Your clinician should have explained why you need B12 injections, and decided that the intramuscular route is the best option for you.
B12 is usually given as an intramuscular injection, every 12 weeks.
This guide is for adult patients who:
- Have a long-term need for intramuscular vitamin B12 replacement
- Have received the initial loading doses at the surgery (usually 6 injections over 2 weeks)
- Have opted to be treated at home for their personal convenience (this may be due to work, family, transport or mobility reasons)
- Where they, or a family member, have agreed to and have the manual dexterity / and cognitive ability to administer the injection as prescribed
- Have attended a registered nurse appointment to be advised about and supervised self-administering a B12 injection
Equipment needed to self-inject
Obtained via FP10 prescription
- B12 medicine called hydroxocobalamin 1000 micrograms in 1ml – 2 vials i.e. a 6 month supply will be issued each prescription – you can reorder in the usual way through the NHS app. It is important to keep the medicine safe, it is NOT kept in the fridge.
- Sharps box with a yellow lid (1 litre size) – needles and the glass vials must be disposed of in the sharps box. This needs to be stored somewhere safe at home, out of the reach of children and animals. Sharps boxes only need to be replaced when the fill is reached – they can then be closed and handed into reception to be safely disposed of (they must NOT be put in household waste).
Supplied by the practice
- 1 syringe (3 ml)
- 2 needles (1 for drawing up the drug and 1 for administration) – For an IM injection; the needle gauge should be 21 to 23 dependant on the size of the patient. The needle length is between 1- 1 ½ inches (up to 3 inches for larger adults)
Alcohol swabs
Patient to purchase
- Cotton wool / plasters (in case there is a small amount of bleeding)
Please note a prescription charge will apply (unless you have an exemption) for both the B12 vials and sharps box. However, sharps boxes can also be purchased on amazon, and this may be more cost effective.
Intramuscular injections: site and needle angle
The easiest site when self-administering an IM injection is the middle third of the vastus lateralis muscle of the thigh. The vastus lateralis site is in the lateral middle third of the thigh between the greater trochanter and the knee. When injecting, lift the vastus lateralis muscle away from the bone.
Another option is the deltoid muscle of the upper arm – This may be useful if you have a carer or a family member willing to administer your injection. The thickest part of the deltoid muscle is 2.5-5cm (1-3 finger breadths) below the lower edge of acromion process of the scapula over the midaxillary line.
The angle of the needle with IM injections should be 90 degrees.
How to give an injection
- Wash and dry hands to reduce the risk of infection.
- Assemble the syringe and needle and withdraw the whole 1ml of drug from the ampoule
- Disperse air bubbles from the syringe.
- Change the needle. Doing so will ensure that the needle used for the injection is sharp, thereby reducing pain.
- Insert the needle quickly into your preferred site and slowly and steadily inject the medicine. There is no need to pull back on the syringe to check for blood.
- Dispose of the used needle and glass vial in a sharps container.
- Document the injection date and record any complications
Please see the below site for more information…
How to self-inject intramuscular vitamin B12 – Overview | Guy’s and St Thomas’ NHS Foundation Trust
Self-administering a vitamin B12 injection – Training Record
Patient must successfully complete face-to-face training in:
- Medication storage, preparation and injection technique
- Safe handling and disposal of sharps
- Recognition of serious complications e.g. anaphylaxis and what to do (call 999)
- Recognition of minor complications e.g. injection site reaction, missed or incorrect dose,
accidental needle stick injury and what to do (contact surgery or 111)
Please contact the surgery via our medical triage system or on 01753 643195 if: - You have any concerns following your injection
- You wish to revert to receiving the injections at the surgery at any point
- You feel you need a refresher session on how to inject
Please be aware that the right to self-inject may be withdrawn if at any stage there are any concerns
that the proper technique is not being followed, there are new medical conditions that increase
injection risk or the policy is revoked due to NHS or practice policy changes on best practice.