Manual self injection procedure

Manual self injection with the vial-to-vial method

Today different injection techniques exist. Patients can choose between a manual injection (standard) and an automated injection with one of the two autoinjectors Betaject comfort® or Betaject light®, if both devices are available in your country (for description see link with Self injection with an autoinjector). The complete manual self injection with the vial-to-vial technique is described here:

The main steps are:

1. Preparing for self-injection
2. Drawing up the solvent (1.2 ml) into the syringe.
3. Injecting the required volume of solvent into the vial of Betaferon (Reconstitution)
4. Drawing up the required volume of the solution for injection (1.0 ml) into the syringe
5. Choosing and preparing the injection site and injecting the Betaferon solution subcutaneously (under the skin)
6. Rotating injection sites

The steps in detail:

1. Preparing for self-injection

• Wash your hands thoroughly with soap and warm water.
• Collect all your equipment before you begin the process.
  

You will need:

• vial of solvent for Betaferon (sodium chloride solution 0.54%)
• vial of Betaferon
• 2 ml syringe
• one needle for reconstitution
• one needle for injection
• alcohol wipes
• disposal unit (a container for used syringes and needles)
• Remove the protective caps from both vials.
• Use alcohol wipes to clean the tops of the vials – move in one direction and use one wipe per vial. Tip: When wiping the vials with an alcohol wipe, turn over the wipe and leave the clean side on top of the vial until you are ready to use it.
  

2. Drawing up the solvent (sodium chloride solution) into the syringe.

• Resting your hands on a stable surface, remove the syringe from its wrapping. Do not touch the tip (nozzle) of the syringe. Tip: If you touch accidentally the tip of the syringe, use a fresh one.
• Take one needle (e.g. a 21-gauge needle) out of its wrapping and place it firmly onto the tip of the syringe. Remove the needle guard from the needle. Do not touch the needle. Tip: If you touch the needle accidentally, use a fresh one.
• Pull back the plunger (on the syringe) to the 1.2 ml mark.
• Insert the needle straight through the rubber stopper, into the top of the vial. If you do touch a stopper, clean it with a fresh alcohol wipe.
• Turn the vial of solvent upside down. Keep the needle tip in the liquid.
• Hold the vial and syringe in one hand and slowly draw up that amount of liquid to the 1.2 ml mark. Tip: You should rest your arms on a stable surface to do this, to ensure you draw up an accurate volume of diluent.
• Keep the vial upside down, gently tap the syringe until any air bubbles rise to the top of the barrel of the syringe.
• Carefully push in the plunger to eject ONLY THE AIR through the needle. Make sure that the syringe contains 1.2 ml of solvent.
• Remove the needle with the syringe from the vial of solvent.
  

3. Injecting the required volume of solvent (1.2 ml) into the vial of Betaferon (Reconstitution)

• Find the Betaferon vial and throw away the alcohol wipe on top of it.
• Holding the Betaferon vial on a stable surface, slowly insert the needle of the syringe (containing 1.2 ml of liquid) all the way through the stopper of the vial.
• Push the plunger down slowly, directing the needle toward the side of the vial to allow the liquid to run down the inside wall (injecting solvent directly onto the powder will cause excess foaming).
• Make sure that the needle does not come into contact with the powder or the resulting solution.
• After the solvent in the syringe has been completely injected into the Betaferon vial hold the vial and rotate gently your hand to completely dissolve the white powder of Betaferon. DO NOT SHAKE!
• Look closely at the solution (it should be milky). Tip: If the mixture contains particles or is discoloured, throw it away and start again.

4. Drawing up the required volume of the solution for injection (1.0 ml) into the syringe

• Slightly incline the vial of Betaferon solution and keep the needle tip at the lowest point of the vial.
• Pull back the plunger to withdraw 1.0 ml of liquid into the syringe.
• Turn the vial upside down and hold the syringe with the needle pointing upward.
• Tap the syringe gently until any air bubbles rise to the top of the barrel of the syringe.
• Carefully push in the plunger to eject only the air through the needle. NOTE: Already a single drop of the drug on the outside of the needle can cause injection site reactions. This is why one uses after reconstitution a fresh needle for injection.
• Remove the syringe from the needle. Leave the needle in the vial.
• Place the syringe (without needle) on a surface. Make sure that the tip (nozzle) of the syringe does not touch the surface.
• Find a second needle (e.g. a 27-gauge needle), take it out of its wrapping and place it firmly onto the tip of the syringe.
• Throw away unused portion of the solution remaining in the vial and the needle in it.
  NOTE: The injection should be administered immediately after mixing.

5. Choosing and preparing the injection site and injecting the Betaferon solution (1.0 ml) subcutaneously (under the skin)

• Use a different area each day you inject (see 6. Rotating injection sites). The injection sites should be situated in the following areas:
• arms (upper back portion)
• abdomen (except around navel and waistline)
• buttocks
• thighs (front and sides except at groin and knee)
  NOTE: Do not use any areas in which you feel lumps, bumps, firm knots or pain. Do not use any area in which the skin is discoloured, depressed, scabbed, or has broken open. Talk to your doctor or healthcare professional about these or any other unusual conditions that you find.
• Use an alcohol wipe to clean the skin at the injection site; let it air dry.
• Throw away the wipe.
• Find the syringe with the fresh needle on it. Remove the needle cap from the needle.
• Gently pinch the skin together around the site (to lift it up a bit). Tip: The best areas for injection are loose and soft (flabby), away from joints, nerves, bones, and other important structures.
• Resting your wrist on the skin near the site, stick the needle straight into the skin at a 90° angle with a quick, firm motion.
• Inject the drug by using a slow steady push in until the syringe is empty.
• Hold a swab on the injection site. Remove the needle from the skin.
• Gently massage the injection site with a dry cotton ball or gauze. Tip: Some people press a cooling patch for some minutes at injection site to prevent swellings.
• Discard the syringe and the needle in the disposal unit.

6. Rotating injection sites

It is necessary to choose a new site for each injection as changing sites each time gives the area time to recover and helps prevent infection. The schedule shown at link “Betaferon medical record” will help you to vary the sites adequately. You can print out the pages of the medical record and use it to document your injection sites. Tip: if you administer the first injection into the right side of the abdomen, choose next time the left side for the next injection, then move to the right thigh and so on. By following this schedule, you will come back to your first area (e.g. the right side of the abdomen) after 8 injections (16 days). As per the diagram you should then, however, not use the same section in that area as during your first injection but the section which is most distant. If all areas become tender, talk to your doctor about choosing other injection sites.

Manual self injection with the pre-filled diluent syringe

The main steps of the self injection procedure with the pre-filled diluent syringe are the same as described above for the vial-to-vial method. Only the step “Drawing up the solvent into the syringe” (step No. 2 in the list above) is not necessary any more, which makes the injection more easy. All of the following steps are identical, this is why we refrain from repetition here.
The main steps with the pre-filled syringe are:
1. Preparing for self-injection
2. Injecting the required volume of solvent into the vial of Betaferon (Reconstitution)
3. Drawing up the required volume of the solution for injection (1.0 ml) into the syringe
4. Choosing and preparing the injection site and injecting the Betaferon solution subcutaneously (under the skin)
5. Rotating injection sites

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