Epogen SC administration

[Lacie]

Some of the insurance companies are requiring we now give Epo via SC route over IV in our unit (chronic). I generally give them if the pt allows in the abdominal area as usually the b/p cuff on one arm and the fistula/graft is in the other. My FA and the LPN are giving them in the "lower forearm" same as you would for a PPD. Is this an acceptable area especially for some who require rather large amounts that require numerous sticks? In my 30 years of working in hospitals I never gave sc injections in this area and dont feel comfortable doing so. Any documentation on this as I cant find anywhere saying this is an acceptable site for any sc injection?

[PDHDRN]

I work in PD and HD and we had always given Epo SC in PD and IVP in HD. Epo works longer if it's given SC. I believe CMS does not recommmend Epo to given SC to HD pts.

[happybunny1970]

I work in Acute, and we have always given Epo SQ -- the doseage is less, and the absorption and results are supposed to be superior to IV.

We always give the patients a choice: Upper arm or abdomen, their choice. I have had patients vehemently claim that one is more painful than the other, but each person has their own opinion. I set it at the bedside to warm to room temperature (which is supposed to be less painful) and pinch up the area for injection -- if I manage to pinch it right, the patients feel my pinch and not the injection. Of course, the closer you get to that full CC, the more painful it's likely to be!

[nursingisok]

Maybe you should ask your medical director of the clinic what he thinks and then tell the FA what he said...

[anurseadvocate]

Patients should always be given the option (HD) if they want sc or IV, as well as having the pros/cons explained to them. Facilities use 'less' epogen when it is given sc and therefore, cuts into revenue. I remember reading that revenue is in the high 20% for epogen, etc. RenalRuth

[Lacie, BSN, RN]

Thanks for the responses but did anyone read my initial question? I know epo can be given IV or SC. That was not my question. Anyway I have double and tripled checked including medical director and at no time should any sc injection be given in the lower forearm as an acceptable site. All literature states the same. I was questioning location of which the (former) FA was instructing staff to administer a sc injection of epo not it's mode of administration.

[MSLNT1.1]

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.

Lacie,

My sentiments too. Epogen can be administered through the med port on the dialysis lines or SC as indicated on the package insert. The bottom line is that we were taught in school what are acceptable sites for administration of medication. And as far I know SC is either given in the arm or abdomen. It should not matter about the Epogen protocol. I agree with TRAUMA RN there is not enough fat in the lower forearm for the absorption. Stick to the fatty area of the arm or abdomen. I train pt's to do dialysis in the home and they administer their Epogen themselves and they usually do it the abdomen unless their training partner is trained in which I train them to give it in the fatty part of the arm. Hope this helps. Also take a look at your companies policy. :nuke: