How to give your Child a G-CSF or GM-CSF Injection
Your child will receive a granulocyte colony-stimulating factor (G-CSF or GM-CSF). These factors are proteins that occur naturally to speed up the growth of a certain type of white blood cell (a neutrophil). These cells grow in the soft spongy inner area of the bone called the bone marrow. They help to fight infections. When the neutrophil count is low, below 1000, your child has a higher risk of getting sick. G-CSF or GM-CSF are often started at least 24 hours after chemotherapy has stopped. They are most often given daily as an injection given in the fatty layer of tissue just under the skin. Sometimes, it is given through a central line catheter. You will be asked to give this medicine daily until your child’s neutrophil count returns to a more normal level. As a rule, it takes 7-10 days for white cells to return to a more normal level after chemotherapy. For some children it may take longer.
While your child is getting the injections, he will need a complete blood count two times a week, most often on Mondays and Thursdays. Your nurse practitioner or doctor will check these lab tests and tell you when you should stop the injections. If you do not hear from your doctor or nurse on the day of your child’s blood counts, please call the doctor’s office for results.
Common side effects
- aches and pains in the bones or muscles
Less common side effects
- low grade fever (99.0°-100.4° F)
- chills
- weakness
- lack of energy
- diarrhea
- allergic reactions, such as shortness of breath or skin rash
Call your doctor or nurse if your child is having any of these side effects. You may give acetaminophen (Tylenol®) for discomfort, but check for a fever first. If your child has a fever, do not give the acetaminophen and call your health care provider. Tylenol® may hide a fever and may prevent you from detecting an infection.
How to give an injection
Keep this medicine in the refrigerator. Do not let it freeze.
1. You may want to apply a “numbing cream”. L.M.X.4 can be purshased at your loval pharmacy without a prescription and should be applied 30 minutes prior to the shot. EMLA® to the site one hour before giving the shot. Some children may want to use the cream. Other children find that using the cream makes them more nervous and fearful. If your child does not like to use the Tegaderm to cover the cream, then you may make it more fun by using a colored plastic wrap. You can wrap and tape the plastic wrap around the leg or arm to cover the cream.
Once the right time has passed, remove the covering and wipe away the cream. The site should be numb to the touch. See Health Facts for You #5706 EMLA Cream or Health Facts for You #6836 Topical Lidocaine - L.M.X.4.
2. Wash your hands well.
3. We suggest that you give the shot in the back “fleshy” part of the upper arm or the front to side area of the thigh. Use different sites each day.
4. Open a sterile alcohol wipe and clean the site where you will be giving the shot. Allow the site to dry.
5. Take the cover off of the needle. Do not let the needle touch anything.
6. Hold the syringe like a pencil or dart.
7. With your other hand, pinch up the skin at the injection site between your thumb and index finger.
8. Insert the needle into the skin at a 45-degree angle with a quick firm motion. Do not press down on the top of the plunger while the needle enters the skin.
9. After the needle is fully inserted into the skin, release the skin that you are pinching, and hold the syringe in place.
10. Inject the G-CSF or GM-CSF by slowly pushing down on the plunger until the syringe is empty.
11. Pull the needle out quickly and gently at the angle in which it was inserted. Do not rub the site.
12. Do not recap the needle. Throw the syringe and needle into the proper container. See Health Facts For You # 4587 Disposal of Sharp Wastes at Home.
Helpful hints
Sometimes you may forget where the last shot was given. To make this simple, record where it was given each day on a calendar.
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Don’t worry if you notice blood at the site after the injection. If you notice some clear fluid at the site, this is medicine that followed the needle track to the surface. If either of these things occurs, you can hold a 2 x 2 gauze pad to the site.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 03/11/2010
Copyright © 03/11/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5924
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