Medication Extension Set Makes Subcutaneous Hyaluronidase Injections Easier, More Comfortable in Cancer Treatment


A medication extension set may be the preferred method for subcutaneous hyaluronidase injections compared with a traditional needle.

Oncology nurses found the use of a medication extension set to be a feasible and comfortable method of administering subcutaneous hyaluronidase injections, according to a poster presented at the 47th Annual Oncology Nursing Society Congress.

Volunteer nurses across 6 pilot sites were asked to use the medication extension set for 6 injections and to answer a corresponding survey. Notably, 100% of nurses reported difficulties or complaints with traditional needle injections, while only 20% of nurses experienced problems with the novel method and 0% reported difficulty with dexterity using the extension set. Furthermore, 80% of respondents indicated a preference for the extension set over a traditional needle.

“The survey results were favorable for use of extension set over the use of the needle,” Sarah Digirolamo, RN, of Yale New Haven Health Smilow Greenwich, said in a presentation of the findings. “Eighty percent of our respondents reported that they would prefer to use the extension system.”

In 2017, Greenwich Hospital began administering subcutaneous injections which contained hyaluronidase. The hospital currently administers rituximab (Rituxan), daratumumab (Darzalex), and pertuzumab (Perjeta) with trastuzumab (Herceptin). The administration of these injections can take between 3 to 8 minutes to administer and can be uncomfortable for nurses because of the length of time they need to be in close proximity to the patient.

“It can be really hard to push some of those drugs (through a traditional needle),” Digirolamo explained. “It takes 3 to 8 minutes to push and not only are you hurting your hands, [but] you could be moving the needle into the patient. With the extension side, it is just easier to push it through.”

She added that once the COVID-19 pandemic hit the world, their health care system implemented social distancing guidelines, like many others.

“Nurses noted that social distancing always was a challenge when delivering patient care but was especially compromised while administering subcutaneous injections. It became apparent that there was a need for other administration options to address the concerns of improper body mechanics, increase the ease of device to administer these medications and promote social distancing during the administration of these medications, all while maintaining safety and comfort for their patients.”

To this end, they decided to consult with nursing professionals, development specialists, pharmacists, a patient education specialist, and frontline staff to explore possible alternatives. The selection criteria for their alternative included approval for subcutaneous use, availability, staff familiarity, and presence of safety features (a needle safety lock to protect both the nurse and the patient). Ultimately, the team chose to initiate use of a medication extension set.

Digirolamo noted that throughout the project, some nurses raised concerns about the residual medication that would be in the syringe extension, particularly because there is a small amount of tubing between the syringe and the patient to mitigate the dosing errors. The team therefore educated their nurses to conduct “air locking” or “air sandwich technique” before and after administering the drugs.

“With the extension set, we are teaching them to conduct a little ‘air sandwich,’” she advised. “[This entails pulling the needle, putting some air in, and then pushing it through so that we are priming it and [the] drug goes all the way through.”


Digirolamo S, Gineo E, Roselli E, Bocchetta N, Sumpio Catherine. Administering subcutaneous (SubQ) hyaluronidase injections with a medication extension set (ExSet). Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P30.

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