Insulin Administration by Syringe

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Considerations:

  • Your school nurse or other licensed health care professional must review the procedure with you to ensure that you have the skills to perform insulin administration competently.
  • Because insulin doses depend on blood sugar, food intake and activity levels, it critical to give the exact dose ordered.
  • It is best practice to have a second person double check the insulin dose you draw up before administering it to be sure it is correct; check with your school nurse or the student’s healthcare provider if you are unsure if a double check is needed.
  • Insulin is administered subcutaneously. This is the tissue between the skin and muscle mass, typically known as the fat layer.
  • Insulin is best absorbed when injection sites are rotated. The common injection sites are abdomen, upper arm, upper buttock, and outer thigh.
  • Be sure to check with the student or the student’s parents to discuss preferred injection sites and rotation of sites.
  • Do not shake the insulin vial.
  • The insulin syringe has a needle under the orange cover on the end. The barrel of the syringe has numbers and bars next to numbers to indicate the units of insulin. Underneath the cover on the other end is the plunger which you push to give the insulin.
  • If the student is old enough and has been trained in their diabetic care, encourage them to assist to help the student learn self-care skills, according to the child’s care plan and the school nurse’s direction.

Supplies:

  • Insulin vial
  • Gloves
  • Alcohol swabs
  • Insulin syringe
  • Authorized sharps disposal container

procedure download skill competency
insulin-pen
Click on the photo to access video.

  1. Explain the procedure to the child at his/her level of understanding.
  2. Assemble the needed supplies and place on a clean surface.
  3. Review the student’s medication order to ensure the proper dose of insulin is given.
  4. If you have any questions regarding the insulin dose, DO NOT GIVE THE MEDICATION, consult with the school nurse before giving insulin.
  5. Determine where the injection will be given on the student, with the student’s assistance as appropriate.
  6. Check the insulin vial and the student’s medical order to ensure that it is
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time and
    5. Being given by the right route.
    6. Also check to ensure the medication has not expired.
  7. Wash your hands.
  8. Put on gloves.
  9. Recheck the insulin vial and the student’s medical order to ensure that it is:
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time and
    5. Being given by the right route.
    6. Also check to ensure the medication has not expired.
  10. If the vial is new, date the vial with the current date, then remove the lid.
  11. Wipe the stopper with an alcohol swab.
  12. Carefully remove the cap from the insulin syringe without touching the needle.
  13. Pull air into the syringe by pulling back on the plunger until the black bar is even with the line showing the exact units of insulin needed.
  14. Push the needle through the rubber top of the vial at a 90 degree angle.
  15. Leave the syringe in place in the vial and push the plunger so the air goes from the syringe into the vial.
  16. Leave the syringe in the vial and turn the vial upside down being sure that the needle does not fall out of the vial.
  17. Pull insulin into the syringe slowly by pulling back on the plunger until the top of the black bar is even with the line showing units of insulin needed.
  18.  If present, remove air bubbles by tapping on the outside of the syringe and expelling the air or by pushing the dose back into the vial and pulling back on the plunger again to withdraw the correct dose of insulin.
  19. Remove the needle from the vial. Recheck dosage with a second person.
  20. Cleanse the injection site with soap and water, or an alcohol swab, and allow it to air dry; never fan or blow on the area cleansed with the swab.
  21. Gently pinch the skin of the chosen injection site and insert the needle at a 45-90 degree angle into the skin.
  22. While pinching the skin, slowly push the plunger to inject all of the insulin.
  23. Wait 5-10 seconds while keeping the insulin syringe and needle in place to ensure that the insulin dose is given.
  24. Once 5-10 seconds have passed, release the skin and remove the syringe with needle from the injection site.
  25. Do not recap the needle.
  26. Place used syringe in an approved sharps disposal container.
  27. Remove gloves and wash hands
  28. Document insulin administration, including date, time, dosage and site of injection.
  29. Return supplies to appropriate location.
  30. Follow-up with parent or guardian and healthcare provider, as needed.

Resources:

American Diabetes Association: Webinar: Safe at School: Keeping Kids with Diabetes Safe at School

American Diabetes Association: Training Resources

BD: Insulin Injection with a Syringe

BD: Insulin Syringe

National Diabetes Education Program: Diabetes in Children and Adolescents Webinar Presentation

National Diabetes Education Program: Helping the Student with Diabetes Succeed: A Guide for School Personnel


References:

American Diabetes Association.  (2014).  Diabetes Care in the School and Day Care Setting.  Diabetes Care, 37(1).  Available at: http://care.diabetesjournals.org/content/37/Supplement_1/S91.full.pdf+html

American Diabetes Association.  (2015).  Insulin Routines. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-routines.html

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.


Acknowledgment of Reviewers:

The procedure list and video for this procedure were developed in collaboration with the Wisconsin Department of Public Instruction.

Bette Carr, MSN, RN, NCSN
School Nursing and Health Services Consultant
WI Department of Public Instruction

Teresa DuChateau, DNP, RN, CPNP
School Nurse Resource Coordinator
WI Public Health Association


Page last updated: July 24, 2015