Steroids 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.
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 needlerquote 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 yourquote 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).
- 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.
- Always use a new needle and syringe for each injection.
- Steroids are injected into a muscle - normally the buttock or thigh. Never inject steroids into a vein.
- Never share needles, syringes or multi-use vials.
- Don't inject more than 2mls of fluid into one muscle area at a time.
- Dispose of used needles and syringes in a sharps bin and return them to your needle exchange.
- 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!
- 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.
- 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.
- 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.