Practical Management of Patients with Neuroendocrine Tumors - Episode 8
Andrew E. Hendifar, MD: Mariah, can you explain the differences between the deep subcutaneous injection and the intramuscular [IM] injection?
Mariah Mahotz, RN, BSN, OCN: Yeah, absolutely. The deep subcutaneous injections have a much smaller needle. In terms of administration, they are a little more all-inclusive than the IM injections, where they have a larger needle and it takes a little longer. Patients sometimes report a little more pain with the intramuscular injection than they do with the deep subcutaneous injection. But definitely, some different administration set-ups and techniques are needed with them.
Andrew E. Hendifar, MD: How is octreotide LAR [long-acting release] usually injected?
Mariah Mahotz, RN, BSN, OCN: That is the intramuscular injection. It comes as a whole kit, and the medication itself is in a powder form. You have to kind of set up the medication itself, inject the saline into it, and let the medication dissolve; the preparation process in drawing it up into the syringe is pretty tedious. So is giving it, because it can react with the needle and clot. When you go to give it, you have to kind of give it right away and inject quickly to make sure that the medication gets administered.
Andrew E. Hendifar, MD: How does that compare with the administration using lanreotide?
Mariah Mahotz, RN, BSN, OCN: Lanreotide is kind of an all-in-1 included. The syringe comes prefilled. There’s no mixing needed. There’s a new design for the syringes that has gotten great feedback from patients. There is a bigger syringe, so it’s easier for us, from the nursing standpoint, to give the medication because it’s a little easier to grip and grasp. And then the plunger is a little bigger as well, so it doesn’t feel as flimsy. There’s not as much movement, and the needle seems a little sharper when you give it. I’ve had patients report that this injection is much better. They feel as if they can’t feel a thing.
Andrew E. Hendifar, MD: That’s good to know.
Mariah Mahotz, RN, BSN, OCN: Even patients who have gotten the medication for years are really happy with this new injection setup.
Andrew E. Hendifar, MD: It’s definitely a neat device.
Mariah Mahotz, RN, BSN, OCN: Yes, definitely.
Andrew E. Hendifar, MD: Can you tell us a little more about your personal experience using this new device?
Mariah Mahotz, RN, BSN, OCN: Yeah. Previously with the old lanreotide syringes, there was a device around the plunger that you did have to take off. Now it’s an all-in-1. All you have to do is remove the cap. But personally, I think it’s a much sturdier syringe. It’s much easier to use. There’s a lot of different grip support, whether it’s on the barrel, the plunger, or even the needle cap itself. One of the biggest risks nurses face is accidentally poking themselves with the needle. They need to be just a little more sturdy to support the syringe itself.
Andrew E. Hendifar, MD: Have you received any feedback from patients using this new device?
Mariah Mahotz, RN, BSN, OCN: Yes, patients love it. They say that they can barely feel the needle going in. I feel that because the syringe itself is so much easier for the nursing staff to handle, there’s not as much movement during the injection. The medication itself is pretty thick, so it does get injected over about 20 seconds. Usually, the best thing to do is just kind of have an open dialogue with patients. If you talk to them while you’re giving the medication, the 20 seconds flies by pretty quickly, and they get through it pretty well.
Andrew E. Hendifar, MD: Is there any practical advice you can offer other nurses who use this device?
Mariah Mahotz, RN, BSN, OCN: Definitely make sure you have reviewed the steps of the lanreotide injection, especially versus the LAR, because they are very different. Make sure that when you go to give it to the patient, you’re letting them know where you’re going to give it. Always make sure you’re alternating which side of the gluteal you’re giving it, because they can develop little nodules. Definitely make sure not to give it where a nodule is, and always give it in the outer part of the gluteal subcutaneous tissue.
Andrew E. Hendifar, MD: Those are great recommendations. Thank you.
Transcript Edited for Clarity