In Depth Steroid Injection Procedure

What is an
intramuscular (in-tra-MUS-q-lar) (IM) injection? An intramuscular injection is
a “shot” of medicine given into a muscle. A syringe (suh-RINJ) with
medicine in it, is attached to a needle. The needle goes through the skin and
into a muscle. The medicine is pushed into the muscle by pressing on the
syringe plunger. When the medicine has been pushed into the muscle, the needle
is removed.

Why did my caregiver choose this kind of shot? Your caregiver has chosen this
kind of shot because of one or more of these reasons:

The amount of medicine to be given.

The kind of
medicine to be given. Certain medicines must be given into a muscle.

The medicine needs to be fast acting.

What should I know about the syringe?

A syringe has 3 major parts: the needle, the barrel, and the plunger. The
needle goes into the muscle to put in medicine. The barrel holds the medicine.
The plunger is used to get medicine into and out of the syringe.

The syringe has marks on the side of the barrel like a ruler. Instead of
inches, the markings are in cc’s or ml’s with marks between for fractions of
cc’s or ml’s. Each cc will have a number (1, 2, 3) next to the correct marking.
On some syringes the half cc will also be marked.

What should I know about the medicine?

Always know the name of your medicine and why you need to take it. Know how
much medicine you need to take or give. If you have questions about your
medicine ask your caregiver before taking it.

Medicine given in a shot is measured in cc’s (cubic centimeters) or ml’s
(milliliters). A cc is the same amount of liquid as an ml. They are the same
measurement with different names.

Look carefully at the ampule or vial containing the medicine. Check to make
sure 4 things are there:

The name of the medicine.

The number of cc’s or ml’s in the vial or ampule. (Make sure you have enough
medicine for several doses.)

The amount of medicine in each cc or ml.

The last date the medicine is safe to use. This is called the expiration
(x-per-A-shun) date.

How will I know the medicine is safe to give? Check the ampule or vial to make

The medicine is not out of date. The expiration date will be on the bottle.

There are no crystals or lumps in the ampule or vial.

The medicine is the correct color. Ask your caregiver or pharmacist what color
the medicine is should be.

The name of the medicine is the same name your caregiver told you or wrote
down. If you are not sure, call your caregiver.

How do I get the medicine out of an ampule? First, wash your hands carefully
with soap and dry them completely. Put on gloves if you need them.

An ampule is a tiny bottle with a narrow neck and a long, thin, hollow top.

The ampule may be scored to make it easier to break.

The ampule may be colored or clear.

If the ampule is either a dark color or is clear with clear medicine, it is
hard to see the medicine inside. This is important because the hollow top of
the ampule can trap enough medicine to keep you from getting the correct dose.

You may not take medicine out of the top of the ampule after it is broken. You
need to make the medicine go into the bottom of the ampule before you break it.
To make the medicine go from the top of the ampule to the bottom, flick or snap
the top with your finger. You may have to flick it a few times.

To break the ampule, wrap a wet alcohol wipe completely around the neck of the
ampule. Hold the top and the wrapped neck with the fingers of your writing
hand, and the bottom with the fingers of your other hand. Break the ampule.

Put the bottom of the ampule on a flat surface.

Take the cap off the syringe by pulling it straight off.

Carefully aim the needle through the broken neck of the ampule into the liquid
in the bottom.

Pull back on the plunger to suck the medicine into the syringe.

Once the syringe has the medicine in it, turn it upside down so the needle is
pointed straight up and the plunger is below it.

Pull down on the plunger until you see that the needle and a small area at the
top have no medicine. If necessary flick the side of the barrel to make any air
bubbles rise to the top of the barrel.

Push up on the plunger to the correct marking. This will make some medicine
squirt out of the needle. It will also force all the air out of the syringe.

How do I get the medicine out of a vial? A vial is a small bottle with a
plastic or metal top covering a rubber stopper. The vial may hold enough
medicine for several doses or only one dose. The medicine may be liquid or
powder. If the vial is a multiple dose vial, make sure you write the date you
opened it on the label.

If the medicine is a powder, it has to be made into a liquid:

Your caregiver will order the correct sterile liquid to add to the powder.
There are only two kinds of sterile liquids that may be used: sterile saline
and sterile distilled water. They are packaged in vials with metal or plastic
tops covering a rubber stopper. Use only the liquid that your caregiver
provided or ordered. If you were told to use sterile saline, you may not use
sterile distilled water. If you were told to use sterile distilled water you
may not use sterile saline. Never use tap water.

Remove a syringe from its wrapper. If you need to add more than 3 cc’s of
liquid, you will need to use 2 syringes. The first syringe is needed to add the
sterile liquid. The second syringe is needed to give the shot.

If you have instructions from your caregiver, follow them. If you do not have
instructions from your caregiver, read the label or package insert information.
It will tell you how much liquid you will need to add to the powder to make the
correct solution.

Take the metal or plastic top off the sterile saline or sterile distilled water
vial. Do not take the rubber stopper off.

Wipe the top of the vial containing the sterile liquid you will use to dilute
the powder with an alcohol wipe.

Also wipe the top of the vial with the medicine as a powder in it. Do not touch
the tops of the vials after wiping them.

A vial has a certain amount of pressure in it. When air or liquid is removed, it
must be replaced. To do this, first put the vial on a flat surface. You will
only remove air from the vial. Leave the powder at the bottom of the vial. To
remove air:

Insert the needle into the top of the vial with the powder and pull back the
plunger to take air from the bottle. Take the same amount of air as the number
of cc’s of liquid you will add to the powder. You may have to pull back harder
on the syringe than you expect.

Remove the needle from the vial with the medicine. Stick the needle into the
top of the vial with the sterile liquid. Push down on the plunger to inject the
air into the sterile liquid vial.

Turn the vial attached to the syringe upside down. The sterile liquid will come
back to about the same amount as the air you put in. Adjust the amount if

Remove the needle from the sterile liquid bottle.

Stick the needle into the vial with the medicine and push the plunger all the
way down. The liquid should go in easily.

With the needle still in the vial, push it up to the hub. You do this so you
cannot touch the sterile needle. Gently mix the liquid and the powder into a

If you see powder in the vial, keep mixing until you see only liquid.

If you needed to use a large syringe to add liquid, remove the needle and follow
the directions below: “If the medicine is already a liquid”.

You may use the same syringe to prepare medicine and give the shot. If so, turn
the medicine and the syringe upside down.

Pull the needle down so the tip is in the medicine.

Pull the plunger back to the correct marking on the syringe barrel for the

When you have the correct amount of medicine in the syringe, remove the needle
and put the cover back carefully over the needle.

If the medicine is already a liquid:

Do not use any medicine that has crystals or lumps in the vial.

Ask your caregiver or pharmacist what color the medicine should be. Do not give
a medicine that is not the correct color.

You need to add air to the vial in the same amount that you plan to take out in
order to get the medicine out of the vial. To do this, you need to know how
much medicine to inject.

Pull the plunger back to the amount you plan to give. Remove the plastic or
metal top of the vial, if it is still in place, and clean the rubber stopper
with an alcohol wipe.

Insert the needle into the vial and push down on the plunger.

Once the air has been pushed into the vial, turn the vial, attached to the
syringe, upside down. Make sure the tip of the needle remains below the level
of the medicine. The medicine will come back into the syringe and stop at or
near the correct place.

When you have the correct amount of medicine in the syringe, remove the needle
and carefully put the cover back over the needle.

Things that may go wrong:

If you put in too much air, the plunger will be difficult to push.

If you don’t put in enough air, the plunger will be difficult to pull.

If you are using a multiple dose vial, too much or too little air may have been
put in for a previous dose. If so, you will have to adjust the pull or push on
the plunger.

Where can I give an IM shot? The skin, and the muscles under the skin, cover
nerves, blood vessels, and bones. It is important to give a shot where you will
not hurt any of these body parts. There are 8 possible areas, 4 on each side of
the body, where an IM shot can be given. It is important to choose the correct
area. If caregivers showed you what areas are safe, follow their directions.
Change the areas where you give shots. If you give a shot in the same place
every day or even every week, scar tissue can build up. The scar tissue will
affect how the medicine will work. Following is information about the safe
areas to give a shot.

Vastus Lateralis (VAS-tuss lat-er-AL-iss) Muscle (Thigh): The thigh is used
often for children, especially children under 3. It is also a good place for an
adult. The thigh area is especially useful if you need to give yourself a shot
because it is easy to see.

Look at the thigh that will get the shot. In your mind, divide the thigh (the
area between the knee and the hip) into three equal parts. The middle third is
where the shot will go.

This muscle is called the vastus lateralis. It runs along the top of the thigh
(the front) and a little to the outside. Put your thumb in the middle of the top
of the thigh, and your fingers along the side. The muscle you feel between them
is the vastus lateralis.

Ventrogluteal (ven-trow-GLUE-tee-ull) Muscle (Hip): The hip is an area with
good bone landmarks and very little danger of hitting blood vessels or nerves.
It is a good place for a shot for adults and children over 7 months old. The
person getting the shot should be lying in his or her side.

To find the correct place to give a shot in the hip to another person: Place
the heel of your hand on the hip bone at the top of the thigh. Your wrist will
be in line with the person’s thigh. Point your thumb at the groin, fingers
point to the person’s head. Form a “V” with your fingers by opening a
space between your pointer finger and the other three fingers. Your little
finger and ring finger will feel the edge of a bone along the fingertips. The
place to give the shot is in the middle of the V-shaped triangle.

Deltoid (DEL-toyd) Muscle (Upper arm muscle): The person getting the shot can
be sitting, standing or lying down. Start with a completely exposed upper arm.
You will give the shot in the center of an upside down triangle. Feel for the
bone that goes across the top of the upper arm. This bone is called the
acromion process. The bottom of it will form the base of the triangle. The
point of the triangle is directly below the middle of the base at about the
level of the armpit. The correct area to give a shot is in the center of the
triangle, 1 to 2 inches (2.5 to 5 cm) below the bottom of the acromion process.

Dorsogluteal (door-so-GLUE-tee-ull) Muscle (rear-end): The upper rear end area
is the area where most people have gotten shots. Expose one entire cheek of the
rear-end. With an alcohol wipe draw a line from the top of the crack between
the cheeks to the side of the body. Starting in the middle of the same side,
draw another line across the first one with the alcohol wipe. Start from about
3 inches above the first line to about half way down the middle of the cheek.
You should have drawn a cross. In the upper outer square you will feel a curved
bone. The shot will go in the upper outer square below the curved bone.

How do I choose the best muscle for the shot? If your caregivers have told you
which muscle to use, follow their directions. Muscles change with age. For
example, the rear-end area is never used for infants or children under 3 years
old because it is not developed well enough. The deltoid may work well for a
person with developed muscles in the upper body. The deltoid cannot be used if
that area is very thin or underused. The muscle must be easy to reach.

What items do I need to give a shot?

One alcohol wipe wrapped in foil.

One sterile dry 2×2 in a paper wrapper.

An ampule or vial containing the medicine.

The correct size needle and syringe. Your caregiver should give you this

You may want to use gloves for your protection or the protection of the person
getting the shot.

How do I inject medicine into a muscle? Please read this entire section before
giving the shot. It is important to get a general idea of what you are about to
do before beginning. Read the step-by-step procedure again as you do it.

Wash your hands carefully with soap and dry them completely. Put on gloves if
necessary. Open the foil covering the first alcohol wipe.

Take the cover off the needle by holding the syringe with your writing hand and
pulling on the cover with your other hand. It is like taking a cap off a pen.

Hold the syringe in the hand you use to write. Place the syringe under your
thumb and first finger. Let the barrel of the syringe rest on your second
finger. Many people hold a pen this way when they write.

Wipe the area where the needle will go with the alcohol wipe. Let the area dry.

Depress and pull the skin a little with your free hand. Keep holding the skin a
little to the side of where you plan to put the needle.

Use your wrist to inject the needle at a 90 degree needle (straight in). The
action is like shooting a dart. Do not push the needle in. Do not throw the
needle in, either. Throwing the needle will make a bruise. The needle is sharp
and it will go through the skin easily when your wrist action is correct.

Let go of the skin. The needle will want to jerk sideways. As you let go of the
skin, hold the syringe so it stays pointed straight in.

Pull back on the plunger just a little to make sure you aren’t in a blood
vessel. (If blood comes back, remove the needle immediately. Do not inject the
medicine. If this happens, dispose of both the syringe and the medicine. Get
more medicine in a new syringe. When you give the second shot give it on the
other side.) Pulling back on the plunger is easier said than done. Use your
other hand to pull back on the plunger while keeping the syringe in the
straight up position. It will feel clumsy at first.

Push down on the plunger and inject the medicine. Do not force the medicine by
pushing hard on the plunger. Some medicines hurt. They will hurt more if the
medicine goes in quickly.

After all the medicine is injected, pull the needle out quickly at the same
angle it went in.

Use the dry sterile gauze 2×2 to press gently on the place where the needle
went in.

How can I get rid of used syringes and needles? Your caregiver may have given
you a hard plastic container made especially for used syringes and needles. If
you were not given this kind of container, you will need to look around your
home for a hard plastic container with a screw-on top such as clothes softener
bottle or a hard plastic detergent bottle for washing clothes. Make sure you can
put both the syringe and the needle into the container easily. Whatever
container you choose, make sure that the needles cannot break through the
sides, bottom or top. Call your caregiver or a pharmacy to find out what your
state or local requirements are for getting rid of used syringes and needles.

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