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Testosterone injections- MA scope

  • 1.  Testosterone injections- MA scope

    Posted 11-18-2022 11:21
    Does any practice currently have MA's administering testosterone injections? If so what location, and what needle size is utilized? Thank you!

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    Holly Davis
    Frederick Health Medical Group
    New Windsor MD
    (301)639-5702
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  • 2.  RE: Testosterone injections- MA scope

    Posted 11-20-2022 12:25
      |   view attached
    I hope that you are ONLY referring to the unit dose Xyosted™ autoinjector. Otherwise, I certainly hope not, unless a "physician" is taking "full legal esponsibility" for the MA training and competency for the "unit dose only" injection admininstration. 

    One, there are several different types of testosterone injections. 
    ... Testosterone cypionate, testosterone enanthate (available generically), and testosterone undecanoate injections come as a solution (liquid) to be injected into a muscle and as a pellet to be injected under the skin by a doctor or nurse (according to the prescribing refeence) in an office setting or clinic.

    DEPO-Testosterone Injection is for intramuscular use only. The needle should be long enough to reach into the muscle (usually 1.25 or 1.5 inch), and a guage between 22g - 25g.

    ... Testosterone enanthate injection (Xyosted) comes as a solution (liquid) to be injected subcutaneously (under the skin) once a week by the patient or caregiver.  Xyosted™injection: [Xyosted™ autoinjector] is given as a shot under the skin in the stomach area.  Before injection, the solution should be clear to light yellow in color and free of visible particles. It is not to be use if cloudy, contains visible particles, or if the expiration date on the package has passed. Testosterone enanthate injection (Xyosted) in the left or right side (transpyloric regions) of the abdominal area 2 inches around the umbilicus. It is not to be injected iin an area where the skin is tender, bruised, red, or hard; where there are scars, tattoos, or stretch marks.

    Keep in mind, reading andfollowing the directionin the physician prescribing reference is the responsibility of the provider. Delegation of this skill to the MA must be under the supervision of someone who is fully accountable for maintaining the standard of care and the prescribing guidelines. 

    Source(s):
    Testosterone Injection. Medline Plus. American Society of Health-System Pharmacists. Inc. 2022.  https://medlineplus.gov/druginfo/meds/a614041.html
    XYOSTED (testosterone enanthate) injection (attached file with administration instructions)

    ------------------------------
    Aleesa Mobley PhD RN ANP-BC CPHQ
    Assist. Professor /Clerkship Director
    Rowan University (SOM)
    Williamstown NJ
    (856)230-1229
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    Original Message


  • 3.  RE: Testosterone injections- MA scope

    Posted 11-21-2022 09:03
    What a comprehensive response, Dr. Mobley. Thank you. 
    This topic triggers me a little bit!
    The multispecialty medical group practice where I was employed as an NP allowed MAs to administer testosterone (the formula requiring deep IM injection). One day a patient was scheduled with me for an urgent visit due to 'back pain' the day after he had his injection. Turned out that the MA administered the injection in his flank area and he had a very ugly abscess. Obviously she visualized no landmarks. Thankfully the patient suffered no long term sequelae. 
    Processes changed after that.

    ------------------------------
    Leslie McDowell ANP-BC, DNP, RN
    QI Specialist / Curriculum Developer
    Northwest AHEC / Wake Forest University School of Medicine
    Winston Salem NC
    (336)972-7852
    ANP-BC, DNP, RN
    ------------------------------

    Original Message


  • 4.  RE: Testosterone injections- MA scope

    Posted 11-21-2022 09:09

    I thought Testosterone was a controlled substance, requiring special storage and accountability for inventory/dispensing? When I have given it in the past, there were patient-specific considerations ie: labs, symptoms...critical thinking/assessments that may make me not want to give it.  I haven't given it for many years so maybe things have changed... ?

     

    Deb

     




    Original Message


  • 5.  RE: Testosterone injections- MA scope

    Posted 11-21-2022 08:32

    Hi,
    At our organization MA's can administer under their scope of practice. However, it must be under direct supervision while being drawn up and administered, by an RN or provider. Therefore, it most cases it is administered by the nurse as this requires less staff to be involved. Best practice is that it should be administered into a deep muscle, our practice is using the ventrogluteal muscle as we have moved away from using dorsogluteal. 

    tash



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    Tash Rounds, MSN Ed, RN, AMB-BC, NPD-BC
    Clinical Nurse Educator -Ambulatory
    Skagit Regional Health
    Mount Vernon, WA
    Office: 360-814-6743
    NRounds@skagitregionalhealth.org
    ------------------------------

    Original Message


  • 6.  RE: Testosterone injections- MA scope

    Posted 11-21-2022 11:45
    Hi Holly

    Yes our MAs are administering Depo-testosterone via IM. As mentioned below, needle size is usually 1 - 1.5 inches depending on the size of the patient. This is within the scope of the MA. Annually comps are performed and all medications and vaccines are verified with a nurse or practitioner prior to administration.

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    Kristyl McCray MSN RN-BC
    RN Clinical Director, Education & Prof. Practice
    PIH Health Physicians
    Whittier CA
    (562)698-0811
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    Original Message


  • 7.  RE: Testosterone injections- MA scope

    Posted 11-23-2022 11:06
    Thank you for your response. Would you be willing to share your facilities protocol or policy?

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    Holly Davis
    Frederick Health Medical Group
    New Windsor MD
    (301)639-5702
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    Original Message


  • 8.  RE: Testosterone injections- MA scope

    Posted 11-30-2022 12:15
    Hi Holly

    Our organization doesn't have a "medication-specific" policy. It discusses proper med techniques and storage in general.

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    Kristyl McCray MSN RN-BC
    RN Clinical Director, Education & Prof. Practice
    PIH Health Physicians
    Whittier CA
    (562)698-0811
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    Original Message


  • 9.  RE: Testosterone injections- MA scope

    Posted 11-21-2022 13:01
    During the first few years I was at UF Health, only an LPN/RN could give Testosterone as it was a controlled substance.  Most of our patients bring their medication in, so we don't have to obtain it from our inhouse pharmacy.  The educators met with Pharmacy and developed a plan to train the MAs on how to give the medication.  We then rewrote the policy to allow the MAs to administer Testosterone.  We do annual skills with the staff on how to draw up and dilute medications.  Hope this helps.

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    Teresa] R. Cummins, MSN, RN, CEN
    Clinical Care RN Coordinator
    UF Health Jacksonville Jacksonville, FL]
    904-244-2577
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    Original Message


  • 10.  RE: Testosterone injections- MA scope

    Posted 11-23-2022 11:08
    Thank you for your response. Would you be willing to share your facilities protocol or policy?

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    Holly Davis
    Frederick Health Medical Group
    New Windsor MD
    (301)639-5702
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    Original Message


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