IM injection protocol

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This is a protocol for self-administering an intramuscular (IM) injection. This protocol is specific to administering testosterone but can be adapted to other IM injections. This protocol assumes the upper outer thigh as the injection site since this is the most accessible when self-injecting.

It is not necessary to use two different gauges of needles but you do need to change the needle between drawing up and injecting.

How to find an IM injection site

Where to inject on the thigh

Thigh injection site

• For thigh injection (recommended for self injection)
  • divide your thigh horizontally into 3 sections
  • aim the injection on the outer top part of this middle section

Buttock injection site

Where to inject on the buttock- Aim for injection where the 'X's are

• For buttock injection (recommended if someone else is doing the injection for you)
  • divide each buttock into 4 parts
  • aim the injection in the upper outer quarter, towards the hip bone

What to before an IM injection

1. You must check the medication is correct. Talk to the patient and check if it's:
   • The right medication- Check the medication labeling to ensure it's what you expect to be in the bottle, and consider substance testing.
   • The right dose- check the dose is what is intended.
   • The right time(and date).
   • The right route- Check it's not an SC or IV injection, for example.
   • The right person- Talk to the person, make sure they're expecting the medication and that they recognise the medication as medication intended for them.
2. Warm up the vial:
   • you can do this by placing the vial in a glass of warm water
   • warming up the vial will make the injection more comfortable but isn't necessary
   • this is more important with Nebido than Sustanon.
3. Whilst the vial warms, set up a 'work' station. Place everything you need on a clean surface including:
   • needle for drawing up from the vial (smaller gauge)
   • needle for injecting (larger gauge)
   • syringe.
4. Wash your hands and wear gloves if you're doing this on someone else and gloves are readily available.
5. Sit down on a chair or couch, ensuring legs are able to fully relax.
6. Clean the injection site by either:
   • washing the injection site with soap and water
   • using an alcohol wipe, ensuring that you only wipe once over the injection site.
7. Open the warmed vial of testosterone
   • most Sustanon vials are glass bubbles with a line and dot. Place your thumb on the dot, grip with fingers on the other side and snap.
8. Draw up with the smaller gauge needle
   • attach the smaller gauge needle onto the syringe
   • remove the cap and draw up the oil from vial
   • this will take about 1 minute- you have to create a vacuum in the syringe and just wait until the oil fills the empty space.
9. Replace lid on needle and flick to remove air bubbles.
10. Whilst holding syringe so that the needle is pointing up, remove the smaller gauge needle and dispose of it in a sharps bin.
11. Attach the larger gauge needle and remove the lid.
12. Eject the air in the syringe until you see that a small amount of oil comes to the end of the needle. Replace the cap until you are ready to inject.
13. If you really struggle with a decisive stab, ice the area beforehand
    • Slowly inserting the needle will increase discomfort over following days so should be avoided.

How to do an IM injection

1. Insert needle into the upper outer thigh or buttock
   • hold the syringe like a pencil
   • pull skin apart so it is stretched tight at injection site with your hand which isn't holding the needle
   • inhale as you insert
   • using a decisive, smooth movement, insert needle at a 90 degrees angle/straight in
2. Pull plunger back slightly to check for blood (also known as aspirating)
   • if blood appears in the syringe, remove needle and start over
   • if no blood, depress/inject the solution as slowly as possible to minimise discomfort
   • exhale as you inject
3. Take the needle out once the syringe is empty
   • sometimes a small amount of blood will come out. This is normal.
   • if blood does come out, apply pressure for 30 seconds and apply a plaster.

What to do after doing an IM injection

• Dress wound (if any)

• Dispose of needle and syringe into a sharps bin and any other waste.
  • When your sharps box is full, find your local needle exchange to drop it off at where you should be able to get replacement needles and syringes.

Any pharmacy displaying this logo will accept your sharps bin and give you new needles and syringes

• Make a note of which leg you injected into and alternate for next time. If it is not possible to alternate, ensure that the next injection site is at least 1 inch away from the previous injection.