Tips on learning self injections

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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.

Inserting a continuous butterfly needle

Tips from a patient to other patients about giving self-injections in relation to the syringe pump

Hold the butterfly needle firmly at 45 degrees in right hand (if right handed) and in the left hand firmly grip between thumb and forefinger, a lump of fatty flesh on the abdomen or thigh and briskly puncture the skin with the needle.
Slide it steadily into position up to the point of the green ‘wings’ of the butterfly. If the initial puncture is done quickly the pain is negligible (it is only the thought of it – you may find which inhibits the correct action?)
If the puncture is done slowly, there is a build-up of resistance in front of the needle which may result in pain, because this is communicated back though the nervous system…
Take it by ‘surprise’ as it were and you will have no problems – just a quick jab and in.

Sometimes you may experience problems with the syringe pump, which causes it to stop – this can be for the following reasons:-

• Incorrect angle of insertion, or jagged, jerky insertion of needle may occasionally result in a small amount of blood being admitted into the tube behind the needle, which may clot and act like a cork in the tube. This may be resolved sometimes by pressing the button below the screw clamp on the syringe driver, just lightly, which forces a very small (if careful!) shot of the drug through the needle thus clearing it. If this fails to unlock the line start again with a new butterfly needle.
  
• Sometimes the line may kink, next to the orange connection, obstructing flow. You may not be aware of this for several hours. However if you reposition the line so that the flow may be restored and press the starter button it is often successful, it just means wearing the gadget that bit longer.
  
• Sometimes if the stop ups occur frequently it could be due again to bad positioning or to a dud battery.
  
• Batteries last a surprisingly long time though i.e. 95 days – Duracell Alkaline 9.0v.
  
• You may find when you start using the pump that you have lumps or bumps or itchy swellings…ignore them, they subside eventually as the drug gets absorbed.
  
• It is helpful to use alternate sides of the abdomen / thighs each day. Also, it is all right to use the same side, if this is comfortable the next insertion can be sited 10 cm away from the previous one without harm.
  
• It may be helpful to adapt a cotton traveller’s purse in which the syringe pump may be placed, so independent movement and daily activities may be carried out in spite of being attached to the gadget.
  
• It is helpful to wear loose clothing in order to reduce any obstruction and to disguise the presence of the gadget.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.