Continuous subcutaneous infusion: is community anticipatory prescribing and administration safe?

2021 ◽  
pp. bmjspcare-2021-003259
Author(s):  
Séamus Coyle ◽  
Rebecca Sinden ◽  
Jade Wignall-Coyle ◽  
Sinead Benson ◽  
Paula Powell ◽  
...  
Keyword(s):  
End Of Life ◽  
Clinical Guidelines ◽  
Best Practice ◽  
Dose Range ◽  
Symptom Control ◽  
Cohort Analysis ◽  
Education Programme ◽  
Prescribing Practices ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion

ObjectiveThe anticipatory prescribing of pro re nata medications and continuous subcutaneous infusion (CSCI) medication is essential for the timely management of symptomatic patients at the end of life. There is no evidence to support the safety or appropriateness of anticipatory CSCIs. In 2013, in response to safety concerns about end of life prescribing in the community, we designed an educational intervention to improve prescribing practices among non-specialist prescribers in this area.Methods: how the study was performedWe performed a safety-focussed retrospective cohort analysis of end of life community prescriptions of anticipatory CSCIs over a 12-month period, 5 years after creating clinical guidelines and embedding a multiprofessional rolling education programme. Medications prescribed and administered for symptom control at the end of life are compared between specialist and non-specialist prescribers in terms of their adherence to best practice guidance.ResultsMedications prescribed were not universally administered and more commonly not administered without specialist input. Prescriptions of higher doses of opioids and benzodiazepines beyond those recommended by guidance were significantly greater within the cohort of patients receiving specialist oversight. The prescription of a dose range did not result in excessive dose escalation. For patients not receiving specialist palliative care, median morphine and midazolam doses did not escalate at all once a CSCI was commenced. All midazolam administrations were safe.ConclusionsThe practice of anticipatory CSCI prescribing and administration can be safe in the community non-specialist setting when supported by clinical guidelines, specialist advice and ongoing multiprofessional education.

Continuous Subcutaneous Infusion of Opiates at End-of-Life

2004 ◽  
Vol 38 (6) ◽  
pp. 1015-1023 ◽  
Author(s):  
Stacey L Anderson ◽  
Scott T Shreve
Keyword(s):  
End Of Life ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion

Community prescribing for cancer patients at the end of life: a national study

2021 ◽  
pp. bmjspcare-2021-002952
Author(s):  
Gabrielle Emanuel ◽  
Julia Verne ◽  
Karen Forbes ◽  
Luke Hounsome ◽  
Katherine E Henson
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Best Practice ◽  
Care Home ◽  
Symptom Control ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Service Planning ◽  
National Study ◽  
Life Care

BackgroundGood end-of-life care is essential to ensure dignity and comfort in death. To our knowledge, there has not been a national population-based study in England of community prescribing of all drugs used in end-of-life care for patients with cancer.Methods57 632 people who died from malignant cancer in their own home or in a care home in 2017 in England were included in this study. National routinely collected data were used to examine community prescriptions dispensed for drugs for symptom control and anticipatory prescribing by key sociodemographic factors in the last 4 months of life.Results94% of people who died received drugs to control their symptoms and 65% received anticipatory prescribing. Prescribing increased for the symptom control drug group (53% to 75%) and the anticipatory prescribing group (4% to 52%) over the 4-month period to death.ConclusionsMost individuals who died of cancer in their own home or a care home were dispensed drugs commonly used to control symptoms at the end of life, as recommended by best-practice guidance. Lower prescribing activity was found for those who died in a care home, highlighting a potential need for improved end-of-life service planning.

The effect of dose and method of administration of recombinant bovine somatotropin on fleece growth and body composition in young, fattening lambs

1986 ◽  
Vol 1986 ◽  
pp. 2-2 ◽  
Author(s):  
I.D. Johnsson ◽  
B.W. Butler-Hogg ◽  
D.J. Hathorn ◽  
R. Wilde
Keyword(s):  
Dose Range ◽  
Live Weight ◽  
Optimal Dose ◽  
Bicarbonate Buffer ◽  
Subcutaneous Infusion ◽  
Recombinant Bovine Somatotropin ◽  
Treatment Groups ◽  
Continuous Subcutaneous Infusion ◽  
Soyabean Meal ◽  
Ad Libitum

Daily injections of bovine pituitary somatotropin (growth hormone) can markedly increase growth and muscle deposition in fattening lambs, although the optimal dose range for these effects is not known.This experiment was designed to assess the anabolic and lipolytic activities of biosynthetic somatotropin (produced by genetically-modified bacteria) in fattening lambs, and to determine the effects of dose and method of administration.Dorset Down x Finn-Dorset lambs were individually penned, fed a barley/soyabean meal diet ad libitum (C.P.=155g/kg DM) and allocated to one of six treatment groups, each containing 5 ewe and 5 wether lambs, such that each group had the same initial mean live weight (18 kg). Between 10 and 21 weeks of age, the lambs of each group received one of the treatments shown in Table 1, comparing 3 doses of somatotropin (0.025, 0.1 or 0.25 mg/kg live weight), dissolved in bicarbonate buffer and injected subcutaneously once each day, with the intermediate dose (0.1 mq/kg/day) given by continuous subcutaneous infusion or by daily subcutaneous injection as a suspension in olive oil.

Anticoagulation by Constant Subcutaneous Heparin Infusion

1982 ◽  
Vol 47 (01) ◽  
pp. 001-002 ◽  
Author(s):  
Nenita Parrilla ◽  
Jack Ansell
Keyword(s):  
Clinical Trial ◽  
Impedance Plethysmography ◽  
High Dose ◽  
Intravenous Therapy ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Subcutaneous Infusion ◽  
Subcutaneous Heparin ◽  
Therapeutic Anticoagulation ◽  
Continuous Subcutaneous Infusion

SummaryA preliminary clinical trial was conducted to determine the feasibility of achieving and regulating therapeutic anticoagulation with heparin given by continuous subcutaneous infusion. Five patients with deep venous thrombosis confirmed by impedance plethysmography and/or venography were studied. All patients received an initial heparin dose of 5000 units by IV bolus. This was followed by a continuous subcutaneous heparin infusion at a dose of 15 to 25 units per kilogram per hour. Effective levels of anticoagulation were achieved in all five patients. Regulation and maintenance of therapeutic anticoagulation were no more difficult than with intravenous therapy. No major complications were encountered during therapy.Continuous subcutaneous infusion of heparin may have advantages over standard intravenous therapy or high dose intermittent subcutaneous therapy. However, more extensive clinical evaluation is warranted.

End-of-Life Needs of Dying Patients and Their Families in Mainland China: A Systematic Review

2021 ◽  
pp. 003022282199734
Author(s):  
Guobin Cheng ◽  
Chuqian Chen
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Healthcare Professionals ◽  
Web Of Science ◽  
Empirical Studies ◽  
Symptom Control ◽  
Mainland China ◽  
Spiritual Needs ◽  
Care Needs ◽  
Dying Patients

Objective To map the current research status and understand existing findings regarding end-of-life care needs in Mainland China. Method First-hand, empirical studies on the needs of dying patients and/or their families in Mainland China were searched in Web of Science, Scopus, Proquest, Taylor & Francis Online and CNKI in December 2019. Findings were synthesized. Results A total of 33 (10 qualitative) studies were involved. Chinese dying patients and their families had physical, psychological, social, and spiritual needs and needs for knowledge and information. Prevalent needs of dying patients were mainly symptom control and decent look, being treated kindly by professional caregivers, family accompany, dignity, and comfortable environment. Families mainly need healthcare professionals to take good care of patients and wishes for information, knowledge, and facilities to help themselves become better caregivers. Conclusions Findings lay the foundation for effective and tailored services for Chinese clients and provided insights for future investigations.

Continuous subcutaneous infusion after cholecystectomy. Comparison of two mixtures for postoperative analgesia

2004 ◽  
Vol 29 ◽  
pp. 34-34
Author(s):  
B ADREOTTI ◽  
S APOSTOLAKI ◽  
N VASILAS ◽  
G PROVATAKI ◽  
E KARMIRI ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion
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