Administration of Methotrexate for non oncology conditions subcutaneously or intravenously (SOP)

1. All medical, nursing and pharmacy staff involved in the care of the child receiving low dose Methotrexate therapy.
2. Completed GG&C (RHC/Yorkhill) IV administration of medicines competency package
3. Competency in subcutaneous medication administration.

1. Case notes or electronic patient record
2. Drug kardex / HEPMA
3. Appropriate Personal Protective Equipment (gloves and apron)
4. Spillage kit

1. Some patients may require anti emetics medication, ensure administered as prescribed.
2. Some patients may wish local pain relief such as; local anaesthetic cream, cold spray or BUZZY(e)
3. Check dose to be given against prescription chart. Both staff must calculate dose independently (dose rounded to nearest 2.5mg increment).
4. All in-house presentations require a minimum of 24 hours’ notice to be made up.
5. Ensure procedure explained to family
6. Wash hands and don disposable gloves and apron

A. subcutaneous route

1. 1. Gather equipment needed, there are a number of preparations available; NHS GG&C principally uses Metoject branded single use prefilled PEN which has an integrated needle (there are 2 other prefilled devices on the market). These come in 2.5mg doses from 7.5mg to 30mg. In exceptional circumstances in-house prefilled syringes (IHPFS) from the aseptic pharmacy may be used. You will require; cotton wool and a spot plaster. For IHPFS syringes you will require an S/C 26g needle. IHPFS have a shelf life of 72 hour post preparation.
   2. IHPFS come without air bubbles, no attempt to prime the needle should be made to reduce the chance of medicine leak to the environment. Metoject PENS have a small air bubble as standard, instruction video on line at https://metoject.co.uk/patient/
   3. The S/C injection should be given at a 90 degree angle into the skin. Areas usually used at the upper deltoid of the arm, anterior & lateral aspect of the mid thigh and the abdomen. Sites are rotated weekly.
   4. Spills should be dealt with according to GGC Chemotherapy spill policy (f). Possible spill volumes for syringes are very low (less than 1ml).

B. Intravenous route

1. 1. If a patient is cannulated administration IV may be more patient friendly route.
   2. Gather equipment needed, for an IV medication. In-house pharmacy IV infusion bags are made up to 50ml of with 0.9%NaCl regardless of Methotrexate dose.
   3. No attempt to remove air bubbles or to prime the needles/syringes should be made to reduce the chance of medicine leak to the environment.
   4. All IV infusion bags should be spiked at waste height and in the horizontal plane to reduce risk of medicine spillage and eye contact.
   5. Infusion bags are given over 15 minutes, they can be given over a duration of 5 to 60 mins if required.
   6. Spills should be dealt with according to GGC Chemotherapy spill policy (f). Possible spill volumes for IVI are up to 50ml. Spill kits appropriate to volume should be available.

7. Ensure all procedural waste disposed as per GG&C policy (h)
8. Remove PPE and dispose of as per GG&C policy
9. On completion confirmation of administration on cardex / HEPMA should be completed (g).

This SOP will be reviewed every two years.