"Although the patient is spending a little less time in the clinic, the administration actually requires the nurse to be at the chairside the entire time. This has allowed nurses to spend potentially uninterrupted time to sit and converse with the patients that they may not have had with an IV infusion. It's been a wonderful unintentional outcome from the development of the large-volume subcutaneous injections," Crystal Derosier, MSN, RN, OCN®, clinical specialist at Dana-Farber Cancer Institute, in Boston, MA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about administering high-volume subcutaneous injections in cancer care.

Music Credit: "Fireflies and Stardust" by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Learning outcome: The learner will report an increase in knowledge related to the administration of high-volume subcutaneous injections.

Episode Notes

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast™ episodes. Find a full list of opportunities.
• Oncology Nursing Podcast™ episodes:
  • Episode 326: Intramuscular Injections: The Oncology Nurse's Role
  • Episode 285: Transarterial Chemoembolization: The Oncology Nurse's Role
  • Episode 271: Intraventricular and Intrathecal Administration: The Oncology Nurse's Role
  • Episode 265: Intravesical Administration: The Oncology Nurse's Role
  • Episode 252: Intraperitoneal Administration: The Oncology Nurse's Role
• ONS Voice articles:
  • Administration Considerations Amid the Large-Volume Subcutaneous Injection Revolution
  • FDA Approves Atezolizumab and Hyaluronidase-Tqjs for Subcutaneous Injection
  • Make Subcutaneous Administration More Comfortable for Your Patients
  • Oncology Drug Reference Sheet: Pertuzumab, Trastuzumab, and Hyaluronidase-Zzxf Subcutaneous Injection
  • ONS Voice Oncology Drug Reference Sheets
• ONS book: Access Device Guidelines: Recommendations for Nursing Practice and Education (Fourth Edition)
• ONS course: ONS/ONCC Chemotherapy Immunotherapy Certificate™
• Clinical Journal of Oncology Nursing article: Subcutaneous Administration: Evolution, Challenges, and the Role of Hyaluronidase
• Oncology Nursing Forum article: Administration of Subcutaneous Monoclonal Antibodies in Patients With Cancer

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an Oncology Nursing Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

"Some challenges with subcutaneous injections are with the administration, especially when we're thinking about large-volume drugs. … Some of these patients who have been through multiple therapies, they've been on a long journey, or just in general they may have small amounts of subcutaneous injection areas and tissues, so that could be problematic. … Also, some patients may want to go back to receiving IV medications if they experience severe pain at an injection site during administration, or maybe they had a site-related reaction. This is where the nurses play a huge, crucial role in the administration of these subcutaneous drugs." TS 5:17

"When administering large-volume subcutaneous injections, good ergonomics is very important during the administration because this can help reduce the fatigue and discomfort not only for [nurses] but for the patients as well. If you're trying to hold the needle in place for 5–10 minutes, it's a lot of work. Your arms can start to shake, and that shaking can cause discomfort for the patient as well. The utilization of a winged infusion set for these large volumes allows more space between the patient and the nurse, which supports better ergonomics." TS 11:20

"When they came to the market, there was an unfounded concern from patients and practitioners that these injections would not be as effective as their IV counterparts. This is totally incorrect. We know that these options have the same efficacy and may actually also help to reduce the incidence of any infusion-related reactions, as well as lower side-effect impacts on patients, so overall, a lot of improvement with these high-volume subcutaneous injections for the patient experience." TS 21:37

"I'm just really looking forward to the future landscape of oncology practice and drug approvals and drug administration. It's so important that subcutaneous injections have really made a name for themselves in nursing practice today. We continue to see more subcutaneous formulations on the market that are available for patients, allowing them less time in infusion chairs and more flexibility and freedom outside of the healthcare setting." TS 24:39