tip for epo shots

[petey]

Marvin's latest tip for getting Epo shots (3x week) in stomach...  I put a dab of lidacain cream (the same cream he uses for his fistula before I stick it) on a band-aid.  Then, I pick the spot on his stomach where I'm going to give his Epo shot and put the band-aid with the dab of cream on that spot.  I'll wait 45 minutes to an hour (while he's on the machine).  Then, Marvin takes off the band-aid, wipes the cream off with a gauze, and then cleans the area with an alcohol swab.  I then give him his Epo shot.  No pain at all !

[hyperlite]

if he's on hemodialysis why can't you just put the EPO into his line? That's what I always did...

[Roadrunner]

Marvin's latest tip for getting Epo shots (3x week) in stomach... 

My husband uses his insulin needles to give his epo shots.  They are thinner and he says you can hardly feel them.  The needles he received from the clinic do hurt.  You just need to be careful when using the insulin needles since they bend easily when you try to insert them into the bottle cap.

Below is an interesting article on epo, costs and method of administration.

Use Of Subcutaneous Injections Of Epogen For Dialysis Patients Could Save Medicare $537M Annually

Urology / Nephrology  Article Date: 26 Oct 2006 - 5:00 PDT

Administering the anti-anemia drug Epogen to kidney dialysis patients by subcutaneous injections rather than intravenously could save the federal government hundreds of millions of dollars annually, the Boston Globe reports.
Epogen, which is manufactured by California-based Amgen, is administered to kidney disease patients on dialysis to replenish red blood cells. About 95% of the 325,000 U.S. residents on dialysis receive Epogen intravenously, although studies have found that about 30% less Epogen is required if the drug is injected under the skin, the Globe reports.
Medicare spends close to $2 billion per year on Epogen, more than on any other drug. According to a study conducted by researchers at Detroit-based Henry Ford Hospital and published in the American Journal of Kidney Disease, administering Epogen subcutaneously rather than intravenously would save the federal government as much as $537 million annually. The study found that the annual Epogen cost per dialysis patient in 2002 was $6,000.
Researchers determined that switching to subcutaneous injections would save up to 30%, or $1,761, per patient. A separate study of dialysis clinics in 2004 found that patients received 21% less Epogen when given subcutaneous injections, the Globe reports. Last year, FDA allowed Amgen to change the label on Epogen to state that intravenous delivery is preferred because of a rare disorder called pure red cell aplasia that developed in 175 patients from 1998 through 2003. Those patients received Eprex, a drug similar to Epogen that is manufactured by a Johnson & Johnson subsidiary. J&J said the cases likely were linked to rubber stoppers in some of its syringes and that the outbreak ended after the stoppers were replaced.

Comments
California-based DaVita and Germany-based Fresenius Medical Care, the two leading dialysis clinic chains in the U.S., have said they prefer to administer Epogen intravenously because patients already have IVs inserted while they undergo dialysis, according to the Globe. DaVita chief medical officer Charles McAllister said, "We don't have any opinion on subcutaneous or intravenous" methods, adding that doctors at the company's clinics determine the best way to give Epogen. Fresenius did not comment. Robert Brenner, an Amgen medical director, said, "It is important for patients and physicians to make their own decisions," adding, "Where patients are hooked up to a blood line to a dialysis machine, there would be some logic to have that administration occur intravenously, as opposed to having that patient exposed to an additional injection." Some kidney specialists and patient advocates say DaVita and Fresenius use the intravenous method to boost profits. Noshi Ishak, a kidney specialist who owns an independent dialysis clinic in New Hampshire, said DaVita and Fresenius "give it intravenously" to "milk the system." Ishak, who uses the subcutaneous method, said Amgen sales representatives have told him that he could increase his profits by administering the drug intravenously. Peter Crooks, who oversees dialysis of 3,000 patients for Kaiser Permanente in Southern California, said, "The industry is incentivized to use intravenous because they make a profit margin on every unit they administer," adding, " Many dialysis facilities feel that if it wasn't for the profit margin they make on [Epogen], they would go out of business" (Rowland, Boston Globe, 10/24).

[monrein]

How much epo are you all taking?  I take Aranesp (0.3 ml once a week) by subcutaneous injection.  I give myself the shot by pinching up the skin on my stomach or hip, shoving in the needle, letting go the skin and injecting slowly.  The needle is super thin and it doesn't hurt at all,  I mean nothing.  Is it a case of "no sense no feeling" on my part or are you using a different method?

[Roadrunner]

Dick takes 20,000 units/1ml 3 times a week, down from 25,000 each time.  I think the key is a thin needle.

[monrein]

my dose is pre-measured in the syringe, so I can see that if you have to draw it yourself the needle must be larger.  Surely that could be rectified quite easily. 
Man oh man.

[petey]

The NxStage machine doesn't have a med-port to accommodate Epo through the lines while Marvin's running --    and I think NxStage needs to work on that!!  Anyway, since we started home hemo last summer, I have to give him his Epo shots subcu (8,000 units 3x/week), and the nurse who trained us said the stomach (or back of the arm) was the "fattest" part and easiest place to give it.  The needle I use is a 1 ml needle, and it's small, but Marvin still says it hurts -- or at least it did before we started trying the lidacain cream on the band-aid trick!

[monrein]

Roadrunner, that article you posted on Epo was very interesting. 

[Ang]

when  i  used  to  take  epo  and  aransp  before  dx,i'd  take  it  out  of  the  fridge  and  wait  at  least  30  minutes  before  the  wife  injected  me(she  enjoyed  that  part.)  there  was  pretty  much  no  pain.

[JDHartzog]

I had to have 80,000 units of Epo/week while I was pregnant.  I took mine all sub-q in my hip.  I got 40,000 unit single dose bottles so I would have less shots.  Some say the Epo lasts longer if given sub-q instead of IV.  We always thought about sticking the Epo into the venous port in the filter cap of our NxStage machine, but we didn't want to take that risk with the baby.  My tips on Epogen are:

1.  Use 2 needles.  One to stab the bottle; one to stab you.  Fresh needles are sharper and hurt less.  Sticking Epo needles in different places on your butt or hips may hurt less than in your one non fistula arm over and over again.

2.  Don't let them try to make you normal with Epo.  If you get your hemoglobin above 13g/dl you are at a higher risk of stroke and heart problems.  Aim to get your hemoglobin to 12 g/dl.

3.  Make sure your ferritin levels are up if you are trying to raise your hemoglobin.  Epo doesn't work alone it needs iron and B12.

4.  Venous Catheter hemoglobin, fistula hemoglobin and pre and post treatment hemoglobin numbers are all different, so don't take one test tube too seriously.  Epo takes 2-4 weeks to work so don't expect immediate results.

5.  Read Amgen's website's professional information about Epo.  The patient section information is watered down and touchy feely.  If you needed that, you wouldn't be searching for information online.

6.  You can take so much Epo that you waste it.  Epo is ineffective and risky in very high doses.  Amgen's literature gives a study with a maximum effective dose based on body weight.

7.  Learn to give/get shots at home.  Driving to a clinic for a shot is ridiculous with gas at $3.55/gallon.

8.  If you keep Epo at home in a refrigerator, get a refrigerator thermometer and make sure the temperature is low enough where your store the Epo in the fridge.  Don't store Epo in the door; it is too warm.  Make a special place in your refrigerator for your own personal "Epo Depot".

9.  Don't ever get Epo from a questionable source.  There is a black market Epo trade with people refilling used bottles with alcohol or putting lower concentration Epo in relabeled higher concentration bottles and then storing them at room temperature.  Make sure you get your Epo in a bag with its own high temperature thermometer.  (The ones that stain the felt paper if they are too hot.)

10. If your hemoglobin is at 8g/dl or below, don't waste time waiting for Epo to work.  You need a transfusion now.  Make arrangements to get to a hospital.  I went from 8 g/dl to 10 g/dl in one day with 5 units of blood.  You would be anemically hobbling around the house for a month trying to get that result on Epo.

11. Epo is made from mutant chinese hamster ovaries.  Get a cage and some mutant hamsters and make your own Epo.  I believe there is a community of escaped mutant hamsters living in the woods around Amgen's labs.  Save big $$$$$.    Just kidding!!!!!!!

12.  Don't skip a dose!  You'll pay later.
 

   

[Roadrunner]

when  i  used  to  take  epo  and  aransp  before  dx,i'd  take  it  out  of  the  fridge  and  wait  at  least  30  minutes  before  the  wife  injected  me(she  enjoyed  that  part.)  there  was  pretty  much  no  pain.

Ang, Our nurse agrees with you.  She says letting it warm up for 15 to 30 minutes will make it hurt less and the needle will go through the stopper easier.

8.  If you keep Epo at home in a refrigerator, get a refrigerator thermometer and make sure the temperature is low enough where your store the Epo in the fridge.  Don't store Epo in the door; it is too warm.  Make a special place in your refrigerator for your own personal "Epo Depot".

What temperature should it be stored at?  We always leave it in the butter compartment in the door.  I guess this is a no, no.

9.  ...Make sure you get your Epo in a bag with its own high temperature thermometer.  (The ones that stain the felt paper if they are too hot.) 

I've taken the thermometers out into the room for a few days and they never turn red.  I don't think they work.  The house is at 70 degrees and they should show an alarm.  I think they are there to make you feel better.

10. If your hemoglobin is at 8g/dl or below, don't waste time waiting for Epo to work.  You need a transfusion now.  Make arrangements to get to a hospital.  I went from 8 g/dl to 10 g/dl in one day with 5 units of blood.  You would be anemically hobbling around the house for a month trying to get that result on Epo.

Try convincing the clinic of that.  This is one of the reasons we are on home hemo.  I think my husband would be dead by now if we stayed there.

[KR Cincy]

I'm on NxStage at home and I get my  Epo through my fistula needle before treatment starts...once I'm stuck, my wife make sure the needle is in a good place, then pushes the epo and heparin into the blue needle tube, then pushes it through with saline, then hooks me to the machine...wait 5 minutes for the medicines to get into my system, then start the machine. No extra needles needed.

[meadowlandsnj]

I'm on NxStage at home and I get my  Epo through my fistula needle before treatment starts...once I'm stuck, my wife make sure the needle is in a good place, then pushes the epo and heparin into the blue needle tube, then pushes it through with saline, then hooks me to the machine...wait 5 minutes for the medicines to get into my system, then start the machine. No extra needles needed.

At my center it's mandatory to get the shot, they will not do it through the lines anymore.  If you refuse the shot you don't get the Epo. 

Donna