Patient Instructions: HCG

Intramuscular (Novarel, Pregnyl, Profasi ) (3cc) 22G 1 ½ in. 25G 1 ½ in.

OPENING THE MEDICATION

1. Use a new sterile syringe and needle each time you inject
2. Carefully flip the lid of the vial off.
3. Carefully twist the needle cover (clockwise to tighten needle on the syringe) off of the syringe. Do not touch the needle. If you do touch the needle, carefully recap the needle, twist it off of the syringe and replace with a new sterile needle. Twist the new needle on the syringe. Remove the cover. Needles are no longer sterile if they are touched.

RECONSTITUTING (MIXING) THE MEDICATION

1. Making sure that the needle is on the syringe tightly, draw the diluent (sterile water or saline) into the syringe using the following method.
• For ampules: Draw up the diluent into the syringe by holding the ampule in one hand and putting the needle into the liquid in the ampule with the plunger pushed in. Next, pull back the plunger to the proper dose amount. It may be necessary to tilt the ampule - it should not spill due to the design of the ampule. Withdraw 1cc of diluent.
• For vials: Wipe the top of the vial with alcohol swab. Do not touch the top after wiping with anything other than the needle. Draw air into the syringe by pulling the plunger back until 1cc mark. Insert the needle into the vial. Push the plunger in completely. Turn vial upside down without removing the needle. Withdraw 1 cc making sure the tip of the needle remains in the solution. Withdraw the needle from the vial.
2. Slowly empty the syringe of diluent into the ampule or vial containing the powdered medication. Aim the needle at the side of the ampule or vial and not directly on the powder.
3. You can gently rotate the ampule or vial between your fingers to dissolve the powder, but DO NOT SHAKE IT. If bubbles form, let them dissolve spontaneously.
4. If your dose requires more than one ampule or vial of medication, withdraw the solution in the same way you withdrew the diluent and add it to the next ampule or vial of medication. Make sure the tip of the needle remains within the liquid when withdrawing. Repeat this process until your recommended dose is in one ampule or vial.
5. Withdraw all the medication from the ampule or vial making sure the tip of the needle is within the medication.
6. If you are changing needles to a different gauge, carefully recap the needle, twist off and dispose in a sharps container. Twist on the new injection needle and remove the cover. Do not touch the needle. If you do touch it, replace it with a new one.
7. Tap the syringe with the needle pointed up to cause any air bubbles in the liquid  to rise.
8. You are now ready to administer the injection.

INJECTING THE MEDICATION

The best areas for intramuscular injection are the upper buttock and thigh area. The upper buttock is recommended (see picture)

To locate the correct area, divide the buttock into four quadrants. The upper outside quadrant is the location for the injection. This location reduces the risk of hitting a blood vessel or nerve.

1. Clean the injection site with alcohol and allow to air dry.
2. Choose a comfortable position such as lying face down, standing, or leaning against a surface with toes pointed slightly inward to relax the muscles. You may want to shift weight to the side of the body that is not going to get the injection.
3. Pinch the injection site between thumb and forefinger. Hold the needle the way you would hold a pencil at a 90 degree angle about 2 to 3 inches from the skin. Insert the entire needle with a quick motion and release the skin.
4. Pull back the plunger slightly and check for blood. If blood appears in the syringe, do not panic, pull the needle out a bit, change direction, push back all the way in and inject.
5. If there are no signs of blood, slowly push the plunger all the way with a slow steady motion. Gently withdraw the needle and discard in your sharps container. Wipe site with alcohol rubbing gently. If bleeding appears, apply pressure.

CLEAN UP

1. Discard used needles, syringes, ampules and vials in to your sharps container.
2. Your sharps container is classified as medical waste and must be disposed of properly. Ask your health care provider (doctor, nurse or pharmacist) about disposal when it is full.
3. Your injection material must be sterile and cannot be reused.
4. Never leave needles lying around where others can pick them up.
5. Never reuse a needle. Not only does a needle need to be sterile each time you use it, but today's needles are thinner and more delicate for greater comfort so reusing a needle can damage the tip and cause injury and greater pain.