Partial-dose Pegfilgrastim Injections

These instructions are for Children's Hospital of Philadelphia (CHOP) patients with certain types of cancer who are prescribed partial dose pegfilgrastim injections.

Cancer treatment can lower your child's white blood cell count. This medicine is a neutrophil growth factor and can shorten the period of time that the white blood cell count is low.

Important information:

• Pegfilgrastim is given as an injection under the skin (subcutaneous) 24-48 hours following completion of chemotherapy.

• Your healthcare provider will tell you your child's pegfilgrastim dose.

• Your healthcare provider will tell you where the prescription will be filled. This may include CHOP's outpatient pharmacy, CHOP specialty pharmacy, a pharmacy closer to your home, or through another specialty pharmacy. When you get the prescription, it will include a prefilled syringe that contains pegfilgrastim, needles and syringes.

• The prefilled syringe containing pegfilgrastim should be kept in the refrigerator.

• The dose in the prefilled syringe is one dose and is a larger dose than your child needs. There is no way to measure a smaller dose for a child with this prefilled syringe because it does not have any measured markings on it to precisely administer a correct dose. The instructions below will review how to transfer the medicine into another syringe so you can measure the correct dose for your child.

• You may only use a pegfilgrastim syringe one time. Once it has been used, it has been exposed to germs and must be discarded in a sharps container or old laundry detergent container with cap tightened. It cannot be used again due to risk for infection.

• Pegfilgrastim is the generic name of the medicine but comes in different brand names: Udenyca®, Ziextenzo™, Fulphila®, Neulasta®. It is the same medicine and the process for measuring the dose is the same.

• Side effects of pegfilgrastim may include aching bones or muscles in the arms and legs. The dose of pegfilgrastim may be adjusted if your child's pain is severe. The oncology team will discuss with you any dose changes or therapies to help with pain.

Instructions for measuring your child's dose of pegfilgrastim:

(You can also view an interactive module that reviews these instructions.)

Figure 1: Pegfilgrastim syringe without guard wings Figure 2: Pegfilgrastim syringe with guard wings

1. Gather the supplies that you need and place them on a clean surface:

   • One pegfilgrastim syringe

   • One empty (1 mL) syringe

   • One needle

   • Alcohol swab

2. Wash and dry your hands.

3. Remove the empty 1 mL syringe from the package. Save the package for later use. Pull the syringe plunger of the empty syringe to the 0.6ml mark. Be careful not to pull the plunger out of the syringe. If this does happen, throw this syringe away and use a new one. Slide the syringe back into the sterile package.

4. Hold the pegfilgrastim syringe in one hand, and with the other hand, remove the cap from the needle. Do not allow the needle to touch anything.* If needle guard wings are present, be careful not to touch them before use. By touching them, the needle guard may cause the syringe to lock.

5. Pick up the empty 1 mL syringe and put the needle of the pegfilgrastim syringe into the needle attachment hole of the empty syringe. Slowly push the liquid in the pegfilgrastim syringe into the empty syringe. This will prevent the medicine from foaming.

6. Throw the empty pegfilgrastim syringe away into a hard plastic container with a lid.

7. Attach a needle to the 1 mL syringe. Hold the syringe so that the needle is pointing up. Remove the needle cap and gently push on the plunger to remove any air or air bubbles in the syringe. Continue to push the plunger to the correct line for your child's dose. It is best to do this over a sink or paper towels to catch the excess fluid that is pushed out. Use the "scoop" method to recap the needle when the plunger is at the correct dose.

8. You are now ready to give the pegfilgrastim to your child. If you are concerned that the dose or volume is not correct (for example: too much medicine was pushed out) contact your healthcare provider immediately.

9. Options for making injection more comfortable:

   • You may want to apply an ice pack on the site for a few minutes to numb the area. The ice pack should be placed over a layer of clothing and not directly on the skin.

   • You can use EMLA™, L-M-X-4®, or AneCream™ to numb the skin surface before giving pegfilgrastim.

   • When the medicine is cold, the injection can be uncomfortable. You may want to remove the medicine from the refrigerator 30 minutes before administering the injection to allow it to warm to room temperature.

Reviewed on March 1, 2022, by Meredith Johnson, MSN, RN, CRNP-AC; Erika Pineda, PharmD, BCPPS