While the idea of injecting yourself may be stressful, learning to administer shots at home can help ease the burden of your treatment
Some medications used by cancer patients must be given by injection. And for some injections, you or a caregiver may be able to give the shot at home. If you find the idea of injecting yourself to be stressful, keep in mind the benefits: it can free you from repeated trips to the doctor’s office and associated co-pays. The first step is to understand different kinds of injections.
Subcutaneous (SQ) injection is a shot of medicine into the fatty tissue just below your skin. Since there is little blood flow in fatty tissue, the medication is absorbed more slowly. These injections usually use short, very thin needles, and don’t cause much discomfort. Medications given this way include heparin, enoxaparin (Lovenox®), insulin, pegfilgrastim (Neulasta®), adalimumab (Humira®), etanercept (Enbrel®), gosrelin (Zoladex®), and epoetin alfa (Procrit®)
Intramuscular (IM) injection is a shot of medicine deep into a muscle. Since muscles have a very good blood supply, the medication is absorbed quickly. To reach into tougher muscle tissue, the needle may be a bit longer and wider and may be more uncomfortable than a subcutaneous injection. Medications given by IM include antibiotics (penicillin, streptomycin), flu and COVID vaccines, testosterone and medroxyprogesterone (Depo-Provera®) and immunoglobins such as immune globulin intramuscular (IMIG) given to help prevent hepatitis A, measles or chickenpox if you have been exposed.
Where to give an injection
The best sites for your injections will depend on whether you need a subcutaneous injection (into the fatty tissue just under the skin) or an intramuscular injection (deeper into the muscle).
For subcutaneous injections, choose one of these sites: the front outer thigh, upper outer arm, or belly (at least an inch away from the belly button). Pinch the skin up so you are sure to inject into the fatty tissue and not the muscle. If you are giving the injection to yourself, or if you have a large amount of liquid to inject, your healthcare team may recommend that you use the thigh or belly site. The upper, outer arm can be difficult to reach on yourself and injecting a large volume of fluid in the arm may cause more discomfort than injections in the thigh or belly.
For intramuscular injections, your nurse or doctor will tell you the best sites for you because an exact location must be used and some sites may be difficult to reach if you are giving the injection to yourself. For injections that must go into a muscle, these four muscles sites are commonly used:
- deltoid muscle in upper arm (where most vaccines are given)
- vastus lateralis muscle in the front outer thigh
- entrogluteal muscle in the hip
- dorsogluteal muscle in the buttock
How to give an injection
Your doctor or nurse will give you instructions for your injections. The angle of the needle will vary based on whether you need a subcutaneous or intramuscular injection.
1. Wash your hands thoroughly to prevent infection.
2. Gather and check your equipment. Make sure the medication is not cloudy and that there is no sediment. If you see either, throw it away and use a new syringe (if prefilled syringe) or vial.
3. Pick a location for the injection. Avoid areas where the skin is red, irritated, bruised, burned, hardened, scarred, or has lumps or stretch marks. DO NOT use the same area for each injection — rotate sites so your skin stays healthy and able to absorb medication. If you are using a prefilled syringe (such as enoxaparin/Lovenox®) continue to step 4. If you have to fill a syringe, see “How to fill a syringe” below.
4. Clean the area of skin. Using an alcohol swab or pad, clean a two-inch area around the site you have chosen. Begin at the center of the site and move outward in a circular motion. Allow the skin to dry; this will help avoid stinging during the injection. If your doctor tells you to clean the area differently, always follow your doctor’s directions.
5. Remove the cap and hold the syringe in your dominant hand.
For a subcutaneous injection, use your other hand to pinch a one-inch fold of skin. This helps prevent injecting the solution into a muscle. Hold the syringe like a pen and with a quick, smooth motion, push the needle into the skin at an angle between 45 and 90 degrees. Keep the angled (beveled) side of the needle facing up, toward you. Inject the medication by pushing carefully and slowly on the plunger.
For an intramuscular injection, you’ll need to insert the needle at a 90° angle to the skin with a quick thrust and push down on the plunger to inject the medication. A 90° (straight up/down) angle is needed with an IM injection to make sure the medication is released into muscle and not the fatty tissue. Inject the medication by pushing carefully and slowly on the plunger.
6. Wait briefly and then withdraw the needle at the same angle as it was inserted. Hold a cotton ball or alcohol prep pad over the site; do not rub. If there is any bleeding after five seconds, cover with a Band-Aid®.
7. Use each syringe only once. Discard the used syringe into a hard container right away; do not try to get the cap back on.
8. Wash your hands when you are done.
9. Check the injection site after two hours for signs of redness, swelling, or tenderness; if any of these occur, report it to your clinic.
How to fill a syringe
If you need to fill a syringe with medicine from a vial, follow these steps:
- Wipe the top of the bottle with an alcohol wipe. Let it dry. Do not blow on it.
- Know the dose you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of medicine you want. Example: If you need to draw 3 ccs of medicine, pull the plunger back to the 3 cc mark.
- Put the needle into and through the rubber top of the bottle. Push the plunger so the air goes into the bottle.
- Keep the needle in the bottle and turn the bottle upside down.
- With the tip of the needle in the liquid, pull back on the plunger to get the right dose into the syringe.
- Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the bottle, then pull back to get the right dose.
- When there are no bubbles, take the syringe out of the bottle. Put the syringe down carefully so the needle does not touch anything.
- Go back and continue with Step 4.
Roswell Park has a video on how to give a subcutaneous injection. If you are using prefilled syringes, you can start the video at time marker 1:37.