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

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.

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.

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

Comparison of hydromorphone continuous subcutaneous infusion and basal rate subcutaneous infusion plus PCA in cancer pain: a pilot study

Pain ◽  
1993 ◽  
Vol 53 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Marie-Claude Vanier ◽  
Gaston Labrecque ◽  
Dolorès Lepage-Savary ◽  
Éric Poulin ◽  
Louise Provencher ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cancer Pain ◽  
Subcutaneous Infusion ◽  
Basal Rate ◽  
Continuous Subcutaneous Infusion

scholarly journals Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Per Fürst ◽  
Staffan Lundström ◽  
Pål Klepstad ◽  
Peter Strang
Keyword(s):  
Palliative Care ◽  
Adverse Effects ◽  
Pain Control ◽  
Performance Status ◽  
Infusion Pump ◽  
Eastern Cooperative Oncology Group ◽  
Moderate Increase ◽  
Subcutaneous Infusion ◽  
Dying Patients ◽  
Continuous Subcutaneous Infusion

Abstract Background Continuous subcutaneous infusion (CSCI) via ambulatory infusion pump (AIP) is a valuable method of pain control in palliative care. When using CSCI, low-dose methadone as add-on to other opioids might be an option in complex pain situations. This study aimed to investigate the effects, and adverse effects, of CSCI for pain control in dying patients, with particular interest in methadone use. Methods This was an observational cohort study. Imminently dying patients with pain, admitted to specialized palliative inpatient wards and introduced on CSCI, were monitored daily by staff for symptoms (Integrated Palliative Care Outcome Scale - IPOS), sedation (Richmond Agitation and Sedation Scale – RASS), performance status (Eastern Cooperative Oncology Group - ECOG) and delirium (Confusion Assessment Method - CAM). Results Ninety-three patients with a median survival of 4 days were included. Of the 47 patients who survived ≥3 days, the proportion of patients with severe/overwhelming pain decreased from 45 to 19% (p < 0.001) after starting CSCI, with only a moderate increase in morphine equivalent daily dose of opioids (MEDD). Alertness was marginally decreased (1 point on the 10-point RASS scale, p = 0.001), whereas performance status and prevalence of delirium, regardless of age, remained unchanged. Both patients with methadone as add-on (MET, n = 13) and patients with only other opioids (NMET, n = 34), improved in pain control (p < 0.05 and 0.001, respectively), despite that MET patients had higher pain scores at baseline (p < 0.05) and were on a higher MEDD (240 mg vs.133 mg). No serious adverse effects demanding treatment stop were reported. Conclusions CSCI via AIP is an effective way to reduce pain in dying patients without increased adverse effects. Add-on methadone may be beneficial in patients with severe complex pain.

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