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Note: The following information is for educational purposes only. The purpose of the following is to be exhaustive in the procedures a student might take in learning about how to administer HCG (Human Chorionic Gonadotropin). For specific medical advice, diagnoses, and treatment, consult a doctor. This article does not endorse the use of illegal drugs.
Items:
HCG
5000 IU ampule of HCG
5 ml of Solvent (Bacteriostatic Water, or included solvent)
1 Ampule Opener
1 Empty Pre-Sealed Sterile Vial
1 Insulin Needle w/ syringe (29 G x 1/2? 1 CC)
4 Alcohol Swabs
Steps:
1) Collect all Items
2) Use 1 Alcohol Swab per item to disinfect the following: Ampules, Vial(s)
3) Draw 4 cc of Bacteriostatic Water (BSH20) into Syringe (may take several times depending on the size of the Syringe, i.e. if the Syringe holds 1 cc it will take 4 times)
4) Inject the 4 cc of BSH20 into Pre-Sealed Sterile Vial
5) Use Ampule Opener to open both ampules
6) Draw 1 cc of BSH20 (or included solvent) with same Syringe and Needle
7) Inject the 1 cc of BSH20 into the ampule containing the HCG powder
8) Mix solution (1 cc of BSH20 and HCG powder)
9) Draw the solution into the same Syringe and Needle
10) Inject the solution into the Vial containing the 4 cc of BSH20
11) Mix the new solution (5 cc of BSH20 and HCG powder)
12) Draw .25 cc to get 250 IU of HCG
13) Determine injection site (thighs, arms, abdomen, buttocks)
14) Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle
15) Insert the needle at a 90 angle to the skin fold (if lean area, 45 angle to avoid muscle)
16) Hold the pinch so the needle doesn't go into the muscle
17) Push the plunger to inject the insulin
18) Release the grip on the skin fold
19) Remove the needle from the skin
20) Dispose of syringe/needle and ampules into Sharps container
21) Refrigerate Vial containing solution in between uses
Full Explanation:
The main variant is the amount of HCG powder per ampule, more common sizes contain 1000, 1500, 2500, 5000 IU of HCG powder. Conservative uses for HCG recommend 500 IU per week, administered in biweekly injections of 250 IU. It takes a few calculations to determine the concentrations of HCG in a solution and the correct amount of solution to put into the syringe.
Definitions:
1) Solvent: a substance that dissolves another to form a solution; i.e. Bacteriostatic Water (BSH20)
2) I.U. (International Unit): an internationally agreed upon standard, to which a particular quantity of such a substance causes a specific biological effect. The measurement is based on effect, not volume or weight of the substance.
3) ml (Milliliter): 1/1000 of a liter; a VOLUME measurement. In reference to liquids, it is equivalent to one cubic centimeter (cc)
4) cc (cubic centimeter): a VOLUME measurement. Most syringes measure their capacity in cc's; a 5cc syringe holds 5ml of liquid in it; 1 cc = 1 ml
To Calculate:
Take the amount of HCG in the ampule and divide that by the amount of total solvent (the amount used to mix the powder in the ampule and the amount in the pre-sealed vial) to get the amount of HCG per cc. Then, divide the amount of HCG desired for the injection by the amount of HCG per cc that we just calculated to get the amount of cc to withdraw from the solution.
Formula:
a = the amount of HCG in the ampule
b = amount of solvent added to the HCG ampule to dilute
c = amount of additional solvent added to the pre-sealed vial
d = b+c ;gives the total amount of solution
e = a/d ;gives HCG per 1 cc
f = amount of HCG desired
x = f/e ;gives the amount of cc to withdraw from the solution of BSH20 and HCG powder for injection
A student will take b, the amount of solvent that was added to the ampule containing the HCG powder during mixing and add that amount to c, the amount of additional solvent previously added to the pre-sealed vial; this gives d. Taking a, the amount of HCG powder that was originally in the ampule, and dividing that by d, gives the amount of HCG powder per 1 cc. To get the amount of cc to withdraw from the solution into the syringe, the student takes f, the amount of HCG desired, and divides that by d.
Examples:
If the ampule of HCG contains 1000 IU of HCG powder (a), a student can then add .5 cc of a solvent (b) into the ampule for mixing. After drawing the mixture into the syringe and injecting it into the pre-sealed vial containing the previously injected solution of .5 cc of solvent (c) gives the total amount of solution (d). Dividing (a) by (d) yields 1000 IU HCG in the solution per 1 cc (e). The student already knows that they desire to ready 250 IU of HCG into the syringe (f), so they take (f) and divide that by (d) to know how many cc to withdraw from the solution into the syringe.
d = b+c
d = .5 cc + .5 cc
d = 1 cc
e = a/d
e = 1000/1
e = 1000 IU HCG per 1 cc
x = f/e
x = 250/1000
x = .25 cc
1 cc (same as 1 ml) of a solvent (like BSH20) gives 1 cc with a concentration of 1000 IU of HCG. Thus, .5 cc gives 500 IU of HCG and .25 cc gives 250 IU of HCG.
If the ampule of HCG contains 1000 IU of HCG, then adding 2 cc (same as 2 ml) of a solvent (like BSH20) gives 2 cc with a concentration of 1000 IU of HCG. Thus, it takes the full 2 cc to get the full 1000 IU of HCG. Therefore, 1 cc gives 500 IU of HCG and .5 cc gives 250 IU of HCG. Contrasted with the previous example, this shows how to change the concentration of a solution by adding more solvent.
Last example, If the ampule of HCG contains 2500 IU of HCG, then adding 5 cc (same as 5 ml) of a solvent (like BSH20) gives 5 cc with a concentration of 2500 IU of HCG. Thus, there are 2500 IU per 5 cc of solution, or 500 IU per cc (divide 2500 by 5). 5 cc gives 2500 IU, 4 cc gives 2000 IU, 3 cc gives 1500 IU, 2 cc gives 1000 IU, 1 cc gives 500 IU and .5 cc gives 250 IU of HCG.
Additional Notes to the Student:
The types of ampules described in this article are designed for 1 time use.
Ampule Opener
Ampule Openers (also called Ampule Breakers) are used to increase student confidence and competency during ampule handling. Students avoid contact with broken glass and are reliable and economical. Ampule Openers offers faster and cleaner manipulation and ampule breakage at the neck.
Aspirate?
Q: When giving a subcutaneous (SC) injection, like with HCG is it necessary aspirate?
A: The term for pulling back slightly on the syringe plunger to check for blood before injection is called aspiration. The technique is used when injecting medication into the muscle called intramuscular injection (IM) and uses a longer needle of 1 to 1.5 inches. Aspiration is used to signal if a major blood vessel has been breached. The medical field uses the IM technique so that the medication absorbs slowly into the muscle and eventually into the blood stream; not immediately into the blood stream. Because muscle is more vascular the likelihood of hitting a major blood vessel is greater and aspirating during an IM is necessary. If blood appeared in the syringe before injecting intramuscularly, the needle would be withdrawn and reinserted into a different injection site.
Subcutaneous (SC) injections use a shorter needle, no greater than .5 inches into subcutaneous tissue, which does not contain major blood vessels. If an individual is overfat a regular .5 inch needle is best, but for leaner adults a shorter needle (3/16" or 5/16 ") would be inserted at a 45-degree angle. This prevents the substance from being injected into muscle and absorbing faster.
Note: if blood appears on the skin after withdrawing the needle it is likely the needle went through a tiny capillary, not that an intramuscular injection was mistakenly given or that a vein was breached.
Users administering HCG using an insulin needle and the SC technique do not need to aspirate.
Articles on Subcutaneous Injections
Article 1:
The subcutaneous route is used for a slow, sustained absorption of medication, up to 1-2ml being injected into the subcutaneous tissue. It is ideal for drugs such as insulin, which require a slow and steady release, and as it is relatively pain free, it is suitable for frequent injections (Springhouse Corporation 1993).
Traditionally, SC injections have been given at a 45 angle into a raised skin fold (How and Home 1990). However, with the introduction of shorter insulin needles (5, 6 or 8mm), the recommendation for insulin injections is now an angle of 90 (Burden 1994). The skin should be pinched up to lift the adipose tissue away from the underlying muscle, especially in thin patients (Fig. 3). Some studies using computerized tomography to monitor the destination of the injections, have found that SC injections can be inadvertently administered into muscle, especially in the abdomen and the thigh (Peragallo-Dittko 1997). Insulin that is injected into muscle is absorbed more rapidly and can lead to glucose instability and potential hypoglycaemia. Hypoglycaemic episodes may also occur if the anatomical location of the injection is changed, as insulin is absorbed at varying rates from different anatomical sites (Peragallo-Dittko 1997). Therefore insulin injections should be systematically rotated within an anatomical site for example, using the upper arms or abdomen for several months, before there is a planned move elsewhere in the body (Burden 1994). When a diabetic patient is admitted to hospital, the current injection area should be assessed for signs of inflammation, oedema, redness or lipohypertrophy, and observations recorded in the nursing notes. It is no longer necessary to aspirate after needle insertion before injecting subcutaneously. Peragallo-Dittko (1997) reported studies that found blood was not aspirated prior to SC injection, indicating that piercing a blood vessel in a SC injection was very rare. Additionally, patient education literature from the manufacturers of insulin devices does not advocate aspiration before injection. It has also been noted that aspiration before administration of heparin increases the risk of haematoma formation (Springhouse Corporation 1993).
Intramuscular injections deliver medication into well perfused muscle, providing rapid systemic action and absorbing relatively large doses; from 1ml in the deltoid site to 5ml elsewhere in adults (these values should be halved for children). The choice of site should take into consideration the patients general physical status and age, and the amount of drug to be given. The proposed site for injection should be inspected for signs of inflammation, swelling, and infection, and any skin lesions should be avoided. Similarly, two to four hours after the injection, the site should be checked to ensure there has been no adverse reaction. If injections are repeated frequently, the sites should be documented to ensure an even rotation. This reduces patient discomfort from overuse of any one area and lessens the likelihood of the development of complications, such as muscle atrophy or sterile abscesses resulting from poor absorption (Springhouse Corporation 1993).
Article 498. Workman B (1999) Safe injection techniques. Nursing Standard. 13, 39, 47-53.
Article 2:
How to Inject Insulin
The thought of injecting yourself with insulin takes a little getting used to, and doing it properly requires some practice. But once you've made it through your first shot, insulin injection will quickly become a regular part of your daily routine.
Injecting at the proper depth is an important part of good injection technique. Most healthcare professionals recommend that insulin be injected in the subcutaneous fat, which is the layer of fat just below the skin. If you inject too deep, the insulin could go into muscle, where it's absorbed faster but might not last so long (and, it hurts more when you inject into muscle). If the injection isn't deep enough, the insulin goes into the skin, which affects the insulin's onset and duration of action.
Most people pinch up a fold of skin and insert the needle at a 90 angle to the skin fold. To pinch your skin properly, follow these steps:
Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter mini-pen needle to inject, you don't have to pinch up the skin when injecting at a 90 angle; with this shorter needle, you don't have to worry about injecting into muscle.)
* Insert the needle.
* Hold the pinch so the needle doesn't go into the muscle.
* Push the plunger (or button if you're using a pen) to inject the insulin.
* Release the grip on the skin fold.
* Remove the needle from the skin.
Note that not everyone injects at a 90 angle. If you inject into an area of the body that has less fat, you may need to inject at less than a 45 angle, to avoid injecting into a muscle. The angle you should use to insert the syringe or pen needle into your body depends on your body type, the injection site, and the length of the needle that you use. Your healthcare professional can help you determine the right angle of injection for you.
BD has created a set of animated Insulin Injection Demonstrations especially for this website. The demonstrations will take you step by step through the entire insulin injection procedure. You can even customize this interactive guide to the size of the syringe that you use, and there's a special demonstration for mixing different types of insulin.
http://www.bddiabetes.co.uk/dyn_en/injection_technique.html
http://www.bddiabetes.com/us/main.aspx?cat=1&id=257
Items:
HCG
5000 IU ampule of HCG
5 ml of Solvent (Bacteriostatic Water, or included solvent)
1 Ampule Opener
1 Empty Pre-Sealed Sterile Vial
1 Insulin Needle w/ syringe (29 G x 1/2? 1 CC)
4 Alcohol Swabs
Steps:
1) Collect all Items
2) Use 1 Alcohol Swab per item to disinfect the following: Ampules, Vial(s)
3) Draw 4 cc of Bacteriostatic Water (BSH20) into Syringe (may take several times depending on the size of the Syringe, i.e. if the Syringe holds 1 cc it will take 4 times)
4) Inject the 4 cc of BSH20 into Pre-Sealed Sterile Vial
5) Use Ampule Opener to open both ampules
6) Draw 1 cc of BSH20 (or included solvent) with same Syringe and Needle
7) Inject the 1 cc of BSH20 into the ampule containing the HCG powder
8) Mix solution (1 cc of BSH20 and HCG powder)
9) Draw the solution into the same Syringe and Needle
10) Inject the solution into the Vial containing the 4 cc of BSH20
11) Mix the new solution (5 cc of BSH20 and HCG powder)
12) Draw .25 cc to get 250 IU of HCG
13) Determine injection site (thighs, arms, abdomen, buttocks)
14) Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle
15) Insert the needle at a 90 angle to the skin fold (if lean area, 45 angle to avoid muscle)
16) Hold the pinch so the needle doesn't go into the muscle
17) Push the plunger to inject the insulin
18) Release the grip on the skin fold
19) Remove the needle from the skin
20) Dispose of syringe/needle and ampules into Sharps container
21) Refrigerate Vial containing solution in between uses
Full Explanation:
The main variant is the amount of HCG powder per ampule, more common sizes contain 1000, 1500, 2500, 5000 IU of HCG powder. Conservative uses for HCG recommend 500 IU per week, administered in biweekly injections of 250 IU. It takes a few calculations to determine the concentrations of HCG in a solution and the correct amount of solution to put into the syringe.
Definitions:
1) Solvent: a substance that dissolves another to form a solution; i.e. Bacteriostatic Water (BSH20)
2) I.U. (International Unit): an internationally agreed upon standard, to which a particular quantity of such a substance causes a specific biological effect. The measurement is based on effect, not volume or weight of the substance.
3) ml (Milliliter): 1/1000 of a liter; a VOLUME measurement. In reference to liquids, it is equivalent to one cubic centimeter (cc)
4) cc (cubic centimeter): a VOLUME measurement. Most syringes measure their capacity in cc's; a 5cc syringe holds 5ml of liquid in it; 1 cc = 1 ml
To Calculate:
Take the amount of HCG in the ampule and divide that by the amount of total solvent (the amount used to mix the powder in the ampule and the amount in the pre-sealed vial) to get the amount of HCG per cc. Then, divide the amount of HCG desired for the injection by the amount of HCG per cc that we just calculated to get the amount of cc to withdraw from the solution.
Formula:
a = the amount of HCG in the ampule
b = amount of solvent added to the HCG ampule to dilute
c = amount of additional solvent added to the pre-sealed vial
d = b+c ;gives the total amount of solution
e = a/d ;gives HCG per 1 cc
f = amount of HCG desired
x = f/e ;gives the amount of cc to withdraw from the solution of BSH20 and HCG powder for injection
A student will take b, the amount of solvent that was added to the ampule containing the HCG powder during mixing and add that amount to c, the amount of additional solvent previously added to the pre-sealed vial; this gives d. Taking a, the amount of HCG powder that was originally in the ampule, and dividing that by d, gives the amount of HCG powder per 1 cc. To get the amount of cc to withdraw from the solution into the syringe, the student takes f, the amount of HCG desired, and divides that by d.
Examples:
If the ampule of HCG contains 1000 IU of HCG powder (a), a student can then add .5 cc of a solvent (b) into the ampule for mixing. After drawing the mixture into the syringe and injecting it into the pre-sealed vial containing the previously injected solution of .5 cc of solvent (c) gives the total amount of solution (d). Dividing (a) by (d) yields 1000 IU HCG in the solution per 1 cc (e). The student already knows that they desire to ready 250 IU of HCG into the syringe (f), so they take (f) and divide that by (d) to know how many cc to withdraw from the solution into the syringe.
d = b+c
d = .5 cc + .5 cc
d = 1 cc
e = a/d
e = 1000/1
e = 1000 IU HCG per 1 cc
x = f/e
x = 250/1000
x = .25 cc
1 cc (same as 1 ml) of a solvent (like BSH20) gives 1 cc with a concentration of 1000 IU of HCG. Thus, .5 cc gives 500 IU of HCG and .25 cc gives 250 IU of HCG.
If the ampule of HCG contains 1000 IU of HCG, then adding 2 cc (same as 2 ml) of a solvent (like BSH20) gives 2 cc with a concentration of 1000 IU of HCG. Thus, it takes the full 2 cc to get the full 1000 IU of HCG. Therefore, 1 cc gives 500 IU of HCG and .5 cc gives 250 IU of HCG. Contrasted with the previous example, this shows how to change the concentration of a solution by adding more solvent.
Last example, If the ampule of HCG contains 2500 IU of HCG, then adding 5 cc (same as 5 ml) of a solvent (like BSH20) gives 5 cc with a concentration of 2500 IU of HCG. Thus, there are 2500 IU per 5 cc of solution, or 500 IU per cc (divide 2500 by 5). 5 cc gives 2500 IU, 4 cc gives 2000 IU, 3 cc gives 1500 IU, 2 cc gives 1000 IU, 1 cc gives 500 IU and .5 cc gives 250 IU of HCG.
Additional Notes to the Student:
The types of ampules described in this article are designed for 1 time use.
Ampule Opener
Ampule Openers (also called Ampule Breakers) are used to increase student confidence and competency during ampule handling. Students avoid contact with broken glass and are reliable and economical. Ampule Openers offers faster and cleaner manipulation and ampule breakage at the neck.
Aspirate?
Q: When giving a subcutaneous (SC) injection, like with HCG is it necessary aspirate?
A: The term for pulling back slightly on the syringe plunger to check for blood before injection is called aspiration. The technique is used when injecting medication into the muscle called intramuscular injection (IM) and uses a longer needle of 1 to 1.5 inches. Aspiration is used to signal if a major blood vessel has been breached. The medical field uses the IM technique so that the medication absorbs slowly into the muscle and eventually into the blood stream; not immediately into the blood stream. Because muscle is more vascular the likelihood of hitting a major blood vessel is greater and aspirating during an IM is necessary. If blood appeared in the syringe before injecting intramuscularly, the needle would be withdrawn and reinserted into a different injection site.
Subcutaneous (SC) injections use a shorter needle, no greater than .5 inches into subcutaneous tissue, which does not contain major blood vessels. If an individual is overfat a regular .5 inch needle is best, but for leaner adults a shorter needle (3/16" or 5/16 ") would be inserted at a 45-degree angle. This prevents the substance from being injected into muscle and absorbing faster.
Note: if blood appears on the skin after withdrawing the needle it is likely the needle went through a tiny capillary, not that an intramuscular injection was mistakenly given or that a vein was breached.
Users administering HCG using an insulin needle and the SC technique do not need to aspirate.
Articles on Subcutaneous Injections
Article 1:
The subcutaneous route is used for a slow, sustained absorption of medication, up to 1-2ml being injected into the subcutaneous tissue. It is ideal for drugs such as insulin, which require a slow and steady release, and as it is relatively pain free, it is suitable for frequent injections (Springhouse Corporation 1993).
Traditionally, SC injections have been given at a 45 angle into a raised skin fold (How and Home 1990). However, with the introduction of shorter insulin needles (5, 6 or 8mm), the recommendation for insulin injections is now an angle of 90 (Burden 1994). The skin should be pinched up to lift the adipose tissue away from the underlying muscle, especially in thin patients (Fig. 3). Some studies using computerized tomography to monitor the destination of the injections, have found that SC injections can be inadvertently administered into muscle, especially in the abdomen and the thigh (Peragallo-Dittko 1997). Insulin that is injected into muscle is absorbed more rapidly and can lead to glucose instability and potential hypoglycaemia. Hypoglycaemic episodes may also occur if the anatomical location of the injection is changed, as insulin is absorbed at varying rates from different anatomical sites (Peragallo-Dittko 1997). Therefore insulin injections should be systematically rotated within an anatomical site for example, using the upper arms or abdomen for several months, before there is a planned move elsewhere in the body (Burden 1994). When a diabetic patient is admitted to hospital, the current injection area should be assessed for signs of inflammation, oedema, redness or lipohypertrophy, and observations recorded in the nursing notes. It is no longer necessary to aspirate after needle insertion before injecting subcutaneously. Peragallo-Dittko (1997) reported studies that found blood was not aspirated prior to SC injection, indicating that piercing a blood vessel in a SC injection was very rare. Additionally, patient education literature from the manufacturers of insulin devices does not advocate aspiration before injection. It has also been noted that aspiration before administration of heparin increases the risk of haematoma formation (Springhouse Corporation 1993).
Intramuscular injections deliver medication into well perfused muscle, providing rapid systemic action and absorbing relatively large doses; from 1ml in the deltoid site to 5ml elsewhere in adults (these values should be halved for children). The choice of site should take into consideration the patients general physical status and age, and the amount of drug to be given. The proposed site for injection should be inspected for signs of inflammation, swelling, and infection, and any skin lesions should be avoided. Similarly, two to four hours after the injection, the site should be checked to ensure there has been no adverse reaction. If injections are repeated frequently, the sites should be documented to ensure an even rotation. This reduces patient discomfort from overuse of any one area and lessens the likelihood of the development of complications, such as muscle atrophy or sterile abscesses resulting from poor absorption (Springhouse Corporation 1993).
Article 498. Workman B (1999) Safe injection techniques. Nursing Standard. 13, 39, 47-53.
Article 2:
How to Inject Insulin
The thought of injecting yourself with insulin takes a little getting used to, and doing it properly requires some practice. But once you've made it through your first shot, insulin injection will quickly become a regular part of your daily routine.
Injecting at the proper depth is an important part of good injection technique. Most healthcare professionals recommend that insulin be injected in the subcutaneous fat, which is the layer of fat just below the skin. If you inject too deep, the insulin could go into muscle, where it's absorbed faster but might not last so long (and, it hurts more when you inject into muscle). If the injection isn't deep enough, the insulin goes into the skin, which affects the insulin's onset and duration of action.
Most people pinch up a fold of skin and insert the needle at a 90 angle to the skin fold. To pinch your skin properly, follow these steps:
Squeeze a couple of inches of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter mini-pen needle to inject, you don't have to pinch up the skin when injecting at a 90 angle; with this shorter needle, you don't have to worry about injecting into muscle.)
* Insert the needle.
* Hold the pinch so the needle doesn't go into the muscle.
* Push the plunger (or button if you're using a pen) to inject the insulin.
* Release the grip on the skin fold.
* Remove the needle from the skin.
Note that not everyone injects at a 90 angle. If you inject into an area of the body that has less fat, you may need to inject at less than a 45 angle, to avoid injecting into a muscle. The angle you should use to insert the syringe or pen needle into your body depends on your body type, the injection site, and the length of the needle that you use. Your healthcare professional can help you determine the right angle of injection for you.
BD has created a set of animated Insulin Injection Demonstrations especially for this website. The demonstrations will take you step by step through the entire insulin injection procedure. You can even customize this interactive guide to the size of the syringe that you use, and there's a special demonstration for mixing different types of insulin.
http://www.bddiabetes.co.uk/dyn_en/injection_technique.html
http://www.bddiabetes.com/us/main.aspx?cat=1&id=257
