Subcutaneous infusion devices

[Michael Wishart]

Hi everyone

How long do you recommend subcutaneous infusion devices remain insitu for before they are resited? Do you recommended a fixed interval resite, as well as as required?

There appears to be some difference between subcutaneous devices used for opiate infusions, and devices uses for hydration. Can anyone comment on this? There are some recommendations about devices used for opiate infusion in this document: https://www.health.qld.gov.au/__data/assets/pdf_file/0029/155495/guidelines.pdf

Does the latest version of INS make any recommendations for these devices?

Thanks for any help on this.

Cheers
Michael

Michael Wishart
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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[Tim Spencer]

Hi Michael,
This is the recommendation from the INS (Infusion Nurses Society) Standards of Practice 2016 – points F & G are your answers.

56. CONTINUOUS SUBCUTANEOUS INFUSION AND ACCESS DEVICES

Standard

56.1 The clinician assesses the patient for appropriate- ness of the subcutaneous route in relation to the pre- scribed medication or solution, the patients clinical condition, and the presence of adequate subcutaneous tissue.

Practice Criteria

Consider administration of isotonic solutions (5% dextrose in water or 0.9% sodium chloride) via a subcutaneous access device (hypodermoclysis) for treatment of mild to moderate dehydration.1-8 (V)

Consider the subcutaneous route for continuous opioid (eg, morphine, hydromorphone, fentanyl) and other infusion therapies/medications (eg, immu- noglobulin therapy, terbutaline). In addition, admin- ister other medication on an intermittent basis via a subcutaneous access device.2,5,9-11 (V)

Use hyaluronidase to facilitate the dispersion and absorption of 1,000 mL or more of subcutaneously administered hydration solutions in adults and pedi- atric patients. The dosage of subcutaneous solutions administered is dependent upon the patients age, weight, clinical condition, and laboratory values. The rate and volume of subcutaneous fluid administration should not exceed those employed for intravenous infusion.2,3,5-7,12-20 (V)

Consider the use of hyaluronidase to increase the dis- persion and absorption of other injected drugs.19,20 (V)

In patients taking salicylates (eg, aspirin), steroids (eg, cortisone or estrogens), or antihistamines, a larger dose of hyaluronidase for equivalent dispersing effect may be required.19 (V)

Do not use hyaluronidase to enhance the disper- sion and absorption of dopamine and/or alpha- agonist drugs, as the drugs are incompatible. Consult the drug manufacturers references prior to administering any drug with hyaluronidase.19 (V)

When hyaluronidase is added to a local anes- thetic agent, it hastens the onset of analgesia and tends to reduce the swelling caused by local infil- tration, but the wider spread of the local anes- thetic solution increases its absorption; this shortens its duration of action and tends to increase the incidence of systemic reaction.19 (V)

Use with caution in a nursing mother as it is not known if hyaluronidase is excreted in breast milk.19 (V)

Assess for adverse reactions of hyaluronidase of mild local access site reactions such as redness, pain, anaphylactic-like reactions, and allergic reactions.19 (V)

Select a site for subcutaneous access to include areas with intact skin that are not near a joint and have adequate subcutaneous tissue, such as the upper arm, subclavicular chest wall, abdomen (at least 2 inches away from the umbilicus), upper back, and thighs and/or as recommended by the drug manufacturer 1. A stainless steel winged needle is not recommended.5 (IV)

Rotate the subcutaneous access site used for medica- tion administration every 7 days and as clinically indicated based on the access site assessment findings.5,6 (V)

Rotate the subcutaneous access site used for hydration solutions every 24 to 48 hours or after 1.5 to 2 liters of solution has infused and as clinically indicat- ed based on the access site assessment findings.2,7 (V)

Assess the subcutaneous access site and rotate the site when there is erythema, swelling, leaking, local bleeding, bruising, burning, abscess, or pain.1,5-7 (V)

1. For patients receiving subcutaneous immunoglobulin infusions, some swelling and site erythema, pain, and pruritis are common and tend to decrease over time. Persistent reactions may require a slower infusion rate or decreased volume per site, longer needle, or site change.10,22 (V)

I. Use a small-gauge (ie, 24- to 27-gauge) infusion device to establish subcutaneous access, and insert the subcutaneous infusion device according to the manufacturers guidelines. Use a subcutaneous needle labeled for high flow rates when indicated by the drug manufacturer.5-7,21 (V)

J. Perform skin antisepsis prior to inserting the subcutaneous access device using 70% isopropyl alcohol, povidone-iodine, or >0.5% chlorhexidine in alcohol solution.6,23 (V)

K. Aspirate the subcutaneous infusion access device to confirm the absence of a blood return prior to medication and fluid administration.5,6,10 (V)

L. Apply a transparent semipermeable membrane (TSM) dressing over the subcutaneous access site to allow for continuous observation and assessment. Change the TSM dressing with each subcutaneous site rotation but immediately if the integrity of the dressing is compromised.2,5,7 (V)

M. The optimal subcutaneous infusion rate is unknown. Medication infusion rates of 3 to 5 mL per hour are reported, and hydration infusion rates of up to 1500 mL over 24 hours are reported. More than 1 subcutaneous infusion site may be used to accomplish a larger infusion volume. Follow the manufacturers recommended subcutaneous administration rate/infu- sion method for immunoglobulin infusions.2,6,7,9 (V)

N. Regulate the infusion of medications administered as a continuous infusion via a subcutaneous access device using an electronic infusion device that has the ability to titrate the rate up or down if required to improve tolerability.5,21 (V)

O. Infuse isotonic fluids for hydration via a subcutaneous access device using a manual flow regulator.4,6,7 (V)

Hope this helps.

Timothy R. Spencer, DipAppSci, BHealth, ICU Cert, RN, APN, VA-BC
Global Vascular Access, LLC
E: tim.spencer68@icloud.com
W: http://www.vascularaccess.com.au
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Sep 28, 2017, at 10:17 PM, Michael Wishart wrote:
>
> Hi everyone
>
> How long do you recommend subcutaneous infusion devices remain insitu for before they are resited? Do you recommended a fixed interval resite, as well as as required?
>
> There appears to be some difference between subcutaneous devices used for opiate infusions, and devices uses for hydration. Can anyone comment on this? There are some recommendations about devices used for opiate infusion in this document: https://www.health.qld.gov.au/__data/assets/pdf_file/0029/155495/guidelines.pdf
>
> Does the latest version of INS make any recommendations for these devices?
>
> Thanks for any help on this.
>
> Cheers
> Michael
>
>
> Michael Wishart
> Infection Control Coordinator
>
> A 627 Rode Road, Chermside QLD 4032
> P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
>
> P Please consider the environment before printing this email
>
>
> ______________________________________________________________________
> This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
> To send a message to the list administrator send an email to aicalist-request@aicalist.org.au .
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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