Management of Subcutaneous Infusions in Palliative Care
Palliative care “improves quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by ... impeccable assessment and treatment of pain and other problems...” (WHO, 2004).2 Palliative care is provided according to the needs of the individual and may happen days, weeks or months before death. It should be available wherever the person chooses – at home or in a hospital, hospice or residential aged care facility - and be supported by a team of health professionals including a specialist palliative care team if needed.
Subcutaneous administration of medication is common practice in palliative care to manage pain and other distressing symptoms when other routes are inappropriate or ineffective.3 These power driven devices deliver medications at a controlled rate to provide symptom control. Subcutaneous infusion devices have become an important part of care to ensure comfort for many patients.4
Subcutaneous delivery of medication via an infusion device:
- allows continuous supply of medications, bypassing the gut and associated problems with swallowing and malabsorption3;
- can provide more stable plasma levels of drugs and better symptom control as peaks and troughs of intermittent drug administration are avoided3;
- generally involves a small, portable battery operated pump that delivers medications at an accurately controlled rate6;
- provides versatility offering a convenient, accessible alternative for continuous administration of medications;
- can be used for ambulant patients with most devices relatively unobtrusive, not interfering with patients wanting to continue with their normal daily activities;
- can provide continued management of symptoms removing the need for frequent interventions such as repeated oral medications or injections at end of life.
Indications for commencement of a subcutaneous infusion include:
- inability to swallow due to dysphagia from physical obstruction/ tumour in the mouth, throat or oesophagus;
- persistent nausea and vomiting;
- severe weakness;
- bowel obstruction.3
Contraindications for use of this route include:
- lack of permission from the patient and/or family/carer as proxy;
- where other viable routes of administration are available;
- where contraindications exist related to the drugs to be infused.
The decision to commence a subcutaneous infusion of medication should be made after careful assessment and review by health professionals involved in the patient’s care, the patient, and family/carer.
- Cruikshank S, Adamson E, Logan J, Brackenridge K. Using syringe drivers in palliative care within a rural, community setting: capturing the whole experience. International Journal of Palliative Nursing 2010;16(3):126-132.
- World Health Organization. http://www.who.int/cancer/palliative/definition/en/ Accessed 28 July 2013.
- Dickman A, Schneider J. The syringe driver: continuous subcutaneous infusions in palliative care. 4th Edition. Oxford: Oxford University Press; 2016.
- Mitten T. Subcutaneous drug infusions: a review of problems and solutions. International Journal of Palliative Nursing 2001;7(2):75-85.
- Centre for Palliative Care Research and Education. Guidelines for subcutaneous infusion device management in palliative care (Revised Edition). Brisbane, Queensland: Queensland Health;2010.
- McNeilly P, Price J, McCloskey S. The use of syringe drivers: a paediatric perspective. International Journal of Palliative Nursing 2004;10(8):399-404.