Principles
Subcutaneous administration of medicines is a safe and practical way of administering medicines to people in the terminal phase. Continuous subcutaneous infusions often contain a mixture of medicines, e.g. opioid plus antiemetic.
A syringe driver is a battery driven device that delivers medicines continuously.
The dose of each medicine should be individualised, and separate PRN doses prescribed for breakthrough symptoms.
Incompatibilities (e.g. precipitation, particle formulation, chemical inactivation) can occur between medicines and also with diluents used to make up the infusion. The incompatibility may be undetectable by visual inspection. In most cases sterile water as the diluent for subcutaneous infusions is preferred over sodium chloride 0.9%.
For advice on diluents, administration and the compatibility of combinations of medicines within a syringe, contact your local hospice or hospital medicines information centre.
For some carers it is possible, with training, to administer intermittent subcutaneous bolus doses of medicines to the dying, in the absence of a nurse. The nurse inserts a line attached to a bung subcutaneously and the carer uses this line to deliver the medicine, when symptoms are exacerbated.
The caring@home Project has been funded to develop and roll out a standardised resource kit to support nurses in the carer training role. It provides resources applicable Australia-wide for community service providers, health care professionals and carers to support carers to help manage breakthrough symptoms safely using subcutaneous medicines.
Prescribing guidance
palliAGEDgp smartphone application (available as an app or as online content)
Useful information
Brisbane South Palliative Care Collaborative
Safer Care Victoria
Therapeutic Guidelines: Palliative Care (subscription required)
Remember
- Use more than one syringe driver if there are compatibility problems and alternative routes are unsuitable.
- Medicines with long half-lives (e.g. dexamethasone or clonazepam) may be administered separately as a subcutaneous bolus, reducing the likelihood of compatibility problems.
- Be practical - confirm the maximum volume that the syringe driver can handle.
- Training the carer to administer bolus subcutaneous doses of medicines results in improved symptom management as well as being perceived as a privileged role by many carers.
Page created 18 February 2019