Epogen SC administration

jnette, ASN, EMT-I · Dec 30, 2007

Wow.. now THAT is new !!! Since when are they being given SQ ???

We had ALWAYS administered EPO via the bloodline. hmmmmm... wonder why the change?

Not heard of using the forearm, though. All of our OUTpatients had it given SQ in the upper arm. Any reason it couldn't be given there before or immediately after tx., when not on the machine?

adria37 · Dec 30, 2007

I work in oncology and at my clinic we always have given epogen subq. 40,000 units to 60,000 units weekly is the dose which is 1 to 1.5 ml's. We give it in the upper arm or abdomen.

Lacie, BSN, RN · Dec 30, 2007

The justification I was given is now we give it only once per week rather than every treatment with the hope it will sustain in the system longer with less. Personally I believe its nothing more than a "cut cost" issue for the insurance companies. Doesnt really make alot of sense to me especially when some require such large doses. I have a few pts that are being given the sc twice weekly. We just started this about a month ago and pt's hate it as well as me. I have never seen anyone nor remember being taught the inner aspect of the lower forearm an acceptable injection site for any medication besides dermal injections such as PPD, etc. I'm concerned it's opening up more problems for pts who already have insurmountable issues to start with.

adria37 · Dec 31, 2007

We have been hit hard by Medicare reimbursement on epogen. We have strict guidelines that it can not be initiated until the hgb is below 10 and can only be given for 4 weeks if there isn't a rise the dose is increased to 60k for 4 weeks then if the hgb is still low then it is stopped. Think about the weeks for treatment and radiation, the effect on the bone marrow, and the fatigue of anemia. Guidelines are made by people who have no concept of disease, treatment, or quality of life. The number one complaint with cancer treatment is fatigue (nausea and vomiting has been relieved by the new nausea meds and getting insurance approval for those drugs is an entirely different rant).

Lacie, BSN, RN · Dec 31, 2007

We have been hit hard by Medicare reimbursement on epogen. We have strict guidelines that it can not be initiated until the hgb is below 10 and can only be given for 4 weeks if there isn't a rise the dose is increased to 60k for 4 weeks then if the hgb is still low then it is stopped. Think about the weeks for treatment and radiation, the effect on the bone marrow, and the fatigue of anemia. Guidelines are made by people who have no concept of disease, treatment, or quality of life. The number one complaint with cancer treatment is fatigue (nausea and vomiting has been relieved by the new nausea meds and getting insurance approval for those drugs is an entirely different rant).

I'm aware of all the hoopla regarding epo administration. My question is the route of administration. I dont believe the "lower inner aspect of the forearm" is an appropriate nor acceptable practice of administration for SC as my FA is insisting it is. I'm refusing to administer epo via this route and utilizing the abdominal or upper arm, therefore getting grief from my boss. Pt's dont like the forearm site and requested it given in their abdomen which my FA and the staff LPN refuses to do for pts. It's difficult when I'm charge and the LPN insist on administering this way since the FA also does this practice. I cant find any documentation showing this as acceptable or otherwise.

Trauma Columnist · Dec 31, 2007

I would not give epo sq in the lower arm - there is not enough tissue and absorption would be delayed. Not to even mention, the volume is way too much! I would like to see the research supporting this practice. And I too would not give it this way unless shown the literature.

jnette, ASN, EMT-I · Jan 1, 2008

The justification I was given is now we give it only once per week rather than every treatment with the hope it will sustain in the system longer with less. Personally I believe its nothing more than a "cut cost" issue for the insurance companies. Doesnt really make alot of sense to me especially when some require such large doses. I have a few pts that are being given the sc twice weekly. We just started this about a month ago and pt's hate it as well as me. I have never seen anyone nor remember being taught the inner aspect of the lower forearm an acceptable injection site for any medication besides dermal injections such as PPD, etc. I'm concerned it's opening up more problems for pts who already have insurmountable issues to start with.

I certainly agree with you. Never heard of the lower arm for injections, either, except for the ones you mentioned. I'd be asking for something in writing. :stone

chatty-rn · Jan 31, 2008

Hi, I couldn't find anything about forearm being an accepted SQ route, I think they just don't want to have to push up the pts. sleeve or take off the BP cuff! If they think it is acceptable they should be able to show documentation that it is. Good luck

dialysisguy · Jul 31, 2008

Kieser pt's in LA are SQ

bluefabian · Jul 31, 2008

Depending on types, I have given both routes.

To the bloodlines, via venous port during blood return. SC either to the upper arm or stomach post HD. From dosage as low as 2000 IU to 5000IU (I know, I was like - that much at first!).

Lacie, BSN, RN · Jul 31, 2008

Giving SC wasnt the question. I have no problem with that, it was the location of the SC site I was questioning. I am no longer with that company:yeah: as I finally determined it was much to unsafe and also was putting my license on the line daily. I'm the DON at my new clinic, so now I dont really have to argue that point anymore lol. Of course it's with a corporation but it's not one of the biggies. The CEO is also an RN which makes a huge difference in my opinion! I no longer feel like I'm beating my head into the wall daily, just sometimes :banghead: