an ovum donor)

needle is 1/2"? if so you do put it in all the way IANYD. good luck!
posted by supermedusa at 2:25 PM on April 1, 2020 [3 favorites]

Best answer: The bubble formed because you didn't put the needle in far enough so it ended up in your skin tissue instead of the fat layer underneath. Be brave! And quick, like supermedusa said.

The pharmacist who said it won't hurt was lying to you! The needle hurts a bit of course, and the enoxaparin burns too. No real way around that. One thing that helps is to really SCRUB the skin with the alcohol to get all your little nerve receptors focused on the scrubbing feeling instead of the needle feeling.

I'm happy to talk you through it on the phone if you'd like! I'm an RN who gives a lot of enoxaparin shots, and who is personally quite wimpy about needles and has therefore developed some tricks.
posted by adiabat at 2:37 PM on April 1, 2020 [36 favorites]

Best answer: Yes you put the needle in all the way.

Swab your stomach, then grab a chunk of fat, not just a little bit. You are just making it easier to put needle in. Jab that needle in at angle quickly. You must put it in all the way and leave it in as you push the plunger. Depending on how big the dose is, count slowly to five or ten as you push the plunger. Then count again after it is pushed down all the way (edit to add:) before pulling needle out. The bubble indicates the needle was not in far enough and/or you pushed the plunger too fast.

Sometimes shots sting like a b***h!!!! Sometimes they are nearly painless.

IANAD. I have had type 1 diabetes for 26 years and have taken 5-10 shots per day.
posted by ChristineSings at 2:38 PM on April 1, 2020 [9 favorites]

Best answer: IANYD. Not sure which videos you watched, but this is the video that I refer my patients to for reference if they aren't able to come in for nurse supervision with first injection. It is made by the manufacturer and is easy to understand.
posted by honeybee413 at 2:51 PM on April 1, 2020 [2 favorites]

Best answer: For me I have to let the rubbing alcohol totally dry or the needle burns going in. You could also ask about lidocaine if it continues to hurt. Good luck!
posted by jeszac at 2:54 PM on April 1, 2020 [3 favorites]

Best answer: Look for the bevel on the needle. You want the long part down and the cut-out part of the needle on top. If you reverse that there's a lot more pain.

You don't have to put the needle in to the hilt, just far enough that the meds don't leak out when you pull the needle out.

Bubble is normal. The medication is a fluid, and it's not absorbed instantly. It's pushing your skin up. You may have done it too shallowly. I would personally not pinch skin because I can gauge depth better that way. I also like to depress the plunger slowly, which also helps less of a lump to form.

Don't freak out. It sounds like this went fine and you just need to refine your technique. If you ever get tired of injected in your stomach you can also do the fat under your arms.
posted by liminal_shadows at 3:02 PM on April 1, 2020 [3 favorites]

Best answer: "too shallowly" meant to add that's not a problem per se, but it looks weird and i.agree it's comforting to have less of a bump. Follow what I said above and you'll refine your technique to something that pleases you.
posted by liminal_shadows at 3:04 PM on April 1, 2020

Best answer: When I had to do this, I used an ice pack to numb the area first. That really helped, as became obvious when I was away from home and didn’t have one. It still hurt some, but I did get used to it.
posted by FencingGal at 3:16 PM on April 1, 2020 [3 favorites]

Best answer: And don't always inject in the same place. It can hurt more if you keep using the same spot all the time.
posted by a humble nudibranch at 3:21 PM on April 1, 2020 [4 favorites]

Best answer: It varies! I did needles for maybe two years and sometimes it was a tiny sting sometimes a big ouch. I had best luck with lying down and sliding at a slight angle directly into taut skin, opposite of the pinch.

Make sure you follow a clock around your bellybutton so you fairly evenly distribute the injection sites. The bruising on thinners can be spectacular and it’s easy after a while to tell a fresh sore from just bruised.

Ice packs are very nice too. But you will get the hang of it, don’t worry.
posted by dorothyisunderwood at 3:39 PM on April 1, 2020 [2 favorites]

Best answer: It gets better, it really does. I did my first few with the nurse in hospital and it didn't go great but by the time I was home doing them I was a pro. You're doing fine. They wouldn't give these to patients to do alone if it wasn't pretty foolproof.

I found side-belly fat easier but I am well endowed with it and had options to chose from.

Quick is best, the anxiety is worse than the needle. The angle is so you're definitely going through fat only with no risk to your organs

Also you'll end up with bruises everywhere you injected which can be quite satisfyingly horrifying.
posted by kitten magic at 3:55 PM on April 1, 2020

Best answer: Another insulin user here. I find pinching my skin quite hard helps to distract from any pain from the needle going in - I suppose I have more control over the pressure of the pinch so can ensure it hurts just enough to (literally) take the sting out of the needle.

The other thing I was told by my nurses was to make sure the needle was at 90° to my skin, otherwise it hurt more. Obviously you must follow the medical advice you've been given, but on the occasions where the injection hurt a lot, I did observe that the needle tended to be at an angle to the skin.
posted by Martha My Dear Prudence at 4:06 PM on April 1, 2020 [1 favorite]

Best answer: When I was giving my dad multiple needles a day, the nurses told me to think of throwing a dart. That action makes sure you don't gliiiiide it in, which will hurt like a bear. Good luck. You've got the first and the worst out of the way. You can do this!
posted by kate4914 at 4:15 PM on April 1, 2020 [1 favorite]

Best answer: Seconding the ice pack prior. I used to do Humira shots with the pen and it helped tremendously.
posted by stefnet at 4:25 PM on April 1, 2020

Best answer: Good advice in this thread so far. You can also stick the needle (or one of your used needles) into an orange to practice the quick and dart-like motion. It's kind of hard to force yourself to do that motion on your own body when you don't feel confident about it yet, so practicing on an orange might help.
posted by aka burlap at 5:39 PM on April 1, 2020 [2 favorites]

Best answer: Former blood thinner user (2009), former insulin user (2011); the methods are similar but not the same. The most important thing is what kate4914 and others said -- it's like a dart.

Put on fast, upbeat music -- I always used Pink's Bad Influence. Then, swab, and with the bit of fat (low and to the side*) pinched, bounce your wrist like you're going to throw the dart: one, two, JAB...all the way in (closer to at a 90° angle--your wrist and using your low side belly will make it less than a full 90°).

Once the needle is all the way in, THEN depress the button to fill yourself with blood-thinning goodness. SLOWLY--it will sting more, the faster you pump it in. Then count to 5 (Mississippis and all) after you finish before you take the needle out.

And guess what? They fibbed. It hurts. Blood thinner hurts. Insulin hurts. It just hurts. Do not use the same injection site every time. Each day, switch sides -- far left of navel, far right of navel, then again.

And nobody is a needle person. I don't even have pierced ears because I can't stand the idea of needles. But for six months I gave myself blood thinner so that my INR would be in range, because I did NOT want another blood clot. For the first 10 weeks after my diabetes diagnosis, I was on insulin. It was easier because I'd done the blood thinner, but it was never fun.

*"To the side" is relative. My breasts obscured my view, so I had to sit on the edge of the tub and lean slightly so I could do it, and still couldn't get very far to either side.
posted by The Wrong Kind of Cheese at 7:18 PM on April 1, 2020

Best answer: I didn't use that blood thinner, but another one with a slightly different technique...

For me, sometimes it hurt and sometimes it didn't but it's rapidly over and done with. I'm guessing that it's down to whether I happened to be nearer or further away from a nerve. The comments here make me happier that there wasn't some clever trick I was missing, so from that I'd say expect variation.

Also to note that three or four sites in rotation seems to work out okay, and as it is a blood thinner it will occasionally leave a small bruise because, you know, you aren't clotting just there. It won't hurt, but it might look unusual.
posted by How much is that froggie in the window at 7:45 PM on April 1, 2020

Best answer: Definitely check the bevel on the needle and do it bevel (angled side) up. Fast in, slow out seemed to help when I was doing rtha's injections. And moving the location around to avoid overusing any one spot. There are definitely youtube videos about giving yourself injections - some better than others. It will get easier!
posted by gingerbeer at 9:22 PM on April 1, 2020

Response by poster: Thanks everyone! I just did it again and it went WAY better. The ice was super helpful and so was just, well, jabbing it in. I am freaking out considerably less. Seriously, y'all you have no idea how much this has helped! It is really good to hear from other people who have done it. This morning I was a hot mess but now I feel almost confident, which is a good thing, because I might have to do this for a while.
posted by mygothlaundry at 9:39 PM on April 1, 2020 [16 favorites]

With that medicine you may get some bruises at the shot spots. That’s common. Avoid rubbing the spots to minimize this. (You know how when something burns you can make it feel better by rubbing it? Don’t do that. )
posted by SLC Mom at 9:51 PM on April 1, 2020

Hold the icepack to the injection site after the shot, too. Helps to stop the bruise from forming.

(Source: heparin for myself last summer and now for a surgery patient who says the ice is a big improvement over no ice after her previous surgery.)
posted by I claim sanctuary at 10:46 PM on April 1, 2020 [1 favorite]

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