Continuous Subcutaneous Infusions
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Continuous subcutaneous infusions (CSCI) are a common method of medication administration in palliative medicine, especially for patients near the end of their life.

Advantages and indications for subcutaneous infusions

Dying patients often require parenteral medications as they lose the 
ability to take medications orally and the subcutaneous route has many 
advantages over the intravenous route. Some of the advantages include are listed below:
  • No risk of phlebitis or air embolus
  • Allow patient to retain more mobility (IV site typically on hand or arm; subcutaneous sites include chest, thigh and abdomen)
  • More comfortable for patient
  • Less susceptible to occlusion or dislodgement
  • Seen as kinder

The main indication for continuous subcutaneous infusions is for 
medication delivery when the oral route is unavailable. Examples 
include:
  • Drowsiness
  • Severe nausea or vomiting
  • Severe dysphagia

Medications that can be given subcutaneously and comparative dosing information

Medication
Approximate oral dose and subcutaneous dose equivalent
Alfentanil

Clonidine
50microg oral = 50microg subcut
Clonazepam

Cyclizine

Dexamethasone
4mg oral = 4mg subcut (use as state doses)
Diclofenac
150mg oral = 75mg subcut (use only as CSCI as tissue necrosis has been reported with stat doses)
Esomeprazole

FentanylR

Frusemide
40mg oral = 20mg subcut
Glycopyrrolate

Granisetron
2mg oral = 1mg subcut
Haloperidol
2mg oral = 1mg subcut
Hydromorphone
3mg oral = 1mg subcut
Hyoscine butylbromide

Hyoscine hydrobromide

Ketamine
10mg oral = 10mg subcut
Ketorolac
10mg oral = 10mg subcut
Levetiracetam
25mg oral = 12.5mg subcut
Lignocaine

Methadone
10mg oral = 5mg subcut
Metoclopramide
10mg oral = 10mg subcut
+Morphine 
15mg oral = 5mg subcut
Neostigmine

Octreotide

Omeprazole

Ondansetron
8mg oral = 4mg subcut
Oxycodone
10mg oral = 5mg subcut
Paracetamol