A number of cancer treatments involve the regular administration of drugs under the skin (subcutaneous injection). This is because the drug to be injected is a protein and would get broken down by the digestive system. This page gives advice from professionals and patients themselves on how to injection yourself. This advice also applies to family or carers who want to learn to give injections. Any injection is not a pleasant thought but learning how to inject oneself or someone you are caring for  has some major benefits:

• You can give the injection at a time which suits you, not the person who injects it (usually district nurse).
  
• You can give it at home, often district nurses ask you to travel to the nearest GP practice.
  
• You can go on holiday without worrying how to arrange someone to carry out the injection.

Which treatments require injection under the skin?. Most patients requiring insulin in the UK have learnt to self inject but for cancer therapies the injections are usually only for short periods of time so it may not be worth learning in many cases. Certainly you should not regard yourself as failing if you don't want to do it or can't manage it. Treatments in oncology which involve subcutaneous injection include:-

• Interferon (for melanoma and renal tumours) eg Roferon and Inferon.
  
• Growth Factors to stimulate the white cells eg Neupogen or Granucyte
  
• Growth factors which stimulate Red cells eg Eprex
  
• Other treatments require the insertion of a butterfly needle which is kept under the skin continuously.

How to self inject.

Choose a site The best places to self inject are the front of your thigh or your abdomen (avoiding your navel and waist) - see diagram. Try to use a different area each time, this reduces the risk of skin reactions.

Before you start you prepare for the injection. On a clean flat surface have a your equipment ready. Many injection are supplied in a pack containing a prefilled syringe. Check the "use-by" date and ensure the contents are all present. Have a skin swab and "sharps box" ready.

Wash hands.

Ensure injection site is clean and dry.

Hold the syringe like a pencil and remove needle guard.

Pinch the skin where you are going to inject.

Wipe the skin with an alcohol swab and allow to dry.

With the syringe straight up or at a slight angle push it firmly and quickly into the pinched skin

Draw back the plunger a little: if blood comes up into the syringe, you have touched a small blood vessel; remove the needle and syringe and throw away in sharps bin. Prepare a new injection, ensuring you inject into a new site;

if no blood appears, slowly push plunger to inject solution.

When syringe is empty, remove needle and syringe and press on site for at least one minute with a swab or cotton wool. Don't worry if it bleeds a little as that is normal. Put a plaster on the site if you wish.

Put the needle and syringe into the sharps bin.

When your sharps bin is half to two thirds full, shut and lock the lid and return it to your GP or clinic. Please do not over fill it.

HOW TO PREPARE AND GIVE A Neulasta^® INJECTION

Neulasta^® is provided in a prefilled syringe. Neulasta^® should be stored in its carton to protect from light until use. If you are giving someone else Neulasta^® injections, it is important that you know how to inject Neulasta^®. Before getting your Neulasta^® injection, always check to see that:

• The name Neulasta^® appears on the carton and prefilled syringe label.
  
  
• The expiration date on the prefilled syringe has not passed. You should not use a prefilled syringe after the date on the label.
  
  
• The Neulasta^® liquid should always be clear and colorless. Do not use Neulasta^® if the contents of the prefilled syringe appear discolored or cloudy, or if the prefilled syringe appears to contain lumps, flakes, or particles.

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IMPORTANT: TO HELP AVOID POSSIBLE INFECTION, YOU SHOULD FOLLOW THESE INSTRUCTIONS.

Setting up for an injection

1.	Find a clean, flat working surface, such as a table.
2.	Remove the carton containing the prefilled syringe of Neulasta® from the refrigerator. Allow Neulasta® to reach room temperature (this takes about 30 minutes). Remove the syringe from the carton before injection. Each prefilled syringe should be used only once. DO NOT SHAKE THE PREFILLED SYRINGE. Shaking may damage Neulasta®. If the prefilled syringe has been shaken vigorously, the solution may appear foamy and it should not be used.
3.	Assemble the supplies you will need for an injection:
	Neulasta® prefilled syringe with transparent (clear) plastic blue needle guard attached An alcohol swab and a cotton ball or gauze puncture-proof disposal container
4.	Wash your hands with soap and warm water.

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HOW TO PREPARE FOR INJECTION OF Neulasta^®

5.	Remove the syringe from the package and the tray. Check to see that the plastic blue needle guard is covering the barrel of the glass syringe. DO NOT push the blue needle guard over the needle cover before injection. This may activate or lock the needle guard. If the blue needle guard is covering the needle that means it has been activated. Do NOT use that syringe. Dispose of that syringe in the puncture-proof disposal container. Use a new syringe. Do not activate the needle guard prior to injection.
6.	Hold the syringe barrel through the needle guard windows with the needle pointing up. Holding the syringe with the needle pointing up helps to prevent medicine from leaking out of the needle. Carefully pull the needle cover straight off.
7.	Check the syringe for air bubbles. If there are air bubbles, gently tap the syringe with your fingers until the air bubbles rise to the top of the syringe. Slowly push the plunger up to force the air bubbles out of the syringe.
8	Gently place the prefilled syringe with the window flat on your clean working surface so that the needle does not touch anything.

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Selecting and preparing the injection site

9.	Choose an injection site. Four recommended injection sites for Neulasta® are:
	The outer area of the upper arms The abdomen, except for the two inch area around the navel The front of the middle thighs The upper outer areas of the buttocks
10.	Clean the injection site with an alcohol swab.

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Injecting the dose of Neulasta^®

11.	Pick up the prefilled syringe from your clean flat working surface by grabbing the sides of the needle guard with your thumb and forefinger.
12.	Hold the syringe in the hand you will use to inject Neulasta®. Use the other hand to pinch a fold of skin at the cleaned injection site. Note: Hold the syringe barrel through the needle guard windows when giving the injection.
13.	Holding the syringe like a pencil, use a quick "dart-like" motion to insert the needle either straight up and down (90 degree angle) or at a slight angle (45 degrees) into the skin.
14.	After the needle is inserted, let go of the skin. Pull the plunger back slightly. If no blood appears, slowly push down on the plunger all the way, until all the Neulasta® is injected. If blood comes into the syringe, do not inject Neulasta®, because the needle has entered a blood vessel. Withdraw the syringe and discard it in the puncture-proof container. Repeat the steps to prepare a new prefilled syringe and choose and clean a new injection site. Remember to check again for blood before injecting Neulasta®.
15.	When the syringe is empty, pull the needle out of the skin and place a cotton ball or gauze over the injection site and press for several seconds.
16.	Use a prefilled syringe with the needle guard only once.

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Activating the Needle Guard after the injection has been given

17.	After injecting Neulasta® from the prefilled syringe, do not recap the needle. Keep your hands behind the needle at all times. While holding the clear plastic finger grip of the syringe with one hand, grasp the blue needle guard with your free hand and slide the blue needle guard over the needle until the needle is completely covered and the needle guard clicks into place. NOTE: If an audible click is not heard, the needle guard may not be completely activated.
18.	Place the prefilled syringe with the activated needle guard into a puncture-proof container for proper disposal as described below.

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Disposal of prefilled syringes and needle guards

You should always follow the instructions given by your doctor, nurse, or pharmacist on how to properly dispose of containers with used syringes and needle guards. There may be special state and local laws for disposal of used needles and syringes.
Do not throw the container in the household trash. Do not recycle. DO NOT put the needle cover (the cap) back on the needle. Place all used needle covers and syringes in a hard-plastic container with a screw-on cap, or a metal container with a plastic lid, such as a coffee can, labeled "used syringes". If a metal container is used, cut a small hole in the plastic lid and tape the lid to the metal container. If a hard-plastic container is used, always screw the cap on tightly after each use. Do not use glass or clear plastic containers. When the container is full, tape around the cap or lid to make sure the cap or lid does not come off. Always keep the container out of the reach of children.

Further information: Your doctors and specialist  nurses are in an ideal position to give information relevant to your situation. Macmillan has a help line and a prize winning video available in English UK ethnic languages explaining Radiotherapy & Chemotherapy. Cancernet.co.uk is a complete cancer information resource written by an experienced team of doctors, health professionals and patients. It will help you make informed decisions and guide you through the cancer journey including information about: Optimum treatment of specific cancers:  e.g.Breast | Prostate | Bowel.   Common treatments:  Chemotherapy | Radiotherapy | Hormones | Biological agents | Complementary.  Lifestyle and cancer: Books based on the facts | Exercise | Diet | Smoking | Sunbathing | Alcohol. Tip to help with the symptoms of cancer and side effects of treatments. Financial issues: Traveling and cancer | Travel insurance | Links to support groups | Books | Videos | Glossary | About us | Disclaimer | Tests for cancer | Clinical trials | What is cancer | How to avoid cancer