How to Give an Injection Under the Skin With Blood Thinning Medication in a Prefilled Syringe

Time to Read: About 4 minutes

This information will teach you how to prepare and give an injection (shot) of blood thinning medication in a prefilled syringe. For the rest of this resource, the words “you,” “your,” and “yourself” refers to you or your child.

You’ll need to give yourself injections (shots) of blood thinning medication. You’ll get prefilled syringes with the medications already in them from your pharmacy. You’ll use a small, short needle to inject the medication into the fat right under your skin.

Your prefilled syringe may come with a needle already attached, or you may need to attach it yourself. If your syringe doesn’t come with the needle attached, follow the instructions for attaching it in the “Preparing the Injection” section.

You’ll practice preparing and giving the injection with your nurse. When you’re at home, use this resource the first few times you give yourself the injections.

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Preparing the Injection

  1. Prepare a clean area to set up your supplies, such as a kitchen table. Don’t use the bathroom as a work area. Line the area with clean, dry, disposable towels.
  2. Check for the correct name and dosage of medication on the prefilled syringe.
    • For pediatric patients, you may need to waste some of the dosage in the prefilled syringe, according to pharmacy instructions. Your child’s nurse will review this with you before you go home.
  3. Gather your supplies:
    • Prefilled syringe and a 27 gauge 1/2-inch needle or
    • Prefilled syringe with the needle attached
    • 2 alcohol pads
    • Disposable sharps container, such as an empty plastic bleach or detergent bottle with a cap labeled “Home Sharps-Not for Recycling.”
    • 2 x 2 gauze pad or cotton ball
    • Bandage
  4. Clean your hands:
    • If you’re washing your hands with soap and water, wet your hands, put soap on them, then rub them together for 15 seconds, and rinse. Dry your hands with a disposable towel, and use that same towel to turn off the faucet.
    • If you’re using an alcohol-based hand sanitizer, be sure to cover all surfaces of your hands with it, including in between your fingers, rubbing them together until they’re dry.
  5. Check to see if the syringe has a built-in needle. If it doesn’t, follow the steps below to put a needle on the syringe.

Attaching the needle:

  1. Open the package with the fresh needle, but don’t take out the needle yet. Put the open package on your work area
  2. Remove the black cap on the tip of the syringe. Don’t let anything, including your fingers, touch the tip once the cap is off. If anything touches the tip of the syringe, you must throw it away.
  3. Remove the needle from its package. Don’t remove the protective cap from the needle. Don’t let anything, including your fingers, touch the needle. If anything touches the needle, you must throw it away in the sharps container.
  4. Twist the needle onto the base of the syringe using a clockwise (to the right) motion.
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Giving the Injection

  1. Check to make sure that the syringe has the correct amount of medication. Don’t worry if there are tiny air bubbles in the syringe.
  2. Choose an injection site from the areas shown in Figure 1. Keep track of which site you used last and give the injection at a different site each time. Rotate sites according to a schedule. Don’t use an area that’s less than 2 inches (about 5 centimeters) from a scar, cut or wound.
    Figure 1. Choosing an injection site

    Figure 1. Choosing an injection site

  3. Remove or fold back any clothing that covers the injection site.
  4. Apply an ice pack or ice cubes in a plastic bag (such as a Ziploc®) to the injection site for 2 to 5 minutes. This will numb the area and reduce bruising.

  5. Use the alcohol wipe to clean the area where you’re going to give the injection. Let it air dry. Don’t fan or blow on the area.
  6. Pick up the syringe with your dominant hand (the hand you write with). Using your other hand, take the cap off the needle. Don’t let anything, including your fingers, touch the needle. If anything touches the needle, you must throw it away in the sharps container. See the instructions in the section “What to Do if Anything Touches the Needle.”
  7. Hold the syringe like you would hold a dart (in between with your index and middle finger and thumb).
  8. Using your non-dominant hand (the hand you don’t write with), pinch a 1 to 2 inch (2 ½ to 5 centimeters) fold of skin near the injection site between your thumb and first finger. Keep the syringe in your other hand.
  9. Insert the needle into the skin in one quick motion at a 90-degree (straight up and down) angle (see Figures 2 and 3).
    Figure 2. Giving the injection

    Figure 2. Giving the injection

    Figure 3. Inserting the needle

    Figure 3. Inserting the needle

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What to Do if Anything Touches the Needle

If you are using a syringe with a built-in needle, throw it into your sharps container. Start the process again with a new prefilled syringe.

  • If you need to throw away a syringe with a built-in needle, you’ll need to replace the medication. Call your doctor for a prescription.
  • If the needle and syringe were not attached, change the needle using the following steps:
  1. Remove the old needle from the syringe by twisting the base of the needle counter-clockwise (to the left, see Figure 4).
    • If you have trouble twisting it, carefully recap the needle. Then twist it again.
    Figure 4. Twisting the base of the needle

    Figure 4. Twisting the base of the needle

  2. After you remove the needle, place it in your sharps container. Don’t let anything touch the base of the syringe.
  3. Take the new capped needle out of the package. Attach it to the syringe by twisting it clockwise (to the right). 
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Storing Your Medical Sharps

  • Use an empty plastic container with a screw-on cap, such as a laundry detergent bottle.
    • Pick a container that’s strong enough that needles can’t poke through the sides.
    • Pick a container that isn’t breakable.
    • Don’t store your sharps in glass bottles, soda bottles, milk jugs, aluminum cans, coffee cans, or paper or plastic bags.
  • Clearly label the container “Home Sharps – Not for Recycling.” Keep it away from children and pets.
  • Put the sharps in the container point-first as soon as you use them.
  • Don’t overfill the container. When it’s more than half full, stop using it. Wrap the cap with strong tape to create a more secure seal and prevent it from leaking.
  • Keep the container separate from trash that will be recycled.
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Getting Rid of Your Medical Sharps

  • If you live in New York or New Jersey, you can put the sealed container out with your regular trash for collection. Don’t put it in with your recyclables.
  • If you live in a different state, check with your local department of health for instructions.
  • Don’t put the sharps container in with your regular household trash. It should be placed next to your trash, in a container clearly labeled “home sharps.”
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