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)
Advantages and indications for subcutaneous infusions
Medications that can be given subcutaneously and comparative dosing information