1. What to
look for before injecting:
- Check the expiry dates of every product.
- Make sure that the vial or ampoule contains the right drug
in the right strength.
- During the whole preparation procedure, material should be
kept sterile.
- Wash your hands before starting to prepare the injection.
- Disinfect the skin over the injection site.
- Make sure that there are no air bubbles left in the
syringe.
-Once the protective cover of the needle is removed extra
care is needed.
- Do not touch anything with the unprotected needle.
- Once the injection has been given take care not to prick
yourself or somebody else.
1)
Always use a new needle and syringe for each injection.
2)
Steroids are injected into a muscle - normally the buttock
or thigh. Never inject steroids into a vein.
3)
Never share needles, syringes or multi-use vials.
4)
Don’t inject more than 2mls of fluid into one muscle area
at a time.
5)
Dispose of used needles and syringes in a sharps bin and
return them to your needle exchange.
6)
Only insert the needle three quarters (3/4) of the way into
the muscle so it can be removed easier if it snaps. If you
don’t insert the needle far enough into
the muscle and then inject a steroid you could cause an
abscess!
7)
If you feel a hard lump in a muscle where you inject - use
another site.
Step by step for vials
- Wash your hands.
- Disinfect the top of the vial.
- Use a syringe with a volume of twice the required amount
of liquid or solution and add the needle.
- Suck up as much air as the amount of solution needed to
aspirate.
- Insert needle into (top of) vial and turn upside down.
- Pump air into vial (creating pressure).
- Aspirate the required amount of solution and 0.1 ml extra.
Make sure the tip of the needle is below the fluid surface.
- Pull the needle out of the vial.
- Remove possible air from the syringe.
- Clean up; dispose of waste safely; wash your hands.
Step by step for ampoules
- Wash your hands.
- Put the needle on the syringe.
- Remove the liquid from the neck of the ampoule by flicking
it or swinging it fast in a downward spiraling movement.
- File around the neck of the ampoule.
- Protect your fingers with gauze if ampoule is made of
glass.
- Carefully break off the top of the ampoule (for a plastic
ampoule twist the top).
- Aspirate the fluid from the ampoule.
- Remove any air from the syringe.
- Clean up; dispose of working needle safely; wash your
hands.
Injecting
- Wash your hands.
- Reassure yourself / patient's for procedure.
- Uncover the area to be injected (lateral upper quadrant
major gluteal muscle, lateral side of upper leg, deltoid
muscle).
- Disinfect the skin.
- Relax the muscle.
- Insert the needle swiftly at an angle of 90 degrees (watch
depth!).
- Aspirate briefly; if blood appears, withdraw needle.
Replace it with a new one.
- Inject slowly (less painful).
- Withdraw needle swiftly.
- Press sterile cotton wool onto the opening. Fix with
adhesive tape.
- Check yourself / patient's reaction and give additional
reassurance, if necessary.
- Clean up; dispose of waste safely; wash your hands.
1. Injecting procedure:
All oil based and water based anabolic steroids should be
taken intramuscularly. This means the shot must penetrate
the skin and subcutaneous tissue to enter the muscle itself.
Intramuscular injections are used when prompt absorption is
desired, when larger doses are needed than can be given
cutaneously or when a drug is too irritating to be given
subcutaneously. The common sites for in tramuscular
injectons include the buttock, lateral side of the thigh,
and the deltoid region of the arm. Muscles in these areas,
especially the gluteal muscles in the buttock, are fairly
thick. Because of the large number of muscle fibers and
extensive fascia, (fascia is a type of connective tissue
that surrounds and separates muscles) the drug has a large
surface area for absorption. Absorption is further promoted
by the extensive blood supply to muscles. Ideally,
intramuscular injections should be given deep within the
muscle and away from major nerves and blood vessels. The
best site for steroid injections is in the gluteus medius
muscle which is located in the upper outer quadrant of the
buttock. The iliac crest serves as a landmark for this
quadrant. The spot for an injection in an adult is usually
to 7 1/2 centimeters (2 to 3 inches) below the iliac crest.
The iliac crest is the top of the pelvic girdle on the
posterior (back) side. You can find the iliac crest by
feeling the uppermost bony area above each gluteal muscle.
The upper outer quadrant is chosen because the muscle in
this area is quite thick and has few nerves. The probability
of injecting the drug into a blood vessel is remote in this
area. Injecting here reduces the chance of injury to the
sciatic nerve which runs through the lower and middle area
of the buttock. It controls the posterior of each thigh and
the entire leg from the knee down. If an injection is too
close to this nerve or actually hits it, extreme pain and
temporary paralysis can be felt in these areas. This is
especially undesirable and warrants staying as far away from
this area as possible.
INTRAMUSCULAR INJECTIONS ARE SHOWN HERE.
If the gluteal region cannot be injected for some reason,
the second choice would be the lateral portion of the thigh.
Usually, intramuscular injections in the thigh are only
indicated for infants and children. The vastus lateralis
muscle is the only area of the thigh that should be injected
intramuscularly. This site is determined by using the knee
and the greater trochanter of the femur as landmarks. The
greater trochanter is the bony area that you can feel where
the femur joins the pelvic girdle. The mid portion of the
muscle is located by measuring the handbreadth above the
knee and the handbreadth below the greater trochanter.
Injecting into the front of the thigh or inside of the thigh
is extremely unwise. These areas contain nerves as well as a
number of blood vessels.
WHAT TO USE FOR INJECTIONS
It is important to choose the proper syringe for the
administration of injectable anabolic steroids. The
principle components of a syringe include a cylindrical
barrel to one end of which a hollow needle is attached, and
a close fitting plunger. The most acceptable syringe for
injecting anabolic steroids is a 22 gauge 1 1/2" or 23
gauge 1" apparatus with a 3 cc case. This length allows
for penetration to reach deep inside the muscle tissue.
Shorter needles, 5/8" or 1/2" are usually not
sufficient for intramuscular injections and occasionally
leave a portion of the Injection in a subcutaneous area
which will cause a swell between the skin and muscle as well
as impaired absorption. The gauge size of a syringe
represents the needle\rquote s diameter. The lower the gauge
number, the wider it is. A 27 gauge needle is very thin. An
18 gauge is quite wide; it is often referred to as a cannon.
The 22 and 23 gauge needles are not so large that they are
difficult to insert, yet are large enough for solutions to
easily be propelled through them. The use of insulin needles
is not acceptable; they are simply too small. Usually,
insulin pins are 25 to 27 gauge and only a 1/2" long
with a 1 cc case.
INJECTION PROCEDURES
There are a number of steps that should be understood in
order to complete a safe and proper intramuscular injection.
First off, before handling any needles or vials, the user
should take a thorough shower. Next, an alcohol swab should
be used to clean the injection site and another alcohol swab
should be used to clean the rubber stopper on top of the
vial which will be drawn from. Then, take a brand new
syringe out of its wrapper, remove its plastic top, draw
about 2 ccs of air into it and insert it into the vial.
Inject this air into the vial; this creates pressure within
the vial and makes it easier to draw out oil based
preparations. Then, turn the vial upside-down and slowly
draw out the oil until you\rquote ve overdrawn at least 1/4
cc. For example, if someone was going to take a shot of 1
cc, they should pull out approximately 1 1/4 to 1 1/2 ccs of
liquid, then tap the side of the case to help get the air
bubbles that were drawn into the syringe to come to the top.
At that point, the excess 1/4 to 1/2 cc could be injected
back into the vial and the needle removed. Then, hold the
syringe needle-side-up and continue to tap it to encourage
all the air bubbles to come to the top of the syringe. Now,
take another clean syringe, remove it from its sterile
package and unscrew the needle from the syringe. Exchange
the brand new needle for the one that has just been injected
into the stopper. By using two needles for every injection,
you can take advantage of using the full sharpness of the
pin. The needle does suffer some dulling when it is pushed
through the firm rubber stopper on a vial. It is important
not to touch this needle before the injection. It should not
come into contact with a counter top, your fingers, nor
should it be cleaned with alcohol. This needle is sterile
and should not be touched. At this point, once again swab
the injection site with alcohol, then press the stopper of
the syringe holding it needle-side-up, until the slight air
bubbles that are at the top are pressed out. Once a bead of
oil has appeared at the top of the needle, allow it run down
the surface of the needle which provides lubrication. At
this time, take the syringe and hold it like a dart. Use the
other hand to stretch the skin at the injection site and
simply push the sharp clean needle in. After inserting it
deep into the muscle, pull back on the stopper for a few
seconds to make sure it does not fill up with blood which
would indicate that the needle had been injected into a
blood vessel. Providing there is no blood present in the
syringe, slowly press the stopper down until all the oil is
injected. Then, quickly pull the needle out and take another
alcohol swab and press firmly on the injection site. This
will minimize bleeding, if there is any, and by firmly
pressing on the injection site and slightly massaging it,
some of the soreness may be eliminated. It is important that
the liquid is not injected too quickly as this causes more
pain at the site during the injection and in the proceeding
days. After this procedure has been completed, return the
plastic caps to shield the needles and make sure they are
discarded properly. To avoid discomfort and excessive scar
tissue at the injection site, it is not wise to inject more
than 2 ccs of solution per shot. It is also not prudent to
use the same injection site more than twice a week (once a
week is preferred).
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