How to Give Your Child a G-CSF or GM-CSF Injection
Your child will receive a granulocyte
colony-stimulating factor (G-CSF) or
granulocyte macrophage colony-stimulating
factor (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. Neutrophils 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 is
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
venous 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
blood 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, 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 health care team on
the day of your child’s blood counts, please
call your health care provider for results.
Common side effects
Aches and pains in the bones or muscles
Less common side effects
Low grade fever (99.0 θ-100.3 θ F)
Lack of energy
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 your child’s
temperature first. If your child has a
temperature greater than 100.4 F or 38.0 C,
do not give the acetaminophen and call your
health care provider. Tylenol may hide a
fever and may prevent you from detecting
How to give an injection
Keep this medicine in the refrigerator. Do
not let it freeze.
Choose a location on your child’s skin
where you will give the shot. 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.
You may want to apply topical lidocaine or
“numbing cream”. L.M.X.4 can be
purchased at your local pharmacy without a
prescription and should be applied 30
minutes prior to the shot. Apply the cream
and then cover with Tegaderm or plastic
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright 9/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#5924
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
Once 30 minutes has passed, remove the
Tegaderm or plastic wrap and wipe away the
cream. The site should be numb to the
touch. See Health Facts for You #6836;
Topical Lidocaine – L.M.X.4.
Wash your hands well.
Open a sterile alcohol wipe and clean the
site where you will be giving the shot.
Allow the site to dry.
Take the cover off of the needle. Do not let
the needle touch anything. Check for and
remove any air bubbles by pulling back on
the plunger and pushing the air out.
Hold the syringe like a pencil or dart.
With your other hand, pinch-up the skin at
the injection site between your thumb and
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.
After the needle is fully inserted into the
skin, release the skin that you are pinching,
and hold the syringe in place.
Inject the G-CSF or GM-CSF by slowly
pushing down on the plunger until the
syringe is empty.
Pull the needle out quickly and gently at the
angle in which it was inserted making sure
to engage the safety mechanism. Do not rub
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.
Sometimes you may forget where the last
shot was given; to make this simple, record
where it was given each day on a calendar.
A small amount of blood or fluid may be
seen at the site after the injection. If you
notice any blood or fluid, you can hold a
small 2 x 2 gauze pad to the site until the
bleeding or fluid stops.