Intramuscular and subcutaneous injections are a useful route:

They are also useful if venous access is limited, although only small volumes (up to 2 mL) are recommended using this route (Downie et al. [65], Polovich et al. [194], Sewell et al. [230]). Cytotoxic and biological agents administered in this way include (Stanley [239], Weinstein and Hagle [265], Wilkes [268]):

Reasons for not administering cytotoxic drugs via the intramuscular or subcutaneous routes would include the following factors (Polovich et al. [194]):

Although the volume of drug and diluent handled is less than for the intravenous route, preparation and reconstitution of the agents should be commensurate with the information listed in the safe handling section. The use of safety needles to administer medications is recommended by the European Union directive on safe handling of sharps (EU [71]). The nurse should wear an apron and gloves during administration. Disposal of equipment and spillage should be dealt with in the same way as for any other cytotoxic medication. Where community nurses are to be responsible for administration, they must be supplied with adequate information when the patient is discharged and arrangements for cytotoxic waste collection should be in place.

Recommendations about administration should be followed carefully, for example deep intramuscular injection using a Z‐track technique to prevent leakage onto the skin (Wilkes [268]) and rotation of sites to prevent local irritation developing. The skin should be cleaned with antiseptic prior to injection (Sansivero and Barton‐Burke [216]) and the smallest needle used, the gauge of which will allow passage of the solution to minimize discomfort and scarring (Weinstein and Hagle [265]).