`Self-Injection
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`What is an Intramuscular Injection?
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`An intramuscular injection, as illustrated in the figure below, delivers
`medication deep into the muscle tissue. This allows the medication to be
`quickly absorbed into the bloodstream for action.
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`Step 1: Setting Up for the Injection
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`Find a comfortable, well lit working place and inject at the same time each day.
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`1. Remove medication from the refrigerator and let it reach room
`temperature.
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`2. Make sure it is the medication your doctor prescribed. Check the
`expiration date on the vial. Do not use a medication with an expired date.
`If the medication has particles or is discolored, do not use it and check
`with your pharmacy.
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`3. Clean your work area.
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`ALKERMES EXHIBIT 2049
`Amneal Pharmaceuticals LLC v. Alkermes Pharma Ireland Limited
`IPR2018-00943
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`4. Wash your hands.
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`Hand washing is one of the most important things you can do to prevent
`infection. Wash your hands at these times:
` before and after doing any procedure,
` before and after removing gloves,
` after handling any contaminated waste or body fluid,
` after personal hygiene (such as using the bathroom or blowing
`your nose),
` and before eating.
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`You will need an antibacterial soap or you may use an antiseptic gel or hand
`rub that does not require water.
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`Supplies:
`Antibacterial soap
`Paper towel
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`Procedure:
`Wet your hands and wrists under running water.
`
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`Scrub vigorously with an antibacterial soap for 15 seconds. Work lather
`between fingers, under nails, over palms and on backs of hands and wrists.
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`Rinse hands and wrists and dry with a clean paper towel.
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`Turn off faucet with a paper towel.
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`5. Assemble supplies:
`
` Medication
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` Disposable syringe and needle
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` Alcohol swabs
`
` Puncture proof disposal container
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`Step 2: Selecting and Preparing the Injection Site
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`The following are sites for injections. Alternate the injection site each time you
`inject to avoid soreness at any one sight.
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`Find the lower edge of the acromial process and the point on
`the lateral arm in line with the axilla. Insert the needle 1” to 2”
`below the acromial process, usually two or three
`fingerbreadths.
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`Typical injection: 0.5 ml (range: 0.5 to 2.0 ml)
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`
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`Deltoid
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`Use the lateral muscle of the quadriceps group, from a
`handbreadth below the greater trochanter to a hand breadth
`above the knee. Insert the needle into the middle third of the
`muscle parallel to the surface on which the patient is lying.
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`Typical injection: 1-4 ml (range 1-5 ml)
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`Inject above and outside a line drawn from the posterior
`superior iliac spine to the greater trochanter of the femur. Or,
`divide the buttock into quadrants and inject in the upper
`outer quadrant, about 2” to 3” below the iliac crest.
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`Typical injection: 1 to 4 ml (range: 1-5ml)
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`Vastus Lateralis
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`Dorsogluteal
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`Step 3: Preparing the Dose
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`Take the cap off the vial. Clean the rubber stopper with one alcohol swab.
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`1. Check the package containing the syringe. If the package has been
`opened or damaged, do not use that syringe. Dispose of that syringe in
`the puncture-proof disposal container. If the syringe package is
`undamaged, open the package and remove the syringe.
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`2. Pull the needle cover straight off the syringe. Then, pull back the plunger
`and draw air into the syringe. The amount of air drawn into the syringe
`should be the same amount (mL or cc) as the dose that your doctor
`prescribed.
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`3. Keep the vial on your flat working surface and insert the needle straight
`down through the rubber stopper. Do not put the needle through the
`rubber stopper more than once.
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`4. Push the plunger of the syringe down and inject the air from the syringe
`into the vial.
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`5. Keeping the needle in the vial, turn the vial upside down. Make sure that
`the liquid is covering the tip of the needle.
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`6. Keeping the vial upside down, slowly pull back on the plunger to fill the
`syringe with the medication to the number (mL or cc) that matches the
`dose your doctor prescribed.
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`7. Keeping the needle in the vial, check for air bubbles in the syringe. If
`there are air bubbles, gently tap the syringe with your fingers until the air
`bubbles rise to the top of the syringe. Then slowly push the plunger up to
`force the air bubbles out of the syringe.
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`8. Keeping the tip of the needle in the liquid, once again pull the plunger
`back to the number on the syringe that matches your dose. Check again
`for air bubbles. The air in the syringe will not hurt you, but too large an
`air bubble can reduce your dose of medicine. If there are still air bubbles,
`repeat the steps above to remove them.
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`9. Check again to make sure that you have the correct dose in the syringe. It
`is important that you use the exact dose prescribed by your doctor.
`Remove the syringe from the vial but do not lay it down or let the needle
`touch anything.
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`Tips for Minimizing Injection Pain –
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`
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`Inject medicine that is at room temperature
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` Remove all air bubbles from the syringe before injection
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` Wait until the topical alcohol has evaporated before injecting
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` Keep muscles in the injection area relaxed
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` Break through the skin quickly
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` Don’t change the direction of the needle as it goes in or comes out
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` Do not reuse disposable needles
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`Step 4:
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`1. Lise an alcohol swab to clean
`the skin where you will giye
`yourself "13 Shm'
`
`. J
`"
`'
`'
`2. Hold the muscle firmly and insert the needle into
`the muscle at a EU“ angle [straight up and down)
`with a quick; firm motion.
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`3. After you insert the needle
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`completely. release your
`grasp of Ihe muscle.
`
`if
`/F.
`J;
`if ..
`be
`
`.-
`
`. Gently pull basis on the plunger of the syringe
`to check; for blood. [It blood appears. withdraw the
`needle and gently press the alcohol swab on the
`
`injeslion sits. Start dyer with 3 Fresh needle}
`
`_. -'||"-. r. -I:.-'.'-:I1
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`5. It no blood app-ears. inject all of
`the solution by gently and steadily
`pushing down on the plunger.
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`E. Withdraw the needle and syringe and press
`en eldohoi swab on the spot where the shot
`was given.
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`Th:
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`:I..':-'||". 1.
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`xii-21.1. Merlin-seer HI:-:Iil': 5:: .u!|::n||:= Ill: II:
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`Instructions for Disposing of “Sharps”:
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`Disposal of syringes and other sharp objects is monitored by the
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`Environmental Protection Agency (EPA). It is important to dispose of them
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`properly for your safety and for the safety of others. The EPA promotes all
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`recycling activities, and therefore encourages you to discard medical waste
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`sharps in sturdy, non-recyclable containers, when possible. Your state or
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`community environmental programs may have other requirements or
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`suggestions for disposing of your medical waste. You should contact your
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`local EPA office for any information you may need.
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`What Container Should I Use?
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`Place needles, syringes, lancets and other sharp objects in a hard plastic or
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`metal container with a screw on or tightly secured lid. Many containers
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`found in the household will do, or you may purchase containers specifically
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`designed for the disposal of medical waste sharps.
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`If a recyclable container is used to dispose of medical waste sharps, make
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`sure that you don’t mix the container with other materials to be recycled.
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`Since the sharps impair a container’s recyclability, a container holding your
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`medical waste sharps properly belongs with the regular household trash.
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`You should label the container, “Not For Recycling.” In addition, make sure
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`your sharps container is made of non breakable material and has a lid that
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`can be securely closed (screwed on or tightly secured). Before discarding a
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`container, be sure to reinforce the lid with heavy-duty tape.
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`Do not put sharp objects in a container you plan to recycle or return to a
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`store, and do not use glass or clear plastic containers (see additional
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`information below). Finally, make sure that you keep all containers with
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`sharp objects out of the reach of children and pets.
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`Your home care provider may deliver a sharps container with your medical
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`supplies. If so place all needles, syringes and lancets in this container and
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`notify the company when the container is approximately 75% full. Your
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`home care provider will arrange for pickup of the container. For your
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`safety, do NOT bring your container to the hospital or Cancer Center for
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`disposal.
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`Information and Resources:
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`Further information can be found at the United States Environmental
`Protection Agency’s website: www.epa.gov/osw
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`You may also contact the Coalition for Safe Community Needle Disposal at
`1-800-643-1643 for information about the availability of safe disposal
`programs in your area.
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`This document is not intended to take the place of the care and attention of your personal
`physician or other professional medical services.
`Our aim is to promote active participation in your care and treatment
`by providing information and education.
`Questions about individual health concerns or specific treatment options should be discussed
`with your physician.
`
`©2008 The Regents of the University of Michigan
`Document # 0294/ Revised August, 2008
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