As part of your protocol, your doctor has prescribed you HGG 10,000 unit injection. We're going to talk about how to prepare it.

First you pick up your medication from the Markham Fertility Centre Dispensary, and it will look like this. It comes in a white box, and inside this box you'll have two vials. One has liquid, the diluent, and one has a white powder, which is the medication. You'll also receive some injection supplies. You'll have a 3 mL syringe with a 1 inch needle tip, and a smaller needle tip and a alcohol swap.

When you're preparing to do your injection first, you'll take the plastic caps off of the vials and use your alcohol swab to clean the top of each vial. Next, you'll open your 3 mL syringe with the 1.5 inch needle tip, and you'll start by just twisting that needle tip on, so it's nice and snug onto the top of the syringe.

Then you'll take the cap off and pull back air into that syringe and inject this into the vial with diluent first. So the liquid vial is where we go first, push in that air, turn it upside down, making sure that your needle tip stays in the liquid and pull back to 1 mL on the syringe.

Then you'll take that off, set the diluent aside,  and put the liquid into the vial with the powder. So push that in and mix it around. You'll notice that that white powder dissolves almost instantly, and you're left with a clear fluid again, but this time with the medication dissolved in it. Then  you'll turn this upside down and you'll pull back 1 mL back into that syringe.

Make sure that your needle tip is in the fluid in the vial. And keep going until you're at 1 mL on that syringe.

Then you'll make sure to sort of clear any air bubbles that are in your fluid. Your doctor and your nurse will tell you if you're doing it intramuscularly or subcutaneously. If it's intramuscularly, then at this point, you'll push the plunger up until a bleb of fluid comes at the top of the needle and your syringe is at 1 mL.

Now you're ready for your injection.

 

How to Perform an Intramuscular Injection: With your partner or support person's assistance

Now that you've prepared your medication, we're going to talk about how to perform an intramuscular injection. First, we'll talk about a partner performing it on the person receiving the medication, and then we'll go through how to do this medication on your own.

First, these medications go into the upper outer quadrant of your glute muscle, of your buttock, so imagine that your glute is divided into four quadrants, like this image shows, and you're aiming for this green area, this upper outer quadrant of your glute muscle. When you come to clinic, a nurse will very happily help you to landmark this area so we can write right on your skin so you know exactly where you're aiming.

And then within that area, you'll sort of try to move around each day so that you're not poking in exactly the same spot every time. When you're having this injection performed on you by a partner, you should be in a position that allows you to have your leg as relaxed as possible, whatever leg this is going into.

So particularly if a partner's doing it for you, maybe you could be laying down on a couch or a bed on your side so that the side they're going to inject is facing up. But you're completely relaxed. Otherwise you can be standing. Have something to lean on, and just make sure that you have this leg as relaxed as possible when you're going to perform the injection.

Once you're ready, you'll take an alcohol swab and clean the area. And then let that dry. And then partners, you'll take the needle cap off. You'll pull the skin taut so it's nice and tight, and you'll go in quick like a dart about two thirds of the way down the needle, and then push in the medication as slowly as you can until it's all been delivered. And once you're done there, you'll pull it out.

A little bit of blood, a little bit of liquid might come out. That's normal. Use a tissue to hold pressure on the area until it stops bleeding, and then give it a little massage. Work it around to help that medication get worked in. Make sure when you're done, you put your used needle safely into a sharps bin or your medical waste bag. When you're performing this needle on yourself, you'll have a little bit different approach.

 

How to Perform an Intramuscular Injection: On yourself

Now that your intramuscular injection is prepared, we're going to talk about how to perform this injection on yourself without a partner. The area that you're going to be injecting is the upper outer quadrant of your buttock. So imagine that your glute is sort of divided into four quadrants and you're aiming for this upper outer quadrant of your glute muscle.

Your nursing team here at the clinic will happily help you landmark this area, so when you meet with them, they'll be able to draw right on your skin so you know exactly where you should be injecting this medication. Each time that you do it, you'll try to move the injection site a little bit so that you're not poking into exactly the same spot that you did yesterday.

When you're ready, you'll use an alcohol swab to clean the area in preparation for injection.

Now that the area's clean, you're going to set your body up for performing this injection. And the best way to do that when you're on your own is to sort of have a chair or a bench or something nearby that you can sort of get one knee up on the knee that you're going to be performing the injection on so that the weight is kind of taken off of this leg as much as possible.

We want this muscle as loose and relaxed as possible when you're going to perform this injection. Now, usually you're not gonna be able to see the site that you're injecting into, but that's okay. You know where it is. You can use your hand to sort of feel where that injection is going, and when you're ready, again, trying to keep this muscle as relaxed as you can.

You've already cleaned the area. You're gonna take the lid off of your prepared medication, and you're going to inject just like this at 90 degrees. Nice and slowly, about two thirds of the way down the needle into your skin, and then you'll push the plunger as slowly as you can tolerate just like this.

And then when you're done, you'll pull it out. A little bit of blood, a little bit of liquid might come out. That's normal. Use a tissue, hold it on your skin until the bleeding stops. And then make sure that you put your used needle into your sharps bin or your medical waste bag when you're finished with it.

 

How to Perform a Subcutaneous Injection

Now that you have your medication prepared, here's a video on how to perform a subcutaneous injection.

First, these injections are going to go into your abdomen. So you'll pick a spot two fingers away from your belly button and inject anywhere in your tummy.

The injection is going into that fatty layer of tissue right under the skin. So two fingers away anywhere in your tummy, just like this.
When you're doing your injections, you'll pick a spot, and then you'll rotate your sites. So try not to poke into exactly the same spot as you did already today or yesterday. Try to rotate the spots a little bit. Even a finger away is helpful.

When you're ready, you'll use an alcohol swab to clean the area that you're going to inject into, and then you'll give that a few seconds to dry. You'll take the cap off of your prepared needle and pinch your skin where you're going to do the injection. You'll inject at 90 degrees all the way in. Push the plunger on the syringe down until all of the medication has been delivered.

Then you can relax your skin and pull out the needle. A little bit of blood, a little bit of liquid might come out. That's okay. It's normal. You can use a tissue to hold the spot until the bleeding stops.

And then when you're done, make sure that you put your used needle into a sharps container or your medical waste bag.