Intramuscular
Injection Information and Procedures
Both
Testosterone and Human Growth Hormone Replacement Therapy can be
delivered through injection. Although Testosterone can be delivered
in multiple ways, including patch, spray, cream, and dermal implant,
many people prefer to deliver the hormone via injection.
Even
though both HGH and Testosterone can be administered using a needle,
they are injected in different ways. Whereas HGH is injected beneath
the skin using an insulin needle, Testosterone is delivered directly
into the muscle using a method known as Intramuscular Injection.
This
article will more fully explain Intramuscular Injections, and it will
also describe the actual protocol used for injection.
Why
Do We Deliver Some Medicines Intramuscularly?
Intramuscular
Injections are Safer
There are
many reasons why some medications are delivered Intramuscularly, as
compared to Intravenously or Subcutaneously. In comparison to
Intravenous Injections, Intramuscular Injections are considered safer
than Intravenous Injections.
Intramuscular Injections are Easier
In
addition to this, Intramuscular Injections are much easier to perform
than Intravenous Injections. With an Intravenous Injection, it is
necessary to target and hit a vein in order to deliver the
medication. This is easier for some patients than others. Some
patients have deeper veins which are harder to target, and others
have rolling veins, or veins that shift as the needle pierces the
skin, making it hard to actually find the vein with a needle.
Intravenous
Injections can Cause Damage
Intravenous
Injections can also damage the veins, whereas muscle fibers are
constructed in a way where the damage caused by an injection is
negligible. Both Intramuscular and Subcutaneous Injections are easier
and safer to perform than Intravenous Injections. Intravenous
Injections are generally preferred for drugs which "drip" into
the system, meaning that they supply a slow and constant supply of
medication into the blood stream.
Intramuscular
Injections are Fast Acting, but Release Can Be Controlled
Intramuscular
Injections act faster than Subcutaneous Injections, but still deliver
the medication to the body over the course of a number of hours. Many
drugs used via Intramuscular Injection, like Testosterone Hormone
Replacement Therapy, contain ester compounds in order to slow the
release of medication into the bloodstream. Ester compounds have
relatively long half-lives, and release Testosterone slowly over
time.
Some
Testosterone Esters break down completely over a relatively brief
period of time-only a few days. Other Testosterone Esters, like
Testosterone Cypionate and Testosterone Enanthate, take one-to-two
weeks to release the entire dose into the blood stream. This is one
reason why many patients choose Testosterone Injections over less
invasive methods. Most popular Testosterone Shots only have to be
delivered every week or two, whereas most other forms must be applied
on a daily basis. Testosterone Dermal Implants deliver Testosterone
for an even longer period of time, but this form of treatment is much
newer and less popular than other forms.
Do
Intramuscular Injections Hurt?
The pain
associated with injection is considered slightly greater than the
pain associated with Intravenous Injection, but the majority of users
find the pain tolerable and quite bearable.
Where
are Intramuscular Injections Delivered?
Intramuscular
Injections are delivered into muscle tissue that is just beneath the
Subcutaneous layer underneath the skin. This muscle tissue is known
as Striated tissue.
What
Size of Needle is Used for Intramuscular Injection?
The
needles used for Intramuscular injection are slightly larger than
those used from Subcutaneous injection. The needles are usually 1-1.5
inches in length and gauge between 19 and 22. There are certain
muscles that contain more striated muscle tissue than others, and
these are considered the ideal location to perform Intramuscular
Injection. These muscles are the muscles of the thigh (vastus
lateralis), the upper arm (deltoids), and the buttocks (gluteal).
The gauge
and length of the needle depends upon the amount of fat at the
injection site. Individuals that have higher levels of body fat need
longer needles than those that don't. In the case that the needle is
not long enough to pierce into the striated muscle tissue, the
medication will be delivered into adipose fat tissue rather than the
intended muscle.
This is a
more significant issue with women than for men, because women
biologically produce higher levels of fat than men. Injections that
are delivered into the body-fat are known as Intralipomatous
Injections. If injections are accidentally delivered into fatty
tissue, this has the potential to severely restrict the ability of
medication to release into the body quickly and effectively, because
there are very few veins in fat tissue, and this slows down the
dispersion of the medication.
Rotating
injection Sites with Intramuscular Injections
When
patients are required to undergo multiple Intramuscular Injections
over a certain period of time, it is vitally important to change
injections sites with every subsequent shot. Testosterone Injections
are an example of a medical therapy which requires multiple shots
ranging generally from four per week to once every two weeks.
Repeatedly performing injections into the same site can damage muscle
tissue, and cause skin tissue to weaken and pit as well.
Dosage
Volumes with Intramuscular Injection
Like
Subcutaneous Injections, Intramuscular Injections are intended for
relatively small doses of medication, although muscle tissue can
effectively absorb and distribute a higher volume of medication
without causing and major issues. Subcutaneous Injections max out at
a volume of 2 milliliters no matter where the shot is administered.
For Intramuscular Injection, the maximum dosage depends on the size
and location of the muscle which is chosen for injection.
Some
muscles can accept less medication than others. The thighs and
deltoids, for example, can only intake around two milliliters of
medication, but the glutes can safely tolerate up to five milliliters
of medication. Intramuscular injections are generally reserved for
strong and potent medications and treatments, such as Sermorelin
Acetate Therapy and Testosterone Hormone Replacement Therapy for this
reason.
What
Areas Should I Avoid When Injecting Intramuscularly?
When
attempting to deliver your Intramuscular Medication, there are
certain things you want to avoid. It is important to deliver the
injection far away from any blood vessels and major nerves. If a
needle clips a nerve, this will be very painful, and it will also do
damage to the nerve. Nicking a blood vessel is bad because
Intramuscular Injections are not intended for Intravenous
application, and many intramuscular medications can actually be
dangerous if they are injected into a vein. Testosterone Injections,
for example, are delivered via oil solutions so that they soak more
readily into muscle tissue, but if oil directly enters the blood
stream, this can cause dangerous cardiovascular issues such as
embolism or blockage.
Oil
bubbles act just like air bubbles or other physical obstructions in
the blood stream. It is incredibly easy to avoid this, however,
because you will know if you hit a vein because blood will enter the
syringe when you pull the plunger back. This process is known as
aspiration.
You should
also avoid any area of the skin which is irregular or damaged.
Delivering an injection through a patch of skin that is infected can
greatly increase the chance that you will experience a blood
infection. You should also avoid scarred or irritated skin as well.
Side-Effects
of Intramuscular Injection
If you
experience any of the following issues as a result of Intramuscular
Injection, discuss them with your doctor:
Scar
Formation Can be avoided by rotating injection sites
properly and performing injections carefully
Skin
Sloughing Can be avoided by rotating injection sites
properly
Hematoma
Can be avoided by insuring that injections are not delivered
into veins
Embolism
Can be avoided by insuring that injections are not delivered
into veins
Cysts
Injecting too close too nerves can lead to cyst formation
Abcesses
Abcesses can occur as a result of infection. Always
carefully sterilize all equipment, wash hands thoroughly, and clean
the injection site
Why
Choose Intramuscular Injections Over Intravenous Injections?
Although Intravenous Injections are the only choice for delivering
large amounts of medication very quickly, Intramuscular Injections
are ideal for delivering a small to moderate amount of medication
over an extended period of time. One reason why this is so is because
Intramuscular Injections are released slowly by the muscle tissue
into the blood supply.
When
an Intramuscular Injection is delivered, it forms a deposit in the
muscle tissue known as a Depot.
This pocket of medication within the muscle tissue drains slowly into
the blood stream over time. Absorption rates depend upon multiple
physiological factors, including circulation to the muscle, the depth
at which the medication was injected, the type of drug formulation,
and the amount of exercise that the muscle receives.
How
Formulations Affect Absorption
Intramuscular
Injections are very versatile because they can be formulated to
release into the body at various different rates. Water/Saline
Solutions are metabolized by the body at the fastest rate. Oil
solutions take much longer to release into the body.
In
addition to this, medications can be designed as colloids or
suspensions in either oil or water formulations in order to further
increase absorption rate. Drugs can also be chemically combined with
various forms of salt in order to decrease solubility. This works
exceptionally well within oil solutions, because oil absorbs salt
very slowly.
Drugs like
Testosterone Cypionate and Testosterone Proprionate are attached to
ester compounds so that they are released slowly over an extended
period of time. Esters are very effective at providing a large number
of dispersion rates, because Esters Dissolve from their host into the
blood stream at a rate which is specifically correlated with the
number of carbon molecules attached to the ester.
This means
that Bio-Identical Testosterone can be released into the blood stream
over the course of a day or over the course of two weeks simply as a
result of the size of the ester molecule.
What
Type of Medications Are Delivered Intramuscularly?
There are various forms of medication that are delivered via the
Intramuscular route, including:
Haldol
Ativan
Morphine
Codeine
There are also many nutrients and hormones that are delivered via
Intramuscular Injection:
Progesterone
Testosterone
HCG
Vitamin B12
Plasma Injections
Many forms of vaccinations are delivered Intramuscularly. Including:
Flu Vaccines
Rabies Shots
Hepatitis A Vaccinations
HPV Innoculations
How To
Perform an Intramuscular Injection
There are a different set of guidelines for exactly how to deliver an
Intramuscular Injection, dependent upon the muscle that you will
inject the medication. Some muscles may require you to stretch the
skin and bunch the muscle, whereas other locations may require you to
stretch both the muscle and the skin. There are some rules that are
universal, however:
Always wash your hands thoroughly before injection.
If someone else is delivering the injection, they should wear gloves
under any circumstances.
Always disinfect the space in which you will perform the injection.
Always clean the injection site prior to injection.
Never use medication which is out of date.
Always store medications properly.
Administer the injection into relaxed muscle to maximize
effectiveness and minimize pain.
Always use a needle that is of a length appropriate to the injection
site.
Never let the tip of the needle make unnecessary contact.
When drawing medication, always release any air trapped within the
needle by turning it upwards, tapping the syringe, and pressing the
air out with the plunger until all bubbles are released. Injecting
even a single bubble of air is very dangerous and can cause numerous
complications.
Aspirate the needle slightly before injection to insure that you
have not hit a vein. If you have, you will have to adjust the
injection site.
Always dispose of needles in an approved SHARPS container. Used
needles are biohazardous waste and must be treated with extreme
caution and care.
Intramuscular
Injection into the Deltoid:
Deltoid Injections must be delivered by a second party, because it
requires two hands to deliver the injection. This injection-site is
generally utilized for vaccinations and medications which cause
little irritation. This location is intended for small amounts of
medication ranging from 1-2 milliliters in volume. For patients that
have very low muscle mass, Deltoid Injections may not be an option.
To choose an appropriate location for Deltoid Injection, start at the
bone of the shoulder and move about an inch and a half beneath the
process. This muscle is triangular in shape, with its widest portion
at the top of the muscle. Inject into an area at or near the thickest
part of the muscle, which is in the center of the triangle.
It is important to inject in the central portion of the muscle,
because the Radial Nerve and Brachial Artery are located just on the
outer edge of the Deltoids.
For this location, stretch out the skin and grip down around the
muscle, squeeze your fingers together so that the skin remains tight,
but you have squeezed the muscle. Insert the needle into the muscle
at a 90 degree angle.
Intramuscular
Injection into the top of the Thigh (Vastus Laterus):
This location disperses medication quicker then the buttocks, but
slower than the deltoids. The appropriate location to inject into the
top of the thigh is between one hand-width beneath the groin and one
hand-width above the knee. In this window, choose a location near the
thickest part of the muscle.
Thigh injections are often preferred by individuals that self-inject,
because it is easy to access the thigh muscle from either a prone or
sitting position.
Stretch the skin tightly in order to reduce the distance that the
needle must travel. Inset the needle at a right angle to the leg,
directly into the muscle. At this location, you can deliver up to two
milliliters of medication per injection.
Intramuscular
Injection into the Hip (Ventrogluteal):
The Ventrogluteal site is widely considered to be the best location
to deliver an intramuscular injection, either via self-administration
or via the assistance of a second party. This location represents the
thickest portion of the glutes, as this area includes both the
Gluteus minimus and the Gluteus medius. This area also has some the
thinnest layer of fat tissue among anywhere in the gluteal region. It
is also the safest area to deliver injection, because there are no
veins or nerves in range of the needle in this area, so you are
primarily attempting to avoid bone. Using this injection site, it is
safe to deliver up to two milliliters of medication.
Locate the outer protrusion of the upper femur, known as the
prochanter. Then locate the protrusion of the hip bone, known as the
Iliac Crest. Move your hand forward until you reach the point of the
crest furthest from the center. This is known as the Anterior Iliac
Crest. You will deliver the injection at a point equidistant from
both of these protrusions. Laterally, the injection site will be
located halfway between the center of the crest and the front of the
crest. In your mind, this should form an upside-down triangle.
Aim for a location in the center of the triangle, equally far away
from both bones. Tighten the skin around the injection site, then
deliver the needle directly into the muscle at a 90 degree angle.
Intramuscular
Injection into the Buttock (Gluteus medius):
In this location, injections can only be administered by a second
party. This location is ideal for larger injections of up to five
milliliters. You must be very careful when delivering an injection to
this location, because the superior gluteal artery and the sciatic
nerve are located only about three centimeters away from the
injection site, making it vitally important that the injection is
delivered to the correct location based off of physiological
landmarks.
Every time this injection is performed, it is important to physically
locate both the Posterior Iliac Crest and the Trochanter. This area
also has a large amount of fat, and requires longer needles than many
other sites. The amount of fat tissue also slows down absorption,
which should be taken into account when choosing this location.
Locate the protrusion of the upper femur, known as the trochanter.
Then, locate the Posterior Iliac Crest. Place your hand on the
central portion of the protrusion of the hipbone and move your hand
back until you reach the portion of the bone furthest from the
median. You may notice that many individuals have dimples located
directly above this bone.
Imagine that there is a line which stretches directly from the
Posterior Iliac Crest to the Trochanter. Move to the center of this
line, then follow the line one inch further upward. This is the ideal
injection site. Stretch the skin taut and deliver the needle directly
into this point at a 90 degree angle.
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