INJECTION PROTOCOL AND INSTRUCTIONS
Written by , Article reviewed and edited by Dr. Fine M.D..
Published on November 28th, 2018
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Subcutaneous Injection information and Procedures
Both HGH and Testosterone Hormone Replacement Therapy can be provided via injection. In fact, the only safe and effective way to administer Therapeutic Human Growth Hormone is with a shot. Testosterone, on the other hand, can be delivered via a number of different means, including Testosterone Gels, Testosterone Creams, Testosterone Sprays, and even via implanted Dermal Pellets.
Although both forms of medication can be delivered via injection, they are delivered via different techniques. Human Growth Hormone is delivered using a technique known as Subcutaneous Injection. Testosterone is almost always delivered via Intramuscular Injection.
What is a Subcutaneous Injection?
A Subcutaneous Injection is a form of injection which is delivered just under the layers of the skin. Subcutaneous Injections are sometimes referred to by the scientific shorthand, SubQ. This form of injection utilizes a short, thin needle which is specially designed to puncture just below the skin. The medication contained within the syringe is delivered to the space between the deepest levels of the skin and the top layers of the muscle tissue. The needle used for Subcutaneous Injection is often referred to as an Insulin Needle, because it is the type of needle used by diabetics in order to deliver daily Insulin shots.
What Kinds of Medicine Can Be Delivered Subcutaneously?
Many types of medicine cannot be administered orally. Human Growth Hormone is one example of this. Insulin is a second example. These medications cannot survive the digestive process, because enzymes and acids in the stomach are designed to tear apart complex proteins, hormones, and enzymes, rendering them to their component parts.
Usually, this is a good thing. The stomach has to break apart the food that you eat, down to its basic components, so that the organs of your body can reassemble those nutrients in order to serve the purposes of your body. Complex organic medications are different, however. These delicate medications need to be delivered to target organs intact so that they can be properly activated.
Why Are Subcutaneous Injections Superior to Intravenous Injections?
Although it is also possible to deliver medications intravenously, in many cases it is preferable to deliver them in other ways. Intravenous Injections take a certain level of skill and finesse to deliver quickly and efficiently. In order to deliver a medication intravenously, it is necessary to target and hit a vein perfectly in order to direct the contents of the needle directly to the bloodstream.
Subcutaneous injections, on the other hand, are much easier to deliver, as they simply need to be delivered just under the surface of the skin. There is a chance that you will nick a blood vessel when you deliver medication subcutaneously, but if you do so, all you have to do is pick another injection site. Subcutaneous Injection is ideal for delivering very small doses of potent medications. Subcutaneous Injection is convenient, safe, and highly effective.
Subcutaneous Injections are ideal for drug doses up two two milliliters. Human Growth Hormone Injections for Adult HGH Deficiency generally range from 1-2 CCs. Subcutaneous Injections are relatively fast-acting, but still take a little while to be fully metabolized by the body. Generally, Subcutaneous Injections deliver medications over the course of a twenty-four hour period.
What Types of Medicine are Administered Subcutaneously?
Because of the small maximum volume for Subcutaneous dosage, medications that utilize this form of delivery tend to either be incredibly potent, or only needed in small doses. Protein-derived medications are very often delivered subcutaneously because they would not survive ingestion due to the powerful acids contained within the stomach. Hormones, which are derived from proteins, are a second example of medication that is often delivered Subcutaneously.
As we mentioned earlier, Subcutaneous injections are delivered with the same needle that diabetics use to deliver Insulin. Human Growth Hormone is also administered in the same fashion. Subcutaneous Injection is also useful for medications that need to be delivered rapidly, but are effective in small doses.
Epinephrine is an example of a medication that is delivered subcutaneously quickly in emergency situations. Epinephrine injections are generally stored in "pens" that can be activated and used quickly, because Epinephrine is used in order to treat dangerous allergic reactions, such as those that individuals have for substances such as peanuts and poison from bee stings. These Epinephrine Pens are referred to as EpiPens, and you likely know multiple people that carry these with them on a daily basis. A number of pain meds can also be delivered Subcutaneously, especially powerful ones such as hydromorphone and morphine.
Certain powerful anti-nausea medications can also be delivered through an insulin needle, such as dexamethasone and metoclopramide. Allergy shots and some vaccines are delivered utilizing this method as well, although others are delivered Intramuscularly. Subcutaneous Injections also have applications for many drugs which can actually be delivered orally, but the patient is unable to take drugs by mouth.
How Are Subcutaneous Injections Administered?
When administering a subcutaneous injection, it is incredibly important to choose an injection site that is appropriate for maximum safety and effectiveness. In order for the Subcutaneous Medications to work appropriately, they must be delivered just underneath the skin. Although all areas of the body contain this subcutaneous layer, some parts of the body have more to work with than others.
Where Are the Best and Worst Locations To Administer a Subcutaneous Injection?
It is important to choose a location where this sub-dermal area is clear, because it is important to avoid hitting blood vessels, bone, or muscle with the needle. The most ideal areas of the body for Subcutaneous Injection are the stomach, the front of the thigh, or the sides or back of the upper arm
What Type of Needles Are Used in Subcutaneous Injections?
Subcutaneous injections are delivered using needles which are 5/8 inch long. The needle-width is generally fairly small, most often either 25 or 27 gauge. Doses which are between one and two milliliters may require a slightly wider needle.
How Are Subcutaneous Medications Stored?
For most Subcutaneous Medications, the medication is stored as a liquid in small vials. Certain drugs, such as Human Growth Hormone, are stored differently, however. For particularly sensitive and delicate drugs like HGH, pharmacies and medical manufacturers convert the drug to a powder form, through a process known as Lyophilization.
This simply means that the medication is freeze-dried until it is ready to be used. The Lyophilization process is safe to use on delicate medications like Human Growth Hormone and does not alter or break down the chemical structure of the medication. Liquid HGH is incredibly sensitive to both temperature and tampering. It must be stored under refrigeration, even when lyophilized, and even agitating the vial too much can break down the dried HGH and render it inert.
Lyophilized medications like Human Growth Hormone are prepared for Subcutaneous Injection through a process known as Reconstitution. This is generally performed carefully, by combining the Lyophilized medication with sterile solution in order to restore it to its normal composition. For medications that will be used fairly quickly after they have been reconstituted, simple, sterilized water will be sufficient.
For other drugs, including Human Growth Hormone intended to be stored for up to a month after reconstitution, the Lyophilized Medication is generally combined with water that has been treated by a preservative such as benzene. Some vials of medicine are only intended to be used once, whereas others are intended for multiple uses.
Subcutaneous Injection with Pens
Pretty much all Subcutaneous Injections can be delivered using a standard insulin needle and syringe, but there are also other products which are intended to make the injection process easier and simpler. The most common of these is the "Pen." Pens are small machines intended to store and deliver a medication easily, which is shaped like a pen. The pen contains liquid medication, and each time the medication is delivered, it uses a new needle.
These pens are generally engineered so that they automatically deliver a range of doses simply by adjusting a dial. Some medications can also be delivered via computerized, hand-held devices.
Subcutaneous Injection Walkthrough
When preparing to administer a subcutaneous injection, it is important that the first thing you do is to wash your hands thoroughly. If you are delivering a subcutaneous injection for someone else, it is vitally important to wear gloves.
In addition to washing your hands, you should also appropriately sterilize the area in which you plan to arrange your supplies. It is incredibly important to maintain optimal cleanliness throughout the injection process so that you minimize the potential for contamination.
The following steps are necessary when performing Subcutaneous Injections utilizing a syringe:
Make Sure the Right Person is Getting the Right Medication
Before drawing the medicine from its vial, always look at the bottle in order to ensure that you are always injecting the appropriate medication. Nurses and other medical professionals constantly stress the importance of the 5 Rights of Medication Delivery: the Right Medicine, the Right Dosage, the Right Patient, the Right Time, and the Right Route. By following these five steps every time, you ensure that the treatment you intend to deliver is delivered appropriately and effectively.
After you have obtained the appropriate vial of medication, remove the cap and place it to the side. If the pen or vial that you are using is intended for multiple uses, write down the date at which you first opened the vial. After being opened, Subcutaneous Medications often have relatively short shelf-lives. For example, once reconstituted, Human Growth Hormone Replacement Therapy generally keeps for a few weeks. After that point, it is no longer medically potent.
Draw the Medication from the Vial
After removing the cap from the medication, sterilize the rubber stopper on the vial with an alcohol swab. At this point, take your syringe and pull the plunger back so that the amount of air inside represents the dose that you intend to draw. At this point, carefully remove the cap which has been covering the tip of the needle, making sure not to make contact with the needle, itself. If you do accidentally touch the needle, discard it and choose another needle.
Slowly bring the needle into contact with the stopper of the vial. After piercing the vial with the needle, inject the air contained within the needle into the vial. This will maintain air pressure in the vial and make it easier to draw the medication. At this point, tilt both syringe and vial topside down with the needle pointed straight upward. If there are air bubbles in the solution, tap the side of the vial lightly in order to jar any air bubbles to the bottom of the upturned vial.
Draw back the plunger until the dose you intend to inject is contained within the vial. Carefully pull the needle from the vial and check the syringe for any trapped bubbles of air. If there are any bubbles of air, tap the syringe lightly so that they rise to the top. At this point, slowly depress the plunger, ejecting any bubbles contained within. Release the plunger when you see the medication itself breach the tip of the needle.
If Administering Subcutaneous Medication using a Pen:
As we mentioned earlier, Injection Pens are used because they simplify the process significantly. When using a Pen, the medication is already contained within the device and ready for use. The only thing you need to do is replace the needle every dose until either the pen is expended or the medication contained within is out of date.
Make sure that the needle is connected to the pen safely without making contact with the tip of the needle. When using a Subcutaneous Pen, the dial on the side of the pen represents the size of the dose that will be delivered. Turn the dial so that when activated, the pen will deliver the appropriate dose.
Preparing the Injection-Site:
When choosing a location on your body to deliver the medication, we recommend one of the sites mentioned above: the midsection, the sides or back of the upper arms, or the top of the thighs. When selecting a location, pick a spot of clean and healthy skin. Avoid injecting into an area with skin irritation, burns, bruising, hardness, or swelling.
Also, it is important to inject into a different location every time you deliver a shot. Repeatedly injecting in the same general location can structurally weaken the skin or cause irritation and pain. Before settling in for your injection, clean the injection site with an alcohol swab. Set the syringe or pen to the side where it can be picked up and utilized easily.
With one hand, take the patch of skin, and squeeze it between your index finger and thumb so that it is raised. This allows the needle to inject completely into the skin while also delivering the medication to the appropriate layer underneath the skin. Pick up the needle and hold it at a right-angle to the skin. If you have very low body-fat, you may need to turn the needle to a forty-five degree angle in order to inject the medication correctly.
Performing the Subcutaneous Medication
When ready, pierce the skin firmly and steadily with the needle. When the needle is fully inserted into the skin, draw back just a tiny bit. If you draw blood when you pull the plunger back, that means that you have pricked a blood vessel and will need to pull out, replace the needle, and choose a new injection site. If you do not see any blood, deliver the medication by depressing the plunger slowly and completely.
After you have delivered the medication, pull the needle out of the skin quickly, yet carefully. After removing the needle, set the syringe or pen aside and clean the injection site with clean gauze. If you do experience any bleeding after the injection, there should be very little blood. Do not be overly concerned if you occasionally experience bruising as a result of injection.
Dispose of All Equipment Appropriately
After you have completed the injection process, recap your needle and throw it away in an OSHA-Approved SHARPS container. If you do not have a SHARPS container, or other container approved for medical waste, do not inject until you have a way to safely dispose of the needles. Used needles are bio-hazardous waste, and it is both dangerous and illegal to dispose of them improperly.
What Complications are Related to Subcutaneous Injection?
With any injection, there is a non-negligible chance that you will experience an infection. Although there is always a risk of infection, this risk can be reduced a significant amount by following procedures which ensure that all aspects of injection are handled appropriately and cleanly.
Even when you follow all of the appropriate steps for safe injection, you may still experience changes in skin, irritation, or bruising. Changing injections sites with every administration will greatly reduce the risk of experiencing these symptoms.
Patients that have issues with cardiovascular circulation may have issues experiencing the full effects of Subcutaneous Medication, because poor circulation inhibits optimal absorption rates.
Some patients may also be allergic to preservatives contained within medications which are intended to increase the shelf life of larger prescriptions. For these patients, alternative preservatives may be needed, or the patient may opt for smaller vials which do not require preservatives at all.
Information listed in this document is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treatment of a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your health care provider or your representative.
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