As part of your protocol, your doctor has prescribed you hCG 5000 IU injection.

You will have picked up your hCG from the Markham Fertility Centre Dispensary. It comes in a box that looks something like this. Inside the box, you'll see that there's two vials. One is a liquid vial, the diluent; one is a powder vial that has the white powder in it, the medicine. You'll also receive some injection supplies. You'll need a 3 mL syringe with the one and a half inch needle, a smaller needle tip, and an alcohol swab  lab.

When you're ready to do your injection, you'll start by opening the larger needle. First, you'll twist to make sure that the needle tip is on tightly to the syringe. You'll take the plastic covers off of the vials, and use your alcohol swab to clean the top of both vials. You will take the cap off of your needle and pull back some air into that syringe, and then you'll start by injecting into the vial of diluent into the liquid vial. You'll turn that upside down, push in the air,  and then you'll pull back 2 mL of fluid into this vial, making sure that your needle tip is in the liquid at the top, and you'll go all the way back until there's 2 mL of fluid in that syringe, and then you'll pull that out and then inject that fluid into the white powder. So you'll push it into this vial, swirl it around, and you'll notice that that white powder dissolves almost instantly and you're left with a clear fluid again.

Make sure that you set your diluent vial out of the way so you're only working with the vial that actually has the medicine in it now.

If you're doing an intramuscular injection for your hCG 5,000 IU at this point, you'll  turn the vial upside down and draw back on your syringe keeping the needle tip inside the fluid to 1 mL.  And then you'll pull that off and you'll make sure that there's no big air bubbles inside the syringe. You can pull it back, make sure that all of the air is kind of up at the top, and then slowly push the plunger  up until you see a bleb  of fluid come out the top. And your plunger is at the 1 mL mark.

If your doctor has prescribed this injection subcutaneously, then at this point you'll pull back on the syringe so there's air at the top. You'll put the cap back on that intramuscular needle. Twist that off and put on your subcutaneous needle tip.  Take the cap off. And now we're going to push this back up so the fluid is going back to the top. And push until you see the bleb of fluid at the top of the needle tip and your plunger is at 1 mL.

Now you're ready for an hCG 5,000 IU subcutaneous 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.