Getting poked by a needle is not one of life’s most enjoyable experiences. Whether it’s a flu shot, a blood draw, or even an accidental prick while sewing, most people experience anxiety whenever needles are involved. This innate anxiety helps us to avoid getting accidentally poked, but it can also be troublesome when injections are necessary for administering medication.
In this day and age of medical progress, self-injecting medications are become more and more common. On one hand, self-injections can be celebrated as a solution of convenience. You can give yourself your medication on your own schedule without having to stay in a hospital or go to your doctor’s office every week. On the other hand, the idea of administering self-injections can be enough to prevent some from trying a medication that could make their life better. This obstacle of self-injection anxiety is understandable and can be hard to conquer. The best way to break through this barrier is to arm yourself with information on how to give yourself injections in the safest and most effective way possible.
Here are our tips for giving self-injections whether it is your first or one hundredth time:
1. Be honest and be your own advocate:
Being honest with your healthcare provider and yourself about anxiety for self-injections is an extremely important first step to making this process doable. Most patients feel anxious, and expressing that anxiety can help both you and your healthcare provider understand what the best course of action is for your physical and mental health. Remember that healthcare providers, while observant, are not mind readers. If you feel uneasy about self-injections, speak up! There may be other, non-injectable options available or your provider may have other tips for making the shots bearable.
2. Have your pharmacist show you how to give self-injections when you pick up your prescription:
Your pharmacist is a great resource! They will be more than happy to help you get oriented and more comfortable with the equipment you are given. Ask your pharmacist to walk through each step/watch you give an injection. This way you can get used to using the equipment that you will be using and will ensure that you are injecting the correct amount of medication. Plus, you can work out some first-time jitters before being on your own.
3. Have the correct equipment on-hand:
Talk to your pharmacist about the correct length and gauge of needles to accurately and safely administer your injection. Some medications may require different sizes of needles for drawing up medication and for administering it. Keep an inventory of the supplies you have at home and give your pharmacist a heads up when you have a week’s supply of medication or equipment left. Remember that needles manufactured for injections are meant to be used once and should be immediately placed into a sharps container after use. When a needle is used to poke through a thick barrier like skin, it immediately becomes more blunt. Using blunt needles makes injections far more painful and can also cause damage to the skin and muscle.
4. Set your table and your environment:
Each time you prepare to give yourself an injection make sure to arrange all the supplies you will need within arm’s reach. This will not only ensure that you don’t forget a step but will also make the process more streamlined and less chaotic. Play some relaxing music. Light a candle. Make your environment a place where you feel comfortable while still ensuring that you have all the equipment at the ready to give your injection safely, accurately, and quickly.
Set your table with the following supplies:
* Alcohol swab
* Needle(s) / Pen needle
* Medication vial or pen
* Cotton ball
* Band aid
* Sharps container
5. Know your technique:
Being familiar with the technique for your specific injection is essential to make self-injections effective and as painless as possible. First, find out if your injection is meant to be injected into the muscle (intramuscular or IM) or under the skin (subcutaneous or SC). Intramuscular injections go into a large muscle such as the deltoid or thigh muscle. Whereas subcutaneous injections go into the layer of fat under the skin. Most of the steps are similar for both IM and SC injections. Listed below are general steps for injections.
1. Wash your hands with soap and water
2. Clean the top of the vial with an alcohol swab and wait until dry before inserting a needle.
3. Attach the needle to the syringe. Prepare the syringe by pulling the plunger back and filling the syringe with air. The amount of air drawn into the syringe should be the same amount of medication you are planning to inject.
4. Keeping the vial on a flat surface, insert the needle through the rubber top of the vial. Press the plunger down so all the air injected into the syringe goes into the vial.
5. Turn the vial upside down so you are holding it in your hand with the syringe hanging below it. Making sure the tip of the needle is in the liquid, slowly pull on the plunger to fill the syringe with medication to the correct dose. **Try to avoid air bubbles to ensure the dose you are measuring is accurate**
6. Clean the skin where you plan to inject with an alcohol swab. **Make sure to let the alcohol dry to avoid stinging**
7. Insert the needle into your skin at a 90-degree angle.
8. Push down on the plunger of the syringe to inject the medication.
9. Remove the needle at the same angle it was inserted into your skin.
10. Throw away the needle and syringe into your sharps container. **Never recap your needle once it has been used for injection**
11. If you are bleeding after your injection, press the injection site with a cotton ball for 30 seconds until the bleeding has stopped. Then place a band aid over the injection site.
12. Wash your hands again, store your medication and equipment in a secure place
13. Give yourself a high five: you’re done!
Now that you have the basics down, here are specific tips and techniques for two medications that are commonly self-injected:
Intramuscular (into the muscle) self-injection medication example: Testosterone
* Testosterone is a very thick liquid. It makes it a lot easier to use a wider needle when drawing up testosterone into your syringe. For this reason, we suggest using an 18-gauge needle to draw up your testosterone from the vial then switching to a thinner needle (22-23 gauge) to inject the medication into your muscle. This will make the injection less painful. **The smaller the number of the gauge of a needle, the larger the width of the needle. For example, an 18-gauge needle is much wider than a 23-gauge needle**
* The thigh muscle is the easiest large muscle to inject IM testosterone. After you clean the injection area with an alcohol swab, spread the skin between your thumb and index finger to make the skin taught.
* Before pressing the plunger on the syringe to inject the testosterone, pull back gently on the plunger and check for blood in the syringe. If you see blood, pull the needle out of your thigh. Switch needles to a new thin gauge needle and try injecting into another area on your thigh. If there is no blood when you pull back the plunger, you can inject your medication. Talk to your doctor to find out if this step is required!
Subcutaneous (under the skin) self-injection medication example: Insulin Pen
* The skin on the belly is the easiest place to inject SC insulin. Select a location on your belly that is at least 2 inches from your belly button. After you clean the skin, pinch an inch of skin and fatty tissue between your fingers.
* Keeping your skin pinched, insert the needle into the skin. Press down on the plunger to inject the insulin into the pinched skin. Keep the needle in your skin for 10 seconds after the medication has injected. Then release your pinched skin and pull out the needle.
* The next time you inject, rotate sites of injection. Trying using the opposite side of your belly or rotating around your belly button like a clock. Rotating injection sites helps to ensure your medication is absorbed into your body and to reduce skin damage.
Giving yourself an injection may never be something you look forward to. But with the right supplies and a solid understanding of correct technique, you can have the confidence and independence to administer your own medication.
The Ohio State University Wexner Medical Center: Department of Urology. How to Give Yourself a Testosterone Intramuscular (IM) Injection. https://osuwmcdigital.osu.edu/sitetool/sites/urologypublic/documents/PatientEducation/TestosteroneIMInjectionEducation.pdf . Accessed 15 Oct 2018.
MedlinePlus. Bethesda (MD): National Library of Medicine (US); [updated 2018 Oct 19]. Subcutaneous Injections; [updated 2018 Oct 1; reviewed 2017 Nov 15; cited 2018 Oct 18]. Available from: https://medlineplus.gov/ency/patientinstructions/000430.htm
American Association of Diabetes Educators: Insulin Injection Know-How: Learning how to Inject Insulin. https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/Insulin_Injection_How_To_AADE.pdf. Accessed 19 Oct 2018.
University of Michigan Health System. How to give yourself a testosterone IM injection. 8 June 2016. https://www.med.umich.edu/1libr/SpinalCordInjuryProgram/IMselfInjectionTesto.pdf. Accessed 25 Oct 2018.