INSIGHTS FROM: ZOZO GREENHOLZ, RN; ANDREW E. HENDIFAR, MD; ERIC LIU, MD, FACS; MARIAH MAHOTZ, RN, BSN, OCN
Friday, January 31, 2020
Zozo Greenholz, RN: I have been giving this injection since the first approval of lanreotide, and the new design has really improved the safety in the administration and the safety and comfort for the patients receiving the injection.
The biggest improvement was the plunger rigidity, which has really made the injection much easier and more comfortable for the patient. The position of the fingers on the syringe also has been improved, as the plunger was shortened a little. There are now wings on the syringe that fit your fingers perfectly. Prior to injecting the drug in the patient, your fingers can be in the perfect position and never move through the injection—for the 20 seconds that you have to give it.
The new design really has made the injection much easier, sturdier, and more comfortable for the patient. If your nurse is more comfortable giving a shot, the patient certainly feels less apprehension. This has been successful. Also, some of the changes that were made to the retracting space: The mouth is actually much bigger, so there’s less chance of pinching the patient’s skin. They have all appreciated this because that was 1 of the most uncomfortable parts of the injection.
There are a few important points that you must know in being effective and in increasing the comfort to your patients. The first point is, this is not an intramuscular injection. It’s a deep subcutaneous injection that goes above the gluteus, superior to the gluteus, so you do not have to have the patient relax the leg you’re injecting in. What I really like to tell my patients is to stand straight in front of me and hold on to the counter or whatever pole they have to hold on to. I prep the skin, whichever side, and look for the right place where there’s no bump or lump above the gluteus, and clean the area. I ask my patient to push against my hand. I’m making this gesture with my hand because it’s really important to not pinch the skin. It’s really important to extend the skin with your fingers. Once you have the skin in the right position, you can pick up your syringe and inject. It goes as smoothly as I just demonstrated. Once you have done all that, the needle will retract 20 seconds after you’re done injecting. Then you let the patient relax, and you’re done.
We take lanreotide out in the morning, prior to the patient arriving. One of the improvements they’ve made to the package has been with this little tray that holds our syringe, which reduces the risk of dropping it on the floor. The lanreotide has time to warm up. We give it at least a half hour to warm up. Patients have to wait. They wait for us if we’re not ready for them. But it makes a huge difference in how they feel the injection is going if the product is at the right temperature.