Management of Subcutaneous Infusions in Palliative Care
Section 1: The Patient and Family/Carer Experience
At the completion of this section, you should be able to:
- describe aspects of the experience of having a subcutaneous infusion from the patient and family point of view;
- demonstrate understanding of the potential impact on patient and family of having a subcutaneous infusion.
Health professionals involved in end of life care may assume patients accept having a subcutaneous infusion device because it is relatively small and its use facilitates independence and the option of being cared for at home. However there has been little research into patient attitudes to support this assumption.1 Although these devices allow patients to be home with family, health care professionals should be aware patients and family may have a negative perception of a subcutaneous infusion device.
Some studies report subcutaneous infusions are well accepted and can achieve almost 100% compliance amongst people with a life limiting illness2, but being attached to such a device can pose difficulties for the patient and family. In practical terms of normal daily activities, consideration should be given to:
- choosing clothes to wear;
- wearing a seat belt in relation to cannula position;
- the size and weight of the device and its ability to be worn discreetly;
- sleeping position in relation to cannula position;
- devices that may require frequent battery changes or frequent access to a power point for charging may create a reluctance to leave the home;
- reports by some patients that the devices are noisy3 and inconvenient;
- questions about food and alcohol intake;
- patients and family who perceive these changes as a negative impact on their lifestyle.
Patient and family perceptions or experiences of a subcutaneous infusion device are varied and individual to the person, the environment and the underlying cause for use of the device. Being mindful that the device will be perceived differently dependent upon these factors will aid the health professional to provide a positive experience for the patient and family. Remembering that the patient and family may not have considered advance care planning goals, negative perceptions of the infusion device may be influenced by:
- the device may be viewed as an invasion of body privacy;
- the device may be perceived as an indicator of a poor prognosis4;
- the patient and family may have fears associated with drugs commonly used in palliative care;
- the device may become the focus of fear of impending death.
Thoughtful explanation given with care to provide information and support appropriate to the individual patient and family may assist the health professional to understand the significance they attach to the change in care and any associated emotional distress.5 Good anticipatory care with well timed information ensuring patient and family/carer understanding can be associated with a positive experience for patient, family and health professional.
- Read Client and Family/Carer Statements, about the experience of a subcutaneous infusion device.
- Watch excerpt from Chapter 2 – ‘Who Needs one?’ of Brisbane South Palliative Care Collaborative’s Guide for Clinicians – How to Use a Syringe Driver for Palliative Care Patients.
- This quiz will test the objectives and content in Section 1 of the Learning Package and the ‘Guidelines for subcutaneous infusion device management in palliative care’ document.
- Graham F. The syringe driver and the subcutaneous route in palliative care: the inventor, the history and the implications. Journal of Pain and Symptom Management 2005;29(1):32-40.
- Morgan S, Evans N. A small observational study of the longevity of syringe driver sites in palliative care. International Journal of Palliative Nursing 2004;10(8):405-412.
- Fletcher C. Report on comparative evaluation of Graseby syringe driver replacements. North Shore Hospice Trust;2009.
- Coleridge-Smith E. The use of syringe drivers and Hickman lines in the community. British Journal of Community Nursing 1997;2(6):292,294,296.
- 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.