When the oral route is unavailable, the subcutaneous route is the preferred method. Intravenous is more invasive and are no more effective and the injections can be very painful to patients. The subcutaneous route is not reserved only for the dying patient, but should be considered anytime a patient cannot take fluids or medications by mouth. This route helps the patient be more comfortable.
The main reasons for continuous subcutaneous infusions for the terminal patients are nausea and vomiting, inability to swallow (dysphagia), extreme weakness or if a patient is unconsciousness. This route of giving fluids is easily used at home during the last days of life if the patient is unable to manage oral medications. The use of the subcutaneous infusions in terminal care is a major advance, especially to help control symptoms so the patient can be home.
This route of administering fluids is safer and the patient can still be ambulant. It allows the ability to give fluids and or medications, with no risk of air embolus and less risk of infection. When pain medications are given, such as morphine, the patient does not develop a tolerance to them as they can with the IV morphine.
In 1979, a portable pump was developed by Wright. Later that year, Russel suggested that the infusions could be used with terminal malignant disease. The use of the subcutaneous infusions are rarely required just for pain control. The only contraindication to the use of these infusions are if the patient has severe thrombocytopenia.
Thrombocytopenia is when the blood has an abnormally low amount of platelets. This can cause mild to serious bleeding. This bleeding can occur inside the body or underneath the skin or surface of the skin.
Special needles are used for the subcutaneous infusions. Sub Q Sets are available with a 27 gauge x 1/2 cm needles and come 30/case. There are different sizes and lengths to accommodate different patients and some sets, such as the Medtronic sets, are also used for the Insulin Pump patients.
The preparation of the family and patient is very important. Most patients do not have a problem with the infusions and quickly adapt to them. The infusion pump is small, unobtrusive, and easy to use. Many patients soon forget that it is even there. The cannula can be left in for 72 hours or longer, if there is not inflammation or redness.
The different facilities and hospices have protocols to follow for the insertion and care of the infusions. The comfort of the patient is the main idea for the subcutaneous infusions and should always be the main focus.