Hello, I am trying to find litterature to guide a recommendation about frequency of replacement of subcutaneous catheter (we use the BD-Intima) for intermittent opioid dosage.
I found this regarding continuous infusion / hypodermoclysis: The subcutaneous access site used for hydration fluids should be rotated every 24-48 hours or after 1.5- 2 liters of infused fluid and as clinically indicated.1,3,14 b (II) (Standards of practice for infusion nursing of the infusion nursing society, 2011)
Regarding subcutaneous infusion of opiods: Problems associated with subcutaneous infusions are skin irritation at the insertion site and subcutaneous scarring. Skin irritation can be resolved with more frequent site changes and less concentrated opioids. Subcutaneous scarring interferes with the absorption of the opioids resulting in unpredictable analgesia. Reducing opioid volume and rotating the site more often prevent scarring. Ref: Infusion Nurses Society: Infusion Nursing - An evidence-based approach, Third Ed.2010
However, no mention of the frequency of the rotation... Anybody has some guidance to offer?
Thank you!
France
The Standards of Practice is the most recent document and is based on what was found in the literature through mid-2010. The INS textbook was written before the lit search for the Standards. Is there an issue with the q 24-48 h recommendation? Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Lynn,
I think that the nurses would have appreciated a less frequent change... especially that we now change our PIV when clinically indicated. Also, I also assumed that a rotation q 24-48 hours was more related to the amount of fluid given into a subcutaneous site and that with SQ intermittent injection of opioids, the volumes administered are minimal.
Will do with q48!
Thanks a lot,
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
Yes, I see your points about a less frequent time. I think the most research on SC infusion is about fluid infusion and not low-volume med infusion. I am not sure if there is anything new since the INS SOP was finalized in mid-2010. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861