When giving a medication using the ACK track method you need to pull the skin to the side before inserting the needle?

Time to Read: About 6 minutes

This information will help you learn how to give yourself a subcutaneous (SUB-kyoo-TAY-nee-us) injection (shot) using a prefilled syringe. A subcutaneous injection is an injection that’s given under your skin. A prefilled syringe is a syringe that comes with medication inside. 

Your healthcare provider will show you how to give yourself the injection. You can use the information in this resource to remember how to do it when you’re at home.

How to Store Your Prefilled Syringes

How you store your prefilled syringes depends on the medication inside them. Most medications are stored at room temperature, but some need to be kept in the refrigerator. Your healthcare provider will tell you how to store your syringes. Don’t store your prefilled syringes in the freezer or leave them in direct sunlight.

If you have questions about how to store or carry your prefilled syringes when you travel, talk with your healthcare provider.

What to do if the medication freezes

If the medication inside a syringe freezes, put the syringe near the front of the refrigerator or on the shelves inside the refrigerator door so it can thaw. If it freezes more than once, don’t use it. Call your healthcare provider for further instructions.

How to Give Yourself a Subcutaneous Injection

Gather your supplies

Place your supplies on a clean, flat surface (such as a table or countertop). You’ll need:

• 1 alcohol pad
• 1 small gauze pad or cotton ball, except if you’re giving yourself an injection of enoxaparin (Lovenox®) or heparin
• 1 bandage (such as a Band-Aid®)
• A solid container to throw away the syringe and needle (such as a heavy plastic laundry detergent bottle with a lid)
  • Read How to Store and Get Rid of Your Home Medical Sharps for instructions for choosing a sharps container.
• 1 prefilled syringe with a needle cap
  • If you store your prefilled syringes in the refrigerator, take one out 30 minutes before you plan to give yourself the injection. The medication should be at room temperature when you inject it.
  • Don’t shake the syringe. Shaking it may damage the medication inside.

Check the prefilled syringe

Check the medication:

• Name. Make sure it matches what your healthcare provider prescribed.
• Dose. Make sure it matches what your healthcare provider prescribed.
• Expiration date. Make sure the expiration date hasn’t passed.
• Color. Make sure the medication in the syringe is clear and colorless. Don’t use it if it looks foamy, discolored, cloudy, or has crystals in it.

If the medication name or dose doesn’t match what your healthcare provider prescribed, the medication is expired, or the medication is foamy, discolored, cloudy, or has crystals, don’t use the syringe. If you have another, use that one instead. Then, contact your healthcare provider or pharmacist to tell them. You may be able to bring the full syringe to your pharmacy so they can replace it.

Get the injection site ready

Choose an injection site (place on your body to give the injection) where you can pinch a 1 to 2-inch (2.5 to 5-centimeter) fold of skin. It’s best to use one of the following areas (see Figure 1):

• Your abdomen (belly), except for the 2-inch (5-centimeter) area around your belly button
• The middle front or middle outside of your thighs
• The upper area of your buttocks (butt)
• The back part of your upper arms, if someone else is giving you the injection

If your healthcare provider tells you to use a certain injection site, follow their instructions. Some medications work better if they’re injected into a certain area. Don’t inject into an area that’s tender, red, bruised, hard, or that has scars or stretch marks.

Figure 1. Injection sites

Give the injection in a different area each time. It’s helpful to use a notebook or calendar to keep track. Injecting in the same spot each time will make scar tissue form. This can keep the medication from working like it’s supposed to. It will also make it hard to put the needle into your skin.

Once you choose an injection site, follow the instructions below.

1. Clean your hands well with soap and water or an alcohol-based hand sanitizer.
   • If you’re washing your hands with soap and water, wet your hands, apply soap, rub them together well for at least 20 seconds, then 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 your hands with it, rubbing them together until they’re dry.
2. Fold back any clothing that’s covering the injection site.
3. Open the alcohol pad. Using firm pressure, clean the skin at the injection site. Start at the center of the site and move outward in a circular motion.
4. Let your skin air dry. Don’t fan or blow on the area.

Give yourself the injection

1. Take the syringe out of its package.
   • If you’re injecting Lovenox, check to make sure there’s an air bubble in the syringe. If you don’t see one, set the syringe to the side and use a different one. Contact your healthcare provider or pharmacist after you give yourself the injection to tell them. You may be able to bring the full syringe to your pharmacy so they can replace it.
2. With your dominant hand (the hand you write with), hold the syringe around the middle, like a pen or dart.
3. Carefully pull the needle cover straight off (see Figure 2). Once the needle cover is off, don’t set the syringe down. Don’t let anything, including your fingers, touch the needle. If anything touches the needle, put the syringe in the sharps container. Start over with a new one. Contact your healthcare provider after you give yourself the injection to tell them.

   Figure 2. Remove the needle cover

4. If you’re giving yourself an injection of any medication besides Lovenox, check the syringe for air bubbles. If there is an air bubble, hold the syringe so the needle is pointing up. Gently tap the syringe with your fingers until the air bubbles rise to the top, near the needle. Slowly push the plunger up to force the air bubbles out. Don’t do this if you’re injecting Lovenox.
5. Make sure you’re still holding the syringe around the middle, like a pen or dart. Use your free hand to pinch a fold of skin at the injection site.
6. Push the whole needle straight down into your skin in one smooth, quick motion (see Figure 3). Don’t put your thumb on the plunger yet.

   Figure 3. Put the needle into your skin

7. Stop pinching your skin. Use your thumb to slowly push the plunger all the way down until all the medication is injected (see Figure 4). You can use whichever thumb is more comfortable.

   Figure 4. Push the plunger all the way down

8. When the syringe is empty, pull it straight out of your skin.
   • If you gave yourself an injection of Lovenox or heparin, don’t press down on the injection site. Put a bandage over the injection site, if needed.
   • If you gave yourself an injection of any medication besides Lovenox or heparin, place a cotton ball or gauze over the injection site and press down for several seconds. Put a bandage over the injection site, if needed.
   Don’t put the needle cover back on the syringe. Be careful to not poke yourself with the needle.
9. Cover the needle with the needle guard.
   • If you gave yourself an injection of Lovenox, press the plunger down firmly. The needle guard should slide into place on its own.
   • If you gave yourself an injection of any medication besides Lovenox, hold the clear plastic finger grips on the sides of the syringe with one hand. Hold the needle guard with your other hand (see Figure 5). Slide the needle guard over the needle until the needle is completely covered (see Figure 6). You’ll hear the needle guard click into place.

     Figure 5. Hold the needle guard

     Figure 6. Slide the needle guard

10. Place the syringe into the sharps container. Don’t use a prefilled syringe more than once.

Read the resource How to Store and Get Rid of Your Home Medical Sharps for information about choosing a sharps container and disposing of your used syringes and other home medical sharps.

When to Call Your Healthcare Provider

Call your healthcare provider if:

• The injection site won’t stop bleeding.
• You have very bad pain.
• You inject the medication into the wrong area.
• You develop a fever of 100.4 °F (38 °C) or higher.
• You develop signs of an allergic reaction, such as swelling, redness, itching, or a rash.
• You can’t use a syringe because the medication is expired, foamy, discolored, cloudy, or has crystals.
• You can’t use a syringe because something touches the needle before the injection.
• You can’t use a syringe prefilled with Lovenox because it didn’t have an air bubble.
• You have trouble giving the injection.