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Clinical procedure - administration of anti-cancer drugs - intramuscular and subcutaneous

This resource provides guidance on how to safely undertake the procedure. Institutional practice may vary in accordance with local policy.

Only health care professionals who have attained competency (as per institutional guidelines) should perform this procedure.

  Related eLearning:
- Anti-cancer Drug Administration Course (ADAC)
- Immunotherapies

This document provides information on the safe administration of subcutaneous and intramuscular anti-cancer drugs. Only healthcare professionals who have attained competency in the safe administration, handling and waste management of hazardous drugs (as per institutional guidelines) should perform this procedure.

This procedure should be read in conjunction with the Safe handling of hazardous drugs document and the Safe administration of anti-cancer drugs document.

Note: If patient is receiving frequent injections, ensure the injection site is rotated.

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The following is a list of things to consider before commencing this procedure:

  • check that the patient has had all required pretreatment tests and that the treating team has reviewed the results 
  • ensure confirmation to proceed has been documented
  • ensure the patient has valid written consent
  • check that a cancer pharmacist has verified the medication order 

The following is a list of equipment recommended to undertake this procedure:

  • anti-cancer drug prescription and treatment protocol
  • trolley 
  • cleaning agent as per local policy
  • personal protective equipment (PPE)
  • spill kit
  • 2% chlorhexidine and 70% isopropyl alcohol swabs
  • plastic-backed absorbent sheet
  • gauze squares (non-sterile)
  • drug(s) to be administered
  • appropriate sized needles (if not supplied in pre-filled syringe)
  • hazardous/cytotoxic sharps container
  • hazardous/cytotoxic waste bag(s) and bin
  1. Explain the procedure to the patient and obtain verbal consent to proceed
  2. Verify the patient has received education
  3. Assess the patient for side effects and previous adverse events
  4. Position the patient comfortably
  5. Select the appropriate site for administration
  6. Place a plastic-backed absorbent sheet near the injection site
  7. Perform hand hygiene
  8. Put on PPE
  9. Inspect drug container:
    1. if unexpected cloudiness or signs of contamination are present or there is leakage noticed, contact pharmacy for further instructions
    2. if particulate matter is present, gently agitate to mix as medication can settle on storage. Return to pharmacy if drug does not clear
  10. Prepare equipment:
    1. attach appropriate sized needle (if not using a pre-filled syringe)
    2. Note: Do not expel air from the syringe
  11. Check drugs against prescription and treatment protocol with another appropriately trained health professional
  12. Perform Timeout procedure
  13. Administer pre-medications as per protocol
  14. Clean the injection site with 2% chlorhexidine and 70% isopropyl alcohol swabs, ensure contact with skin for a minimum of 30 seconds and allow skin to air dry
  15. Administer the subcutaneous or intramuscular injection using the appropriate technique and needle gauge
  16. Dispose of hazardous waste as per institutional guidelines
  17. Remove PPE and discard
  18. Perform hand hygiene
  19. Document the procedure, including site of administration and any local skin reaction and follow-up care, in the medical record
  20. Where appropriate, provide clinical handover of post-treatment care and clinical monitoring requirements.

Following administration of anti-cancer therapy:

  • Continue safe handling precautions until 7 days after completion of drug(s)
  • Ensure patient receives supportive medications as required

Discharge checklist

  • Discharge medications as prescribed
  • Patient information on treatment protocol
  • 24-hour medical/nursing contact details
  • Arrange relevant laboratory tests and provide patient with appropriate forms
  • Follow-up appointments
  • GP and community nursing referrals, if indicated

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Version 6

Date Summary of changes
16/05/2023

Reviewed and updated in tandem with Nursing Reference Committee and eviQ Education ADAC review. Updated with the following changes:

  • "Pre procedure" section added to document
  • Minor updates including links and formatting throughout
  • Version number increased to V.6 

Next review in 4 years.

Version 5

Date Summary of changes
06/08/2008 Approved on CISCAT.
30/09/2009 Transferred to eviQ and reformatted.
18/07/2011 Reviewed and placed into new SOP.
11/10/2011 Document reformatted to comply with eviQ Clinical Procedure SOP. Some information has been removed and added to new Resource Document (ID 5).
28/08/2013 Protocol reviewed. Minor changes- needles included in equipment. Pre-filled syringes included in procedure. Review 2 years.
01/08/2014 Removed link to 'Drug Excretion Table'.
23/02/2015 Fixed Links.
15/05/2015 Link to 'Excretion Table' removed.
14/01/2016 Protocol reviewed, minor wording changes.
31/05/2017 Transferred to new eviQ website.
09/04/2019 Reviewed electronically by nursing reference committee. Minor changes in procedure and post procedure. Version number changed to v.5. Review 2 years.

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/457

19 Apr 2024