Botulinum Toxin (Botox) Injection Protocol for Neurological Conditions

Pre-Procedure Assessment

Patient Evaluation

• Confirm diagnosis and indication for Botox therapy
• Review contraindications and previous treatments
• Document muscle strength and spasticity patterns
• Obtain informed consent

Equipment Preparation

• Botox vials (per prescribed units)
• Sterile saline for reconstitution
• Appropriate gauge needles (27-30G)
• Alcohol swabs
• EMG/ultrasound guidance equipment (if required)

Reconstitution Protocol

1. Standard Dilution

   • Use 2mL preservative-free 0.9% sodium chloride
   • 100 units Botox per vial
   • Gently mix; avoid vigorous shaking

2. Alternative Dilutions

   • 1mL: High concentration for small muscles
   • 4mL: Lower concentration for larger areas

Administration Procedure

1. Preparation

• Clean injection sites
• Mark anatomical landmarks
• Position patient appropriately

2. Injection Technique

• Use proper needle insertion angle (45° or 90°)
• Confirm placement (EMG if needed)
• Inject prescribed units per site
• Maintain sterile technique

3. Documentation

• Record total units administered
• Document specific injection sites
• Note lot number and expiration date
• Schedule follow-up (typically 12-16 weeks)

Post-Procedure Care

Patient Instructions

• Avoid massage of injection sites (4 hours)
• Report adverse effects
• Activity modifications as needed

Monitoring

• Observe for immediate reactions
• Document treatment response
• Plan for subsequent sessions

Safety Considerations

• Maximum total dose per session
• Minimum intervals between treatments
• Contraindications:
  • Active infection
  • Neuromuscular junction disorders
  • Pregnancy/lactation
  • Aminoglycoside therapy