Injection Basics

Injections can be part of your treatment plan for your bleeding disorder. It is a useful technique where medication can be inserted into the body, also known as a shot or jab. There are several steps to keeping a clean and safe way to perform injections at home or on the go. Below you will find more information about all of the supplies needed and a step-by-step instruction to self-administering an injection.  

Subcutaneous Injections 

Although there are several types of injections, the one currently used in bleeding disorder treatment is the subcutaneous injection. This means the medication is being injected under the skin. Typically, the first time you perform a subcutaneous injection will be at your HTC (Hemophilia Treatment Center). The HTC team will walk you through the self-administration technique and will answer all of your questions.  

When performing an injection, it is particularly important to keep your area clean. Remember that anything going into your body needs to be sterile, such as the needle. Clean means there is no dirt and a reduction in germs. Sterile means that no germs exist at all.  

Here is a list of materials needed to do an injection: 

• Medication vial(s)  
• Syringe (1 mL or 3 mL, depending on volume)  
• Sterile needles  
  • 18-gauge filter transfer needle 
  • 25-, 26- or 27-gauge injection needle 
• Sterile alcohol pads  
• Gauze pad 
• Band aides   
• Gloves (if needed) 
• Clean cloth or disposable pads for work area (optional) 
• Sharps container  
• Treatment log 

Steps for Performing an Injection 

• Gather all necessary materials. 
• Check the label to ensure the correct medication, dose, and route.  
• Make sure the medication is not damaged or expired.  
• Look if the appearance has changed in color or clarity. Do not use the medication if it is discolored or has many small particles inside of it. If this is the case, return the vial.  
• Allow your medication to come to room temperature before administration. This should take about 15 minutes. The medication can be at room temperature for up to 7 days in the original package.  
• Clean your work area before you begin using a sterile alcohol pad. If you would like, you can also place down a clean cloth or disposable pad. 
• Thoroughly wash your hands and arms up to the elbow with soap and warm water. 
• Put on gloves (This step is optional, but if someone else is helping with the treatment they must wear gloves)  

Prepare the Medication 

• Remove the cap from the top of the vial.  
• Clean the top of the vial with a sterile alcohol swab. 
• Remove the syringe from the packaging. If the filter needle is not already attached, attach the filter needle. Do not touch the parts of the needle and syringe that connect. 
• Pull back on the plunger to fill the syringe with air equal to the volume of the medication that will be drawn up.  
• Remove the cap (place it on its side on a clean area like the inside of the syringe wrapper).  
• With the medication vial in an upright position, on a clean flat surface, insert the needle into the center of the cleansed top of the vial.  
• Invert (turn upside down) the vial with the needle inserted.  
• Inject the air with the tip of the needle above the medication to prevent air bubbles. 
• Lower the tip of the needle into the medication and gently pull back on the plunger to draw up the prescribed medication dose.  
• If there are large air bubbles, flick them to the top of the syringe and push the air back into the vial. 
• If the syringe has been over-filled, push the excess back into the vial. 
• Check to make sure you have drawn up the correct dose and then remove the needle from the vial.  
  • The vial should be in the inverted/upside down position at this point; flipping the vial right side up before removing the needle may cause loss of some medication from the vial.  
  • If the prescribed dose requires medication from more than one vial, you will need to withdraw all your medication. Refer to the instructions for use that come with the medication for how to combine vials. Vials come in different concentration strengths, not only different doses, so this should be kept in mind when preparing your medication.  
  • If the total dose volume is greater than 2 mL, you will need more than one injection.  
• Using one hand, recap the filter needle by scooping the tip of the needle into the cap. Once it is covered, press down on the cap to secure.  
• Remove the filter needle and apply the injection needle.
  • Both the filter and injection needle must remain sterile. It is provided in sterile packaging. If it touches anything nonsterile (even a tabletop that has been cleaned), you must discard it and use a new sterile needle instead. Never reuse or share needles.  

Choose and Prepare an Injection Site  

• Choose the injection site  
  • The most common injection sites are the side or back areas of the upper arms and thighs, and the belly. However, because you need two hands to self-administer a subcutaneous injection (one to lift the skin and one to perform the injection), the arm is not the best choice. Other sites might be easier for the injection.  
  • Avoid scars, moles, skin lesions, areas with redness, bruised, tender, or hardened areas, and areas over bony prominences, blood vessels and nerves. 
  • Avoid the 2-inch perimeter of the umbilicus 
  • Sites should be rotated, at least 1 inch from the prior injection to prevent irritation or scarring. 
• Cleanse the area with a sterile alcohol wipe and allow to air dry  

Perform Injection 

• Lift the part of skin where the injection site will be administered by using your fingers to gently pinch the skin. Inject the needle with the angled surface (known as the bevel) up, at a 45–90-degree angle, depending on your tissue and needle length. Your HTC team can recommend to you what specific angle to use.  
• Let go of the lifted skin, being careful that the needle does not accidentally exit the body.  
• Slowly inject the medication. 
• Withdraw the needle at the same angle.  
• Tip: wait a few seconds before you pull out the needle to avoid leakage. 
• Activate the safety shield.  
• Dispose of all needles in your sharp container.  

Post-Injection Care and Cleanup  

• Do not massage the skin after injection.  
• Monitor for any bleeding or adverse reactions and apply a bandage or gauze as needed. 
• You must dispose any leftover medication 
• If you spilled any medication or if there is blood on your work area, use chlorine bleach to clean it. 
• Document your subcutaneous injection in your treatment log.