INTRAMUSCULAR INJECTION INFORMATION AND PROCEDURES

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.