Velcade (bortezomib) can be administered by subcutaneous injection or intravenous bolus; proper technique and handling of missed doses directly affect efficacy and safety.

I. Subcutaneous Injection Site Rotation

1. Recommended Sites

Prefer the subcutaneous tissue of the thighs or abdomen.

Avoid the periumbilical area, scars, ecchymoses, indurations, and broken skin.

2. Rotation Principles

Change the injection site each time; do not repeat injection at the same site within a short period.

Alternate between left and right sides and upper and lower areas to reduce local reactions.

Inject into the subcutaneous depth, with the needle inserted perpendicularly or at a slight angle, avoiding inadvertent entry into a blood vessel.

3. Management of Local Reactions

If redness, swelling, induration, or pain occurs, record it and avoid that area.

If local reactions persist or worsen, inform the doctor for evaluation.

II. Intravenous Bolus Administration Time

1. Administration Method

Intravenous administration is a rapid bolus, not a prolonged infusion.

The bolus is usually given over 3 to 5 seconds, via either a peripheral or central vein.

2. Key Operational Points

Confirm that the intravenous access is patent before bolus administration to avoid extravasation.

Flush with normal saline after the bolus to reduce irritation from residual drug.

Extravasation can cause local irritation; stop immediately and manage it.

3. Distinction from Subcutaneous Administration

The dose and concentration differ between subcutaneous injection and intravenous bolus and must not be mixed up.

Use the route prescribed by the doctor; do not change the administration method on your own.

III. Handling of Missed Doses

1. Basic Principles

Do not double the dose after a missed dose.

Take the next dose according to the original dosing schedule.

2. Interval Requirements

At least 72 hours must elapse between two doses.

If less than 72 hours remain until the next dose, skip the missed dose.

3. Recording and Communication

Record the time and reason for the missed dose and inform the healthcare team.

Frequent missed doses may affect efficacy and require reassessment of the dosing plan.

IV. Precautions

1. Pre-Dose Assessment

Confirm complete blood count, platelet count, and symptoms of neuropathy.

Dose adjustment is required if severe peripheral neuropathy or thrombocytopenia occurs.

2. Patient Education

Patients receiving subcutaneous injections should master site rotation methods.

Intravenous administration must be performed by professionals; patients should not self-administer bolus injections.

Seek timely medical attention for injection site abnormalities, numbness or tingling, or signs of infection.