Drug Extension Set Makes Subcutaneous Hyaluronidase Injections Easier and More Comfortable in Cancer Treatment

According to a poster presented at the 47th Annual Meeting of the Oncology Nursing Society, oncology nurses have found using an extension set of medications to be a feasible and comfortable method of administering subcutaneous injections of hyaluronidase.

Volunteer nurses from 6 pilot sites were asked to use the medication extension kit for 6 injections and complete a corresponding survey. Notably, 100% of nurses reported difficulties or complaints with traditional needle injections, while only 20% of nurses experienced problems with the new method and 0% reported dexterity difficulties with the whole extension. Additionally, 80% of respondents indicated a preference for the extension over a traditional needle.

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

In 2017, Greenwich Hospital began giving subcutaneous injections containing hyaluronidase. The hospital currently administers rituximab (Rituxan), daratumumab (Darzalex), and pertuzumab (Perjeta) along with trastuzumab (Herceptin). Administering these injections can take between 3 and 8 minutes and can be uncomfortable for nurses due to the time they have to be near the patient.

“It can be very difficult to push some of these drugs (through a traditional needle),” Digirolamo explained. “It takes 3-8 minutes to push and not only do you hurt your hands, [but] you could move the needle into the patient. With the extension side, it’s just easier to get it through.

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

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

To that end, they decided to consult with nursing professionals, developmental specialists, pharmacists, a patient education specialist and frontline staff to explore possible alternatives. Criteria for selecting their alternative included approval for subcutaneous use, availability, staff familiarity, and the presence of safety devices (a needle safety lock to protect both the nurse and the patient). In the end, the team opted to initiate the use of an extension set of drugs.

Digirolamo noted that throughout the project, some nurses raised concerns about 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 reduce dosing errors. The team therefore trained their nurses to practice the “air lock technique” or the “air sandwich technique” before and after administering the drugs.

“With the extension set, we teach them to do 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] the drug goes all the way.


Digirolamo S, Gineo E, Roselli E, Bocchetta N, Sumpio Catherine. Administer subcutaneous injections of hyaluronidase (SubQ) with a drug extension set (ExSet). Presented at: 47th Annual Meeting of the Oncology Nursing Society; April 27-May 1, 2022; Anaheim, California. Summary P30.

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