Administering injectable medication

You may have had a discussion about managing the symptoms that you or the person you are caring for are experiencing and how occasional one-off injections may relieve these. The information in this leaflet is intended to help you with your decision about giving these injections yourself and is an addition to the support and training you will receive if this is something you feel you can undertake.

As people become less well, they often lose the ability to swallow oral medications. In these instances, pain relief and symptom management can be controlled by injecting medicines under the skin. These symptoms can occur at any time of the day and night and when they occur, your community nursing team would usually be contacted, and a nurse would come to administer the medication required. Although, it is possible that you or your loved one can be taught how to give these injections.

If this is something you decide, you will continue to receive support from your community nursing team, and they will discuss any concerns with you. You may decide at any time that this is something that you do not feel confident enough to do, if this is the case, the nurses can continue to administer the medications.

What to Expect

• The nurse will insert a line into the layer of tissue just under the skin (subcutaneous tissue). This will stay in place so that medications can be administered through it, to save repeated injections being  given. This line is referred to as the stat line  
• You will be taught what the medications are, what they are for and likely side effects. 
• You will be shown how much medication to give and when to give it. 
• You will be taught how to draw up the medication into a syringe and how to administer through the stat line.
• You will be taught how to flush the line after administering the medication to ensure the whole amount is received.
• You will be shown how to keep a record of medication you have administered.
• Very occasionally, people prick themselves with the needle when they are preparing the medication. If this happens you need to make it bleed, wash it and cover it, and let your community nurse know so that she can provide you with additional advice
• People can experience symptoms throughout the course of their illness, even in the last few hours of life. It may be that an injection you give to ease these symptoms may come close to the end of life of your relative or friend. This is not unusual, and you must not worry that this injection has in any way hastened their death.
   

Medication information

An individualised care plan about managing the symptoms that you, or the person you are caring for, are experiencing will be developed, this may include administering occasional injections. Below are the most common symptoms people may experience and some examples of the medications that can be given to provide comfort.

If frequent injections are required, your nurse may discuss the use of a syringe pump to give continuous relief, alongside injections if required. The syringe pump would be managed by the community nursing team, who will discuss this in more detail, and provide further information, if it is felt this may be beneficial.

A prescription will be written by a Doctor or Specialist Nurse which provides the dose to be given. There will often be a range of doses provided so that the amount can be adjusted as required.

All medications impact people individually and it is not uncommon when medications are first administered for someone to feel more drowsy or sleepy. If you are feeling concerned, please speak to your community nursing team.

Pain and breathlessness

Pain management is focused on controlling pain by administering the right drug, in the right dose, at the right time. Morphine can be used for moderate to severe pain and may be used on its own or in combination with other drugs. Smaller doses of morphine have been used to treat breathlessness as it can help to reduce rapid breathing to a normal rate. For people who cannot tolerate morphine, the doctor or specialist nurse will prescribe an alternative medication.  

Nausea and vomiting

Nausea and vomiting can be caused by a number of factors. The cause will be determined before treatment 
is started and may include other methods to treat the underlying cause. One possible treatment option is Haloperidol, a medication with multiple uses, including anti sickness properties.   

Noisy Breathing/Excess Secretions

Some people experience a different breathing pattern which may be noisy or sound rattly, this may indicate excessive respiratory secretions. Changing position may help with this, and medication like glycopyrronium can be used. These symptoms can be difficult to manage, please discuss with your nurse for further advice.

Agitation /Anxiety

Towards the end-of-life people may appear restless, anxious or agitated. Relaxing medications such as midazolam may be used to help manage this. 

Your community nurses are available to support and advise you whenever you need it, so please contact the team if you have any questions or if any of the following circumstances arise:

• If you feel unsure if you should give an injection or not.
• If symptoms continue after the medication is given or if multiple injections are required within a 24 hour period.
• If there is an unexpected problem such as a needle stick injury.
• If you are concerned that the wrong drug or the wrong dose of a drug or other error has occurred. This must be reported immediately.
• If  more supplies of equipment and medication are needed.
• If you would no longer like to administer subcutaneous medication.