Jump to ContentJump to Main Navigation
Show Summary Details
More options …

The Journal of Haemophilia Practice

1 Issue per year

Open Access
See all formats and pricing
More options …

Subcutaneous injection: learning from experience in other specialties

Debra Pollard
  • Corresponding author
  • Lead Nurse Specialist, Katharine Dormandy Haemophilia & Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Steve Chaplin
Published Online: 2018-05-31 | DOI: https://doi.org/10.17225/jhp00111


Haemophilia treatment is characterised by intravenous infusions of clotting factor concentrates, with nurses frequently taking the lead role in administration, patient training and patient care. In recent years, a number of novel factor and non-factor-based therapies delivered by subcutaneous injection have been developed. These therapies are now undergoing clinical trials and will shortly be available in clinical practice. The coming era of at least some haemophilia treatments being delivered by subcutaneous injection clearly represents a significant change not only for patients (for whom they may be more convenient) but also for haemophilia nurse practice, particularly with respect to bleed and surgical management plans, and hence for nurse training and education. This review describes evidence-based guidance on subcutaneous injection technique and summarises the implications for nurses.

Keywords: Administration; Injection; Patient preference; Subcutaneous


  • 1. Richards M, Williams M, Chalmers E, et al. A United Kingdom Haemophilia Centre Doctors’ Organization guideline approved by the British Committee for Standards in Haematology: guideline on the use of prophylactic factor VIII concentrate in children and adults with severe haemophilia A. Br J Haematol 2010; 149: 498-507.Google Scholar

  • 2. Berntorp E, Dolan G, Hay C, et al. European retrospective study of real-life haemophilia treatment. Haemophilia 2017; 23: 105-14.Google Scholar

  • 3. Collins P, Chalmers E, Chowdary P, et al. The use of enhanced half-life coagulation factor concentrates in routine clinical practice: guidance from UKHCDO. Haemophilia 2016; 22: 487-98.Google Scholar

  • 4. Oldenburg J, Mahlangu JN, Kim B, et al. Emicizumab prophylaxis in hemophilia A with inhibitors. N Engl J Med 2017; 377: 809-18.Google Scholar

  • 5. Pasi KJ, Rangarajan S, Georgiev P, et al. Targeting of antithrombin in hemophilia A or B with RNAi therapy. N Engl J Med 2017; 377: 819-28.Google Scholar

  • 6. Hacker MR, Geraghty S, Manco-Johnson M. Barriers to compliance with prophylaxis therapy in haemophilia. Haemophilia 2001; 7: 392-6.Google Scholar

  • 7. Shaw D, Riley GA. The impact on parents of developments in the care of children with bleeding disorders. Haemophilia 2008; 14: 65-7.Google Scholar

  • 8. Furmedge J, Lima S, Monagle P, et al. 'I don't want to hurt him.' Parents' experiences of learning to administer clotting factor to their child. Haemophilia 2013; 19: 206-11.Google Scholar

  • 9. World Health Organisation. WHO best practices for injections and related procedures toolkit. 2010. Available from www.ncbi.nlm.nih.gov/books/NBK138491 (accessed 16 April 2018).Google Scholar

  • 10. Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin Proc 2016; 91: 1231-55.Google Scholar

  • 11. FIT UK Forum for Injection Technique UK. The UK Injection and Infusion Technique Recommendations, 4th edn. October 2016. Available from http://www.fit4diabetes.com/files/4514/7946/3482/FIT_UK_Recommendations_4th_Edition.pdf (accessed 16 April 2018).Google Scholar

  • 12. The Royal Marsden NHS Foundation Trust. The Royal Marsden Manual of Clinical Nursing Procedures, 9th edn, 2015. Available from http://www.rmmonline.co.uk/ (accessed 16 April 2018).Google Scholar

  • 13. FIT4Safety. Injection Safety in UK and Ireland; Safety of Sharps in Diabetes Recommendations, 1st edn. 2012. Available from http://www.fit4diabetes.com/files/1413/4727/6994/BD4224_FIT_Safety_STG07_AW2_PP.pdf (accessed 16 April 2018).Google Scholar

  • 14. Costigliola V, Frid A, Letondeur, C et al. Needlestick injuries in European nurses in diabetes. Diabetes Metab 2012; 38 Suppl 1: S9-14.Google Scholar

  • 15. Tandon N, Kalra S, Balhara YPS, et al. Forum for injection technique and therapy expert recommendations, India: the Indian recommendations for best practice in insulin injection technique, 2017. Indian J Endocrinol Metab 2017; 21: 600-17.Google Scholar

  • 16. Ogston-Tuck S. Subcutaneous injection technique: an evidence-based approach. Nurs Stand 2014; 29: 53-8.Google Scholar

  • 17. Desplats M, Pascart T, Jelin G, et al. Are abatacept and tocilizumab intravenous users willing to switch for the subcutaneous route of administration? A questionnaire-based study. Clin Rheumatol 2017; 36: 1395-1400.Google Scholar

  • 18. Chilton F, Collett RA. Treatment choices, preferences and decision-making by patients with rheumatoid arthritis. Musculoskelet Care 2008; 6: 1-14.Google Scholar

  • 19. Huynh TK, Ostergaard A, Egsmose C, et al. Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis. Patient Prefer Adherence 2014; 8: 93-9.Google Scholar

  • 20. Bolge SC, Eldridge HM, Lofland JH, et al. Patient experience with intravenous biologic therapies for ankylosing spondylitis, Crohn's disease, psoriatic arthritis, psoriasis, rheumatoid arthritis, and ulcerative colitis. Patient Prefer Adherence 2017; 11: 661-9.Google Scholar

  • 21. Sylwestrzak G, Liu J, Stephenson JJ, et al. Considering patient preferences when selecting anti-tumor necrosis factor therapeutic options. Am Health Drug Benefits 2014; 7: 71-81.Google Scholar

  • 22. Allen PB, Lindsay H, Tham TC. How do patients with inflammatory bowel disease want their biological therapy administered? BMC Gastroenterol 2010; 10:1. doi: 10.1186/1471-230X-10-1.CrossrefGoogle Scholar

  • 23. Pivot X, Gligorov J, Muller V, et al. Preference for subcutaneous or intravenous administration of trastuzumab in patients with HER2-positive early breast cancer (PrefHer): an open-label randomised study. Lancet Oncol 2013; 14: 962-70.Google Scholar

  • 24. Jackisch C, Muller V, Dall P, et al. Subcutaneous trastuzumab for HER2-positive breast cancer - evidence and practical experience in 7 German centers. Geburtshilfe Frauenheilkd 2015; 75: 566-73.Google Scholar

  • 25. Beer K, Muller M, Hew-Winzeler AM, et al. The prevalence of injection-site reactions with disease-modifying therapies and their effect on adherence in patients with multiple sclerosis: an observational study. BMC Neurol 2011; 11: 144.Google Scholar

  • 26. Stoner KL, Harder H, Fallowfield LJ, et al. Intravenous versus subcutaneous drug administration. Which do patients prefer? A systematic review. Patient 2015; 8: 145-53.Google Scholar

  • 27. Jin JF, Zhu LL, Chen M, et al. The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection. Patient Prefer Adherence 2015; 9: 923-42.Google Scholar

  • 28. Ponzetti C, Canciani M, Farina M, et al. Administrative risk quantification of subcutaneous and intravenous therapies in Italian centers utilizing the Failure Mode and Effects Analysis approach. Clinicoecon Outcomes Res 2016; 8: 353-9.Google Scholar

  • 29. Carlson J, Cox K, Bedwell K, et al. Rituximab for subcutaneous delivery: clinical management principles from a nursing perspective. Int J Nurs Pract 2015; 21 Suppl 3: 1-13.Google Scholar

  • 30. Rule S, Collins GP, Samanta K. Subcutaneous vs intravenous rituximab in patients with non-Hodgkin lymphoma: a time and motion study in the United Kingdom. J Med Econ 2014; 17: 459-68.Google Scholar

  • 31. Barbee MS, Harvey RD, Lonial S, et al. Subcutaneous versus intravenous bortezomib: efficiency practice variables and patient preferences. Ann Pharmacother 2013; 47: 1136-42.Google Scholar

About the article

Published Online: 2018-05-31

Citation Information: The Journal of Haemophilia Practice, Volume 5, Issue 1, Pages 35–41, ISSN (Online) 2055-3390, DOI: https://doi.org/10.17225/jhp00111.

Export Citation

© 2018 Debra Pollard, published by Sciendo. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License. BY-NC-ND 4.0

Comments (0)

Please log in or register to comment.
Log in