Subcutaneous Administration of Bortezomib: A Pilot Survey of Oncology Nurses

Abstract

Subcutaneous (SC) administration of the proteasome inhibitor bortezomib was approved in the United States and European Union in 2012. There is limited guidance regarding how to administer SC bortezomib and a general lack of clear direction on optimal techniques for administering SC chemotherapy injections. Nurses may be utilizing different techniques, and inconsistent techniques may result in injection-site reactions, causing patient discomfort and treatment cessatioin. This observational survey of oncology nurses in community oncology clinics aimed to identify techniques being used and explore nurses' opinions about SC bortezomib administration. A 44-question electronic survey was developed, based on the current literature regarding appropriate techniques for administering SC injections. A total of 43 nurses from 17 clinics in 12 states responded. The majority (74%) had been practicing oncology nursing for at more than 5 years. Respondents predominantly used and preferred the abdomen for injections (88%); 81% used a skin lift to ensure injection into adipose tissue. There was no relationship between the angle of insertion and the needle length; 51% used an air-bubble technique. Nurses took 3-5 (49%), 5-10 (35%), 10-30 (9%), or > 30 (7%) seconds to administer each mL of SC bortezomib injection. All nurses completely/somewhat agreed that practice guidelines would be important for standardizing SC bortezomib administration. Advanced practice registered nurses (APRNs) shared the responsibility for ordering SC bortezomib, according to 53% of respondents. These findings could help APRNs improve the quality of patient care, may help minimize adverse events and maximize effective therapy, and could help inform the development of practice guidelines.

Table 1

Characteristics of Survey Respondents^a

Figure 1

Oncology nurse respondents’ (A) injection-site selection, (B) injection-site preference, and (C) correlation between injection-site preference and facility layout, for administration of subcutaneous bortezomib (p = .02, based on Fisher’s exact test).

Figure 2

Responses from oncology nurses regarding (A) needle gauge and length and (B) needle size and angle of insertion (p = .21, based on Chi-square test). Also shown are (C) skin-lift technique, (D) airbubble technique, (E) responses from oncology nurses regarding time taken to administer each mL of subcutaneous bortezomib, and (F) 45° angle of insertion with skin lift (recommended for needles longer than 6 mm).