Administration of DARATUMUMAB by subcutaneous way (SD): what solution to reduce the pain associated with the administration of the drug?

Objectives
SD is administered in a Day care unit (HDJ) for the treatment of multiple myeloma.
Switching from intravenous (IV) to SC administration allows a 97% reduction in injection time therefore a better fluidity in the organization of the HDJ.
However, since the transition to the SC pathway, which lasts about 5 minutes, nurse note the occurrence of musculoskeletal disorders (MSDs).
The objective of this work is to evaluate the use of a syringe pump (SP) for SC injection.

Methods
A comparative questionnaire between manual injection and SP injection is offered to nurse in HDJ.
It is inspired by the OSHA checklist used by the American company NIOSH to detect work situations that may present MSD risks.
The repetitiveness of the gestures, the ease of connection and injection (manual effort / restrictive posture / skin pressure) and patient comfort are criteria scored on a scale of 0 to 3.
At the same time, the economic impact of using a SP is assessed by comparing the costs of the necessary MDS.

Results
The questionnaire carried out by 6 nurses shows satisfaction with the use of SP: the SP seems more comfortable for the patient and for themselves (3/3). No difference exists in terms of ease of connection of the syringe and repetitiveness of gestures.Manual injection requires effort and constraining posture of nurse (0/3) while SP requires none (3/3). A strong painful cutaneous overpressure is notified with the manual injection (1/3) whereas this one is lighter with the SP (2/3).
The use of PS requires additional DMS: an extender, a peripheral short venous catheter and a catheter dressing. The material cost of injecting the DSC via a SP is negligible, it goes from 1.05 € by manual way to 1.73 € with a SP. No additional costs are necessary because the SP are already present in the service.
Concerning the extender, the nurse wanted a long extender for the comfort of laying while the pharmacist recommends a short extender to minimize the dead volume. The compromise is a 25cm extender with a dead volume of 0.2mL, or 1.3% of the total volume to be injected. After an evaluation phase and a learning time for the installation of the SP, the 25cm extender is retained.

Discussion/Conclusion
The development of the SC form allows a better fluidity in the organization of HDJ by significantly reducing the time of presence of patients. SP is a real solution to limit pain in nurse.
The extension of the use of SP for other SC-injected antibodies to be administered in more than 5 minutes is under discussion.

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