Safe intramusclar injection: safe and sterile IM injection
A good safe and sterile IM injection technique will reduce pain and the chance of infection, abscesses and embolism.
The overriding principle for sterility is never to expose syringe fittings, needles or gear to the air for longer than absolutely necessary, where they may attract pathogens.
The following procedure may seem long, but its logic should become second nature.
Preparing and drawing up:
If you like to warm your AAS in hot water or under your armpit, do so first.
Wash your hands well.
Collect your AAS, syringe, needles, and antiseptic and tissues, or swabs, on a clean surface in a clean room.
A suitable, cheap and easily available antiseptic is ordinary Listerine mouthwash on tissues.
If you are using AAS from phials, discard the seal caps if necessary and swab the rubber seals with antiseptic and let them dry.
If necessary score or file ampoule necks for popping. Then swab all necks and let them dry but do not pop them yet.
Meanwhile, without touching them push the syringe tip and the fitting of your drawing up needle quickly through the paper of their packages and join them immediately. Discard the packaging.
Do not remove the needle cap until you are ready to proceed.
For phials: without removing the needle cap, draw into the syringe the same volume of air (and sterile gas in the cap) as the amount of gear you’re going to draw up.
Remove the needle cap and push it slow and straight through the centre of the phial seal. Inject the air. Invert the phial and draw out the desired amount of gear. Once the amount is correct, withdraw the needle smartly and re-cap it immediately.
Repeat for doses from other phials. Avoid mixing and cross-contaminating phials with different gear.
For ampoules: now pop any ampoules you are going to use, immediately uncap the needle, draw up the contents and re-cap the needle. Do not worry about any bubbles.
A modern chamfered multi-facet cut hypodermic needle will stand a couple of passes through phial seals without materially blunting; but needles are cheap enough, so to minimize pain and trauma discard safely any needles you may suspect are blunt.
If you are going to change needles do so now: pull back on the plunger a little to empty the capped needle, snick it off without touching the syringe end, pop a new needle fitting through its pack without touching it and join it to the syringe immediately.
Do not remove the needle cap.
Dispose of the old needle safely in a sharps bin.
Hold the syringe with the capped needle up and expel any bubbles until the gear just about enters the needle. A little air will do no harm.
There is no need to waste gear by squirting it out of the needle; needles are pre-lubricated with PTFE or silicone and do not need wetting.
Now you may pause if desired before injecting. The gear will be safely sterile inside the syringe with capped needle for a few hours if necessary, though it is best not to carry them around but to use them as soon as possible.
Choose your injection site. Swab it well with antiseptic and let it dry.
Assume a steady posture. Relax the muscle completely. There is no need to stretch the skin.
Hold the syringe like a pen, uncap the needle and immediately slide it slowly 1 inch into the muscle. DO NOT STAB! Only the first mm will prick.
If you feel an electric nerve pain or any other unusual pain at any point, pull the needle out smartly, do not touch it on anything and re-cap it. Press on the wound with a tissue. No need to change the needle. If the needle touches anything replace it. Start again at least an inch away elsewhere.
When the needle is an inch in, pull it back out only 1 or 2 mm to ensure the tip is open: this will make aspiration easy and clear.
Then hold the needle top steady with your free hand and ASPIRATE – pull back slightly on the plunger for 2 seconds.
If blood enters the syringe, the needle tip is in a blood vessel and it is NOT safe to inject.
Withdraw the needle smartly, do not touch it on anything and cap it immediately. Press on the wound with a tissue.
It is best not to re-inject clotting blood into a muscle as this will cause a haematoma – bruise – which may be painful and take time to clear.
Hold the syringe needle down and let the blood sink into the needle fitting. Uncap the needle and without touching it on anything expel just the blood into a tissue and recap the needle immediately. No need to change it. If the needle touches anything replace it. Start again at least an inch away elsewhere.
On aspiration some gas bubbles may enter the syringe from the needle or fitting: do not worry about these: a little air will do no harm and will ensure all the gear is pushed into the muscle.
If no blood enters the syringe, inject slowly – maybe 10 secs per ml.
Experienced injectors gain a feel for how fast they can inject. Faster injection will not cause damage or PIP (post injection pain) but can be uncomfortable.
Do not worry about a few air bubbles being injected – they will do no harm.
When the syringe is empty, immediately withdraw the needle smartly to minimize time in the wound and trauma.
Since you are not going to reuse the needle you can press a tissue gently against it as you withdraw it and straight onto the wound to stop any bleeding.
Dispose of the needle safely in a sharps bin.
Now massage the site firmly until any lump has disappeared and the gear is dispersed. There is no danger of infection from clean dry hands.
Keep the muscle moving for some time: it’s best to inject in the morning or before working out, but not before bed. This will minimize PIP.
Used phials, ampoules and syringes – but NOT needles – may be safely disposed of in the normal rubbish.