How to Use Intramuscular (IM) Injection Naloxone
Naloxone (also known by brand name Narcan) is a life-saving drug that can be administered to reverse an overdose until emergency services can arrive. There are several delivery methods for naloxone, including nasal sprays and prefilled injectables. Aniz offers naloxone kits containing a vial of liquid and a syringe, as well as alcohol wipes and a paper copy of instructions on its use.
Used needles should be discarded into a puncture-proof sharps container, and contact with any needle before or after use should be avoided to prevent communication of disease. Use alcohol wipes to sanitize the injection site before and after dosing, and wash your hands or use gloves when possible.
1. Check for an overdose
Unresponsiveness is the first sign of an overdose. Other signs include not breathing, turning blue, deep snoring, gasping, choking, gurgling, or a slowed heartbeat/pulse. If the individual has stopped breathing or begun to asphyxiate, perform rescue breathing immediately. If possible, continue rescue breathing while steps 2-5 are followed by someone else.
2. Call 911 or emergency medical services
Naloxone will wear off thirty to ninety minutes after use and overdose symptoms may reoccur. Calling an ambulance is not optional. When staying with someone who has overdosed waiting for emergency services, you cannot face legal trouble for possession of small amounts of controlled substances or drug paraphernalia, or violation of restraining orders or conditions of pretrial release, probation, or parole.
3. Prepare naloxone
With clean hands or gloves, open syringe packet and remove lid from naloxone vial. Draw up 1mL of air into the syringe, puncture the rubber stopper, and push the air into the vial. Being sure not to touch the needle to preserve sterility, flip the vial upside down and draw back the plunger on the syringe until it is filled with 1 mL naloxone. Turn the vial back over and withdraw the needle. Hold the syringe sharp side up and gently tap the body of the syringe so that air bubbles rise to the top. Gently push the plunger until all air has been ejected from the syringe.
4. Prepare the injection site
Use an alcohol wipe to clean the injection site. Wait for it to air dry (do not blow) before injecting and do not touch the site with anything but a clean needle to prevent contamination. There are several sites an intramuscular injection can be delivered. The red areas on the diagram indicate the surrounding area where your hand should be placed to pinch the injection site (so that the needle will penetrate the entire subcutaneous layer of fat and reach the muscle) and the dark red dot in the center is where the injection should be delivered.
The safest injection site is the ventro-gluteal muscle. It is located at the top of the hip, stretching across the side of the pelvis. Locate it by finding the largest muscle of the hip and stretching it between your index and middle fingers, creating a V with your fingers and pulling the surrounding skin taut with the heel of your hand and thumb. The injection will be given in the space between your first two fingers.
Another simple injection site is the vastus lateralis muscle of the thigh. Seat the person to whom you will administer the dose with their feet flat on the floor, shoulder width apart. Viewing the thigh from above, mentally divide it into three equal horizontal sections. The top, exterior portion of the middle section of the thigh is your injection site.
The most difficult injection site, the deltoid muscle of the shoulder, may be used when other sites are inaccessible. The correct site for injection is the muscle beginning approximately two finger widths down from the end of the clavicle bone. You should be able to feel a triangular muscle in the arm, and inject medicine in its center.
5. Administer naloxone
Insert the needle in one quick, controlled motion at a 90 degree angle, holding the syringe just behind the base of the needle. The needle should be inserted through the layer of fat beneath the skin and into the muscle, which will give a little resistance to the needle. With the tip of the needle in the muscle tissue, push the plunger of the syringe until all medicine has been administered, then withdraw the needle fluidly and gently. Minor bleeding is not uncommon and does not mean the medicine has been given incorrectly, but major, prolonged bleeding or blood that draws up into the needle indicates a blood vessel has been hit. If this is the case, discard old needle and administer another dose.
6. Perform rescue breathing and monitor recipient until help arrives
If safe, move naloxone recipient onto their back before beginning rescue breathing. Place your palm against their forehead and lift their chin back and upwards, away from the spine, to open the airway. With their head tilted back, check if their chest is rising, or they are breathing normally (not gasping, gurgling, or slow and labored breath). If not, begin rescue breathing.
Naloxone takes approximately two minutes to take effect. If no change in responsiveness occurs after naloxone has been given and rescue breathing has been attempted for two minutes, administer a second dose of naloxone. Clean the rubber stopper on the naloxone vial with an alcohol wipe and follow instructions above. Prepare the second injection site on the opposite side of the body as the first shot.
How To: Rescue Breathing
1. Keep the head tilted back and chin down. Pinch their nostrils with the thumb and index finger. Seal your lips over the overdose victim’s mouth. If their mouth cannot be opened, do not pinch the nose and seal lips around nostrils instead.
2. Breathe hard into the victim’s mouth for 1 second and watch for their chest to rise. If the chest rises, breathe into the victim’s mouth again. If the chest does not rise, reposition the head tilted back with the chin down and make another breathing attempt.
3. Perform 30 chest compressions at a rate of approximately two per second. Place one of your hands on top of the other and interlock your fingers, and place the base of your palm low on the victim’s sternum. Use your bodyweight and elbows to push down and towards the head with each chest compression. Then give two more hard, one second breaths.
4. Continue chest compressions and rescue breathing. You should complete approximately twenty chest compressions every ten seconds, administer another hard breath, then repeat until the person starts to breathe regularly without assistance or emergency services arrive.