Hydrocortisone Injection – How to give an Emergency Intramuscular Injection of Hydrocortisone for Adrenal Crisis

Hydrocortisone Injection – How to give an Emergency Intramuscular Injection of Hydrocortisone for Adrenal Crisis

How to give an emergency injection of Hydrocortisone Sodium Succinate for adrenal crisis

Adrenal crisis is a medical emergency and must be treated immediately with one hydrocortisone injection and seek immediate medical attention —call 999, stating Adrenal Crisis.

1. Wash and dry your hands. Lay out one 2ml syringe, 2 blue needles, one sterile water for injection vial, one hydrocortisone injection vial and one alcohol skin wipe.

2. Snap open the sterile water – use a small piece of tissue to protect your fingers.

3. Remove the cap from the vial of Hydrocortisone powder.

4. Peel open the end of the syringe and needle sterile wrappers. Attach the blue needle to the syringe.

5. Remove the needle shield.

6. Withdraw 2ml of sterile water into the syringe by putting the needle in the water vial. Draw up the liquid by pulling the syringe plunger back.

7. Remove air from syringe by  holding the needle upright and squeezing the plunger until a drop of liquid appears at the tip of  the needle.

8. Inject the sterile water into the vial of hydrocortisone powder through the rubber stopper on the vial.

9. Swirl the vial until all the powder is dissolved in the water.

10. Keeping the needle in place, tip the bottle upside down to draw – up the solution into the syringe. Keep the tip of the needle below the liquid level and pull down the syringe plunger. Withdraw all of the contents of the vial into the syringe. Pull the needle and syringe out of the vial.

11. Exchange the blue needle that was used to draw up the injection for the new blue needle. Remove needle shield.

12. Hold the syringe at eye level, and then remove any air by squeezing the plunger until a drop of liquid appears at the tip of the needle.

How to administer an intramuscular injection of hydrocortisone

1. Use an alcohol wipe to clean the bare skin at injection site – right or left upper thigh or upper arm.

    Upper thigh injection site.

Upper arm injection site

2. Hold the syringe between your thumb and index finger. Inject the needle at a 90 degree angle as far as the needle hilt. Then press the syringe plunger and inject medicine into muscle.

3. Grasp syringe and pull needle out of the thigh. Apply pressure to the injection site with a clean tissue for 2 minutes.

4. Dispose of both of the needles and vials in a sharp box (available on prescription from your GP).

What should I say to my GP, ambulance team and A&E doctors when I seek emergency help?

I have adrenal insufficiency and I am on regular steroid tablets. I am unwell; I will urgently need to have either a 100mg of intramuscular injection of hydrocortisone or intravenous hydrocortisone. (If you have administered intramuscular injection of hydrocortisone, inform GP / ambulance / A&E Clinician).  Please check my blood pressure, urea and electrolytes (U&E’s), glucose and other relevant tests. I may need 0.9% sodium chloride / dextrose intravenous infusion.  If I am not treated urgently, my life could be in danger.

What to do when the hydrocortisone injection stock is finished or has expired

Your GP will be able to provide repeat prescription for injection hydrocortisone and water for injection.  They may also supply the 2ml syringes and 23 G intramuscular needles. Contact your Endocrine specialist nurse if your GP is not able to supply the equipment for your hydrocortisone injection.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

For any queries and advice between Monday to Friday 8.30am – 4pm (not on bank holidays and weekends) please contact your Hospital Endocrine Consultants or Specialist Nurse through their Secretary:

Worcestershire and Kidderminster Hospital Endocrine consultants secretary phone number:      01905 760671 / 01905 733039

Email: wah-tr.diabetesadvicewrh@nhs.net

Redditch Alexandra Hospital Endocrine consultants secretary phone number:      01527 503890                                                                   

Email: wah-tr.diabetesadvicealx@nhs.net

Endocrine Specialist Nurse Worcester Acute Hospitals NHS Trust.

Phone: 07563373193

Email: wah-tr.endocrinespecialistnurses@nhs.net

Please Note, these phone numbers and email addresses are not for emergency management or emergency contact.

Some useful websites are below:

Liverpool University Hospital Emergency hydrocortisone injections movie link:

https://youtube.com/watch?v=NXXB3w1ADcIu0026feature=share

UK Addison’s Disease Self Help Group

www.adshg.org.uk

The pituitary Foundation

www.pituitary.org.uk

Medic Alert

www.medicalert.org.uk

Freephone: 0800581420

Patient Experience

We know that being admitted to hospital can bea difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Thursday from  8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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