Administering subcutaneous injections to children: what does the evidence say? A subcutaneous injection is administered as a bolus into the subcutaneous layer of skin directly below the dermis and epidermis and above the muscle (Ansel et al, 2002). This region is rich in capillary blood supply, but relatively devoid of large blood vessels, nerves, and bones. Absorption of medications via the subcutaneous route occurs by slow diffusion into the capillaries (Mallett and Dougherty, 2000) to promote systemic drug action (Ellis and Bentz, 2007). Subcutaneous injections are a relatively convenient way to deliver medication that would otherwise be absorbed too slowly or made ineffective if given by alternative routes. Subcutaneous injections may be given either by manual syringe, pen injectors, syringe drivers, infusion or jet infusions sets (Cefalu, 2004). This paper sets out to discuss the most appropriate sites and techniques for the administration of subcutaneous injections to children, based on current evidence-based practice focusing on manual syringe and pen injectors, which are the predominately used methods for delivering subcutaneous injections. Annersten and Willman (2005) conducted a review on performing subcutaneous injections to identify the scientific foundation for the technical performance of subcutaneous injections. This review included a search in databases and a screening process at abstract level. One hundred and two abstracts were reviewed worldwide and disappointingly only 38 articles met their assessment criteria for quality and covered information on dose, location and complications of subcutaneous injection’s to adults and children. They concluded that the scientific foundation for the technical performance of the subcutaneous injection is weak. This review demonstrates the lack of evidence-based practice in relation to the differing elements of subcutaneous administration of medication; it did however indicate that the amount of subcutaneous fat and appropriate needle length are of high importance for the drug to reach the target tissue. They recommended that further research regarding effective subcutaneous injection technique is needed (Annersten and Willman, 2005). This paper, while acknowledging the deficit in evidence-based practice, offers a examination of a variety of literature published in this field. Angela Cocoman and Carol Barron are Lecturers at the School of Nursing, Dublin City University, Dublin Correspondence: angela.cocoman@dcu.ie Abstract The administration of subcutaneous injections to babies, children and adolescents is a fundamental nursing task and one that should be underpinned by an evidenced-based practice. The subcutaneous route is used routinely with children to administer a wide variety of pharmacological preparations including vaccinations, anticoagulants, analgesics, insulin, growth hormones and some anti-carcinogen agents (Torben et al, 2006). These medications are predominantly administered via injection or continuous infusion. Subcutaneous injection technique varies greatly among nurses and children who self-administer, ranging from the angle of insertion (a 45-degree angle to a 90-degree angle) to the use of an elevated skin-fold or not. The variation in the selection of needle lengths may also result in the possibility of intramuscular injections rather than achieving a true subcutaneous injection (Prettyman, 2005). Paediatric nursing text books (Trigg and Mohammed, 2006), journal articles (Annersten and Willlman, 2005; Tubiana-Rufi et al, 1999) and patient instruction leaflets often give conflicting or inconsistent advice regarding subcutaneous injection technique. The administration of subcutaneous injections can cause stress, anxiety and pain to children (Trigg and Mohammed, 2006) often leaving them apprehensive about receiving future medications, or even becoming noncompliant with medical care (Ellis and Bentz, 2007). Injection pain is often the result of injury to the nerve fibre endings located in the skin and tissue from mechanical trauma caused by the needle puncture. Kuzu and Ucar (2001) have noted that site-pain causes the patient physical and psychological discomfort and bruising often limits possible sites for subsequent injections. This article examines the literature that guides clinical practice and considers recent changes in relation to the administration of subcutaneous injection in children, while acknowledging that there is little evidence- based practice to support the formulation of recommendations regarding the technical aspects of subcutaneous administration (Annersten and Willman, 2005). This paper examines the nurse’s role in administration of subcutaneous medications. Key words n Subcutaneous injections n Injection sites n Angle of insertion n Technique n Pain n Insulin n Heparin Accepted for publication January 2008 Clinical Review 84 Journal of Children’s and Young People’s Nursing February 2008 Vol 02 No 02