As a part of your cycle plan, your doctor has included Neupogen in your protocol. Neupogen is a medication that you'll pick up from your local retail pharmacy. It will come in a box with 1 mL vials, typically 10 vials in one box. When you are using your Neupogen, you'll take out one vial from the box and make all of the doses that you're going to use out of that vial on the same day, and then use them one day at a time until you've used up all the doses that you've made, and then you'll repeat that process again when you've used all of your doses.

Neupogen is dosed based on your weight. Once you've given your nursing team your up-to-date weight, they'll give you the dose, the volume that you should be injecting each day. When you go to do your injections for Neupogen, make sure that you take the syringe out of the fridge about 15 - 20 minunutes ahead of the time that you're going to do the injection to allow it to come to room temperature. That will make for the most comfortable injection process. Make sure that you're not shaking or stirring the syringe of Neupogen in order to warm it up faster.

For example, if my dose is 0.25 mL, I'm going to pull out about four doses from my 1 mL vial in preparation for my Neupogen dosing.

First, I'm going to prepare four syringes with needle tips to draw. You'll open your syringe and a needle tip. And for these syringes, we just push the needle tip onto the end, nice and firm. And I'm just going to do that with all of them so they're ready to go. And again, your dose may be different, so you'll just prepare as many syringes as you'll need to use your 1 mL vial up.

Next I'll take the lid off of the Neupogen vial and I'll use an alcohol swab to clean the top. These doses are usually small and the numbers on the syringes can sometimes be a bit tricky. Your nurse coordinators can help you know exactly which line you're trying to draw to, but for this example, 0.25 would be at the halfway mark between 0.2 and 0.3.

Always start with a little bit of air in your syringe. Take the cap off the needle, pop it into the vial, turn it upside down, push that air into the vial. Make sure that your needle tip is inside the liquid, and then you'll pull back until your dose is in the syringe, and if you get a little bit of air, you can sort of flick it around because these are really small doses.

You want to make sure that that air isn't accounting for part of your medication.

And you'll just kind of do that until you have your dose, in this case 0.25 mL of medication in the vial, and then you're going to pull that out, put the needle tip on, and set that one aside. Then basically you're just going to do the same thing until all of the doses are used out of that 1 mL vial are sort of drawn into syringes.

And sometimes if you get air bubbles into the syringe, if you just push them back into the vial, push it up until the air is back in the vial, that can be helpful and start over. So go until you're at 0.25 mL again, and then put the lid back on. And again, you're just going to do the same thing. It's  a little bit of air into the vial air and then pull back the dose and you're just going to keep doing this until the whole 1mL is used from your vial of Neupogen.

Oftentimes for example, if your dose really was 0.25 mL, it's possible you may not get four doses. You may end up with three, not quite enough for four because in the mixing you inevitably lose a drop here and there. That's okay. Do your best, basically we just keep going until we've used all 1 mL of Neupogen into your syringes. Then you can throw away the vial once it's empty.

And now we have four doses of our Neupogen ready to go. So I'm going to take three of them and put them in my refrigerator. And I'm going to inject one today, and then tomorrow I'll pull the next one out of the fridge; inject that one. Same thing the next day, inject the next one. Same thing the next day, inject the next one. And then on the fifth day, I would get another vial of Neupogen and make my doses again.

To do Neupogen, you're going to do it subcutaneously in your abdomen.

 

How to Perform a Subcutaneous Injection

Now that you have your medication prepared, here's a video on how to perform a subcutaneous injection.

First, these injections are going to go into your abdomen. So you'll pick a spot two fingers away from your belly button and inject anywhere in your tummy.

The injection is going into that fatty layer of tissue right under the skin. So two fingers away anywhere in your tummy, just like this.
When you're doing your injections, you'll pick a spot, and then you'll rotate your sites. So try not to poke into exactly the same spot as you did already today or yesterday. Try to rotate the spots a little bit. Even a finger away is helpful.

When you're ready, you'll use an alcohol swab to clean the area that you're going to inject into, and then you'll give that a few seconds to dry. You'll take the cap off of your prepared needle and pinch your skin where you're going to do the injection. You'll inject at 90 degrees all the way in. Push the plunger on the syringe down until all of the medication has been delivered.

Then you can relax your skin and pull out the needle. A little bit of blood, a little bit of liquid might come out. That's okay. It's normal. You can use a tissue to hold the spot until the bleeding stops.

And then when you're done, make sure that you put your used needle into a sharps container or your medical waste bag.