While most of the stimulant drugs are administered via subcutaneous injection, some injections, including progesterone in oil (PIO) and some “trigger” shots (Human Chorionic Gonadotropin, or HCG) are given by intramuscular (IM) injection.
For those of you who are scared of needles (even despite administering hundreds, if not thousands, of sub – Q injections), the prospect of an IM injection can be utterly horrifying. The needle is 1½ inches long and often 22 or 25 gauge (remember that the lower the number, the thicker the needle so an 18 gauge is much thicker than a 25 gauge needle.)
As with any injection, get everything ready beforehand: extra needles, gauze pads, and, for IM injections, plug in a heating pad for post-injection. Icing the area for 5-10 minutes beforehand can help numb the skin & muscle a little bit making it more tolerable. Often, you will draw up the medication with a larger (18 or 22 gauge) needle, and will then switch to a smaller (22 or 25 gauge) needle for administration. Since it is extremely thick, PIO typically needs to be drawn up and administered with a thicker needle. You can administer it with the thinner (25 gauge) needle, but it will take a little longer to inject the oil.
A couple of things to remember: first of all, switch needles after drawing up the medication and before administering it, even if you are using the same size needle to draw and administer. The needle can get just a little bit dull after it is placed into the vial of medication, and you want as sharp a needle as possible for administration—dull needles hurt a lot more than extra sharp ones! Also, remember to tap all air bubbles to the top of the syringe and depress the plunger a small amount to get the bubbles out. If you push the plunger until a tiny bead of medication comes out the top, that’s a good indicator that all of the air is out.
Now, for the dreaded injection. IM injections must be done in the large muscle of the buttock. To locate the correct area, imagine the buttock is divided into four areas (like an x/y axis). The injection should be given in the upper, outer portions. Another easy way of locating the correct area: place your hands on your hip bone, with your thumb pointing toward your butt crack and your other fingers on the front of your hip, with the area in between the thumb and forefinger flat against your hip bone (like you’re putting your hands on your hips). The injection can be given below the thumb, but not past the tip of the thumb — that area gets close to your sciatica nerve and you want to avoid that area. The easiest way to administer the injection is to have someone do it for you. However, it is possible to do it by yourself.
If you have someone to do it for you, the easiest position is to lean against a counter and put all of your weight on the leg opposite the side of the injection (you should alternate sides each night from left to right to avoid over-irritating one side). Don’t look back. The person administering the injection should hold the skin taut with his/her thumb and forefinger of the hand not holding the syringe, and should be holding the syringe in the other hand like a dart. Have the other person count to three if you’d like, and then go in at a 90 degree angle as quickly as possible— you will feel a slow injection more than a quick one, so make sure they go quickly.
If you are doing the injection yourself, find a comfortable position where you can hold the needle steady and still keep all weight off of the side you are injecting. Twist yourself around so that the hand not holding the needle holds the skin taut between your forefinger and thumb. With the other hand holding the syringe like a dart, inject as quickly as possible at a 90 degree angle.
Once the needle is in (make sure all 1½ inches are in the skin/muscle), pull back the plunger just a small amount to make sure there is no blood, which would mean the needle is in the incorrect position. IF you see blood, DO NOT PANIC. Simply pull the needle out slowly, attach a new needle, and inject again in a different location. You do not need to discard the medication because of the blood. The blood is your own and can be re-injected (with a clean needle) along with the medication.
If there is no blood in the syringe, slowly depress the plunger to inject the medication. When done, quickly pull the needle out in a straight line. Do not panic if you have a little (or even a lot) of blood coming out of the injection site—just put pressure on with a gauze pad for a minute or so and the bleeding will stop. You can put a band-aid on the area if necessary.
Massage the injection area to help spread the medication (especially PIO) around. Put a heating pad on the injection area for 10-15 minutes after the injection, especially with PIO because the heat can dissipate the oil so that it does not harden in an uncomfortable lump. Also make sure to walk around a bit to avoid any muscle soreness and, for PIO, to further spread the oil around.
As mentioned above, there is always the chance that you will hit a blood vessel and draw blood when you draw back the syringe. Do not panic—just withdraw the needle, make sure to change the needle, and re-inject in a different spot.
You may also experience soreness—some people experience more soreness than others. The best ways to eliminate, or at least reduce, soreness was to consistently use a heating pad after the injection, massage the injection area, and walk around a bit. Soreness is more likely with PIO because the oil has a tendency to coagulate in the muscle and cause an uncomfortable lump. Massage, heat, and moving around can help the oil spread out and prevent these lumps.
Finally, there is a chance that you could hit a nerve when administering the injection. If you are careful, this will not happen. To avoid this possibility, make sure you are giving the injection closer to the hip than to the middle of the buttocks.
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