[Beacon Staff]

Subcutaneous Velcade - "air bubble" technique

by Beacon Staff on Thu Mar 12, 2015 6:10 pm

There have been a lot of references here in the forum to the "air bubble" technique that can be used when giving subcutaneous Velcade.

The method is intended to reduce the possibility of a rash and/or itching occurring as a result of the Velcade injections.

To make it easy to find information on that technique, we thought we would create this thread dedicated to it. Anyone with questions about it, or who has experiences about it, is welcome to post here.

The "air bubble" method for subcutaneous Velcade injection was originally described here in the forum by user "Dan in Phoenix" in this posting, in which he wrote:

I was on subcutaneous Velcade shots for ~2 years. I started with my stomach but switched to alternate arms because these hurt less. I was getting them at the Mayo Clinic in Scottsdale, AZ.

Concerning the rash, it went away once the staff was trained to put a small (~100ul air bubble) into the syringe. When they inject the drug they also push a small amount of air into the tissue. It sounds worse then it was and didn't hurt or even feel it.

What the nurses said was that this reduced the "tracking" of Velcade back through the skin when the needle is withdrawn.

This may seem like a small thing to do but it completely got rid of any marks from the injections and reduced the lingering pain I sometimes felt at the site.

I suggest everyone who is getting subcutaneous Velcade ask the nurses to try this!

[mrozdav]

Re: Subcutaneous Velcade - "air bubble" technique

by mrozdav on Thu Mar 12, 2015 6:12 pm

I may be getting subcutaneous Velcade injections in the future, and so this topic is of particular interest to me.

Mindful that many nurses may not be aware of the "air bubble" technique, I recently asked my specialist's nurse if she uses it. At first, she did not seem to know what I was referring to, but then she did remember and said that she didn't think it makes any difference. However, if I want the bubble technique, they can provide it. The whole exchange was not exactly reassuring.

So, here is what I would like to hear from fellow posters who have been getting Velcade injections AND using the "bubble technique": Does it really not make any difference, as the nurse asserted? Several persons have indicated that it most certainly does make a difference. But, are there others out there who suffer rashes and itching despite the air bubble?

For those who have tried aloe for rashes or itching from the Velcade injections: Does a good aloe lotion work as well as the actual plant juice?

[gardengirl]

Re: Subcutaneous Velcade - "air bubble" technique

by gardengirl on Fri Mar 13, 2015 2:39 pm

I'd like to add that, in addition to the air bubble, you need to apply some pressure at the injection site for a short time. This will keep the Velcade pushed down away from the surface.

I did get a rash a couple times with the bubble and then I realized that was the two times pressure was not applied. So, bubble + pressure = no rash.

Hope this helps!

[mrozdav]

Re: Subcutaneous Velcade - "air bubble" technique

by mrozdav on Fri Mar 13, 2015 3:53 pm

Garden girl: This makes sense, and this is good to know. I am hoping others will also post responses soon.

[K_Shash]

Re: Subcutaneous Velcade - "air bubble" technique

by K_Shash on Fri Mar 13, 2015 7:02 pm

Hello mrozdav,

I have become a firm believer in the "AIr Bubble Technique." The first Velcade shot I got (with­out any air bubble) gave me a 2-inch x 3- inch (5 cm x 7.5 cm) sunburn-like rash that itched and burned and I had to apply some over the counter steroid cream to stop the burning. After posting a question on this forum, Multibilly directed me to "Dan from Arizona's" post and I learned about this technique for the first time.

Fortunately for me, the nurse assigned to give me the next weekly shot (second Velcade shot for me) was already aware of this technique and she used the air bubble without any argument or questions, and that solved the burning rash problem completely. I still had a patch of discolored skin, but no burning or itching or any problems taking a shower.

Since then, I have had 11 more shots and a few chemo nurses seemed reluctant to learn anything new, particularly from a patient! However, at least three nurses have learned and mastered the technique well, using a 0.2 cc air bubble, and I have found a way to insist on one of them for my shot. When done right, the discolored skin around the needle mark is barely the size of a penny.

Yes, like gardengirl wrote, putting a bit of pressure on the needle mark would help keep the Velcade from oozing back through that small needle mark. However, it does seem that the small needle mark is quickly clogged by the upper tissue under the skin and I have had no rash even if a little blood came out of the needle mark. The pressure would only help and one of the nurses told me to keep the pressure on till she could apply a band aid on the needle mark. Some chemo nurses give this shot in a slow fashion and that, too, may help stop any backflow of the Velcade after first having to push the air out of the needle mark.

My oncologist and some other university myeloma experts were not even aware of these 'little things that make a cancer patient's life less miserable'. I also feel that a lot of big institutions have the 'experts' and senior oncologists often assign the treatment dosages to the residents or to the chemo pharmacist and 'rubber stamp' the off the shelf' drug regimens. I have read numerous accounts where a patient's dex or Revlimid dosage had to be readjusted, only after some serious reactions and side effects. I am glad that my oncologist did the 'right thing' and tailored the dosage for my BMI, etc. and changed the 'off the shelf' prescription from the chemo pharmacy before signing off on the pharmacy order. All of us should expect this.

K_Shash

[Eric Hofacket]

Re: Subcutaneous Velcade - "air bubble" technique

by Eric Hofacket on Mon Mar 16, 2015 10:46 am

I talked about the air bubble technique with my friend who is an oncology nurse this weekend. She has not heard of it before, but she did comment that, for other types of injections, an air bubble is used, so the idea of putting an air bubble in a syringe is not completely unheard of.

I am not surprised that few doctors have heard of this. They do not administer the drugs. This is the kind of thing I would expect the nursing profession to be on top of and spread through their pro­fes­sional trade magazines, etc.

[K_Shash]

Re: Subcutaneous Velcade - "air bubble" technique

by K_Shash on Fri Jul 24, 2015 6:47 pm

Four weeks ago, I had one of the chemo nurses give me my Velcade shot. She had the best track record with me with the air bubble technique. I hardly ever had a red mark bigger than a penny after she gave me the injections! However, after the injection four weeks ago, I had the worst rash that time since the first week! Almost the same burning, a 2" x 3" (5 cm x 7.5 cm) patch that needed the steroid cream, too.

She gave me the shot yesterday, as I have been including her in my list of 'preferred' chemo nurses. This time, there is no burn or patch at all, after more than 24 hours. No accident this time!

The reason to elaborate on that 'accident' in spite of the air bubble is in all likelihood the syringe was not vertical when the shot was given a month ago, and the air must have passed along with (rather than after) the last drops of Velcade. This must have allowed some Velcade to come in contact with the outer layer of skin, causing the rash, as if there was no air bubble .

Everyone getting this shot should be aware of this potential problem. It is hard to be sitting straight in the chair and getting the shot in one's stomach with the syringe staying vertical.

[Eddie]

Re: Subcutaneous Velcade - "air bubble" technique

by Eddie on Sat Jul 25, 2015 2:54 pm

I have also become the firm believer in the "air bubble" technique for Velcade injection.

So far, I had 11 Velcade injections, most of them with air bubble technique. But some without, or done improperly, as I was not able to get a nurse to properly administer the shot.

The difference is night-and-day.

Here are some hints for those who work with their nurses trying to minimize the burning, redness and other side effects of the injection.

1. Nurse should understand the end goal: Velcade medicine should not touch the skin.
2. Longer needle: I have a fair amount of subcutaneous fat (some due to dexamethasone / Decadron). For me the technique it works better with a 1-inch needle.
3. Air on both sides: there is already air in a newly placed 1-inch needle and nurse adds an air bubble on the top of the syringe.
4. Keep the syringe vertical: even if I am sitting in the chair, I lean back a little to help the nurse to keep the syringe vertical. That helps to push the air through the skin at the end.
5. Slower injection pace: through the trial and error method, an slower injection of about 15-seconds works best.

[Bar-none]

Re: Subcutaneous Velcade - "air bubble" technique

by Bar-none on Sat Jul 25, 2015 5:25 pm

The same technique works for my Lovenox injection to minimize bruising.

Best! BN

[Robert]

Re: Subcutaneous Velcade - "air bubble" technique

by Robert on Wed Sep 09, 2015 9:27 am

Does anyone know if there is a published protocol for nurses that explains the technique for using the air bubble technique for administering Velcade?

A few of the nurses at the clinic I go to are familiar with this technique and oblige when I ask. The result is that I have little or no bruising and no soreness afterward. The others are not, and I end up with large red welts and soreness that lasts a week or more.

A written, published protocol that could be shared with the nurses would be helpful. They are all very kind and truly dedicated to doing all that they can to help with patient comfort. I think that if the technique could be provided in words that relate to the nursing profession that they would be glad to take this step to help.