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Injection Protocols and Procedures

Injectable anabolic steroids are always injected deep into the muscle and this is known as an intramuscular injection (IM). Injecting directly into the muscle will allow for fast abortion of the medication due to the high blood flow.

There are some medications also used by bodybuilders that require injections into the fatty tissue between the skin and muscle and these injections are called subcutaneous injections (SQ or SC). The injected medication is generally absorbed more slowly, sometimes over 24 hours.

This article will explain the procedures for both methods in detail, because improper techniques may result in health concerns such as inflammation, infections, scar tissue or other personal harm.

1. Wash your hands thoroughly. This is the best way to prevent infection.

2. Assemble your equipment:

  • Medication:
    May be a multidose vial of liquid or may be a vial with powder that requires “reconstitution.” If it’s in powdered form follow the manufacturer’s instructions as to what and how much diluent to use. The diluent is usually saline (a mixture of salt water) or sterile water. Avoid shaking the vial once reconstituted, because the active molecules might be damaged.

  • Syringe and needle:
    Oil and water-based steroids should be injected with 21, 22 or 23 gauge needles that are no less than 1 inch or 25mm long. The size of the syringe depends on the volume of liquid to inject, but it’s recommended to use no more than 2ml on small muscle groups and no more than 4 ml on large muscles per injection site. Most reconstituted solutions may be injected with an insulin syringe and needle. They are often found in 0.5-1ml syringes with 27-29 gauge needles. Some have detachable needles where others have fixed needles.

3. Drawing up medication

  • Multi-dose vials:
    1. Remove the soft metal or plastic cap protecting the rubber stopper of the vial.
    2. Clean the exposed rubber stopper using an alcohol swab.
    3. Remove the syringe from the plastic or paper cover. If necessary, attach the needle securely.
    4. Pull back and forth on the plunger by grasping the plunger handle. Grasping the handle end will prevent contamination of the plunger shaft (which is sterile) and help check for easy movement.
    5. With the needle capped, pull back the plunger, filling the syringe with air equal to the amount of medication to be administered.
    6. Remove the cap covering the needle and set it on its side to prevent contamination. Be careful not to touch the needle. The inside of the cap and needle is sterile, and the needle will be covered again with this cap.
    7. With the vial in an up-right position, push the needle through the clean rubber stopper on the vial. Push the needle in at a 90 degree angle, being careful not to bend the needle.
    8. Inject the air in the syringe into the vial. Air is injected into a multi-dose vial to prevent a vacuum from forming. If too little or no air is injected, withdrawing the medication may be difficult. If too much air is injected, the plunger may be forced out of the barrel causing the medication to spill.
    9. Turn the vial upside down, with the needle remaining in the vial. The needle will be pointing upward.
    10. Make sure that the tip of the needle is completely covered by the medication. This will make it easier to withdraw the solution and not air.
    11. Pull back on the plunger to fill the syringe with the correct dose of medication.
    12. Keep the vial upside down, with the needle in the vial pointed upward. Tap the syringe, or “flick” it with your fingertips. This helps move bubbles to the top of the syringe.
    13. Once the bubbles are at the top of the syringe, gently push on the plunger to force the bubbles out of the syringe and back into the vial. Note: It is important to eliminate large air bubbles because they take up space needed for the medication, and they may cause pain or discomfort when injected.
    14. After removing the bubbles, check the dose of medication in the syringe to be sure you have drawn up the correct amount.
    15. After the medication is correctly drawn up, carefully replace the needle cap to prevent contamination. Alternatively you may replace the needle with a new one that has not been blunted by the rubber stopper of the vial.

  • Ampules:
    1. Hold the ampule upright and check if there are liquid in the hollow top of the ampule as it may keep you from getting the correct dose. You need to make the medicine go into the bottom of the ampule before you break it. To do this, flick or snap the top with your finger. You may have to flick it a few times.
    2. 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 one hand, and the bottom with the fingers of your other hand. Break the ampule.
    3. Put the bottom of the ampule that contain the liquid on a flat surface.
    4. Remove the syringe from the plastic or paper cover. If necessary, attach the needle securely.
    5. Pull back and forth on the plunger by grasping the plunger handle. Grasping the handle end will prevent contamination of the plunger shaft (which is sterile) and help check for easy movement.
    6. Remove the cap covering the needle and set it on its side to prevent contamination. Be careful not to touch the needle. The inside of the cap and needle is sterile, and the needle will be covered again with this cap.
    7. Carefully aim the needle through the broken neck of the ampule into the liquid at the bottom.
    8. Make sure that the tip of the needle is completely submerged into the medication. This will make it easier to withdraw the solution and not air.
    9. Once the syringe has all the medicine in it, turn it upside down so the needle is pointed straight up and the plunger is below it. Tap the syringe, or “flick” it with your fingertips. This helps move bubbles to the top of the syringe.
    10. Once the bubbles are at the top of the syringe, gently push on the plunger to force the bubbles out of the syringe, but be careful not to squirt out too much of your medication. Note: It is important to eliminate large air bubbles because they take up space needed for the medication, and they may cause pain or discomfort when injected.
    11. After the medication is correctly drawn up, carefully replace the needle cap to prevent contamination. Alternatively you may replace the needle with a new one that has not been blunted by rubbing against the glass bottom of ampule.

4. Injection sports.

  • Intramuscular Injection spots:
    The skin, and the muscles under the skin covers 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. 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 Muscle (Thigh):
      The thigh is used often and a good place to start. 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.
    • Ventrogluteal Muscle (Hip):
      The hip is an area with good bone landmarks and very little danger of hitting blood vessels or nerves. The person getting the shot should be lying in his or her side. Place the heel of your hand on the hip bone at the top of the thigh. Your wrist will be in line with the thigh. Point your thumb at the groin, fingers point to the feet. Form a “V” with your fingers by opening a space between your pointer finger and the other three fingers. The place to give the shot is in the middle of the V-shaped triangle.
    • Deltoid Muscle (Upper arm muscle):
      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, 2.5 to 5 cm below the bottom of the acromion process.
    • Dorsogluteal Muscle (Gluteus maximus):
      Starting in the middle of the gluteus cheek, draw a imaginary line horizontally across. Then from the top middle draw another imaginary line straight down, this will divide the cheek in four quarters. The outside top is where you want to inject.

  • Subcutaneous Injection spots:
    There are many sites on the body that are safe to give subcutaneous shots. Following is a list of the sites where subcutaneous shots may be given:
    • Upper Arm:
      Find the area in the middle part of the arm, halfway between the elbow and shoulder. Gently grasp the skin at the back of the arm between your thumb and first 2 fingers. You should have 1-2 inches of skin.
    • Abdomen:
      Place your hands on the lower ribs and draw an imaginary line below them. Use this area below your hands for injections, as far around as you can pinch up fatty tissue. Do not use a 25mm area around the navel.
    • Thigh:
      Find the area between the knee and hip. The middle of the thigh, from mid-front to mid-side, on the outside part of the thigh is a safe site. Gently grasp the area to make sure you can pinch one to two inches of skin.

5. Injection procedures.
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.

  • Intramuscular Injection:
    1. Wash your hands carefully with soap and dry them completely. Put on gloves if necessary. Open the foil covering the first alcohol wipe.
    2. Wipe the area where the needle will go in with the alcohol wipe. Let the area dry.
    3. Take the cover off the needle by holding the syringe with your one hand and pulling on the cover with your other hand.
    4. 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.
    5. 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.
    6. Use your wrist to inject the needle at a 90 degree angle (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.
    7. 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.
    8. 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.
    9. 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.
    10. After all the medicine is injected, pull the needle out quickly at the same angle it went in.
    11. Use an alcohol wipe to press gently on the place where the needle went in.

  • Subcutaneous Injection:
    1. Subcutaneous shots can be given straight in at a 90 degree angle, or at a 45 degree angle. Give the shot straight in at a 90 degree angle if 50mm of skin can be grasped between your thumb and first (index) finger. If only 1 inch of skin can be grasped, give the shot at a 45 degree angle.
    2. Open the foil covering the first alcohol wipe.
    3. Wipe the area where you plan to give the shot. Let the area dry.
    4. Take the cover off the needle. Hold the syringe with your writing one hand and pull the cover off with your other hand.
    5. Grasp the skin with the hand not holding the syringe. Holding the syringe barrel tightly with your writing hand, use your wrist to inject the needle. Sometimes the needle goes in easily. Some people have tougher skin and a little more pressure or quickness must be used.
    6. Once the needle is all the way in, push the plunger down to inject the medicine.
    7. Remove the needle at the same angle you put it in.
    8. Use an alcohol wipe to press gently on the place where the needle went in.