Manejo de la vía subcutánea en cuidados paliativos / Management of the subcutaneous way of administration in paliative care

El envejecimiento de la población, el aumento de enfermedades crónico-degenerativas, junto con una mayor esperanza de vida hacen que cada día el número de pacientes que requieren cuidados paliativos sea mayor. La vía de elección para tratar los síntomas en estos pacientes es la oral, pero ciertas circunstancias pueden imposibilitar su uso, siendo necesario recurrir a otras vías. La vía subcutánea supone una alternativa en estas situaciones al tratarse de una técnica sencilla, segura y de fácil manejo. El propósito de este trabajo es contribuir al buen uso de esta técnica y, por lo tanto, a un mejor control de los síntomas, describiendo la técnica, las ventajas y desventajas de su uso en cuidados paliativos, indicaciones y contraindicaciones, las posibles complicaciones, lugares y técnica de inserción, los cuidados posteriores, así como los tipos de administración y fármacos más empleados

The population ageing, the increase of chronic-degenerative diseases, together with a higher life expectancy, have led to an increasing number of patients who require palliative care. The administration way of choice to treat symptoms in these patients will be oral, but certain circumstances may render this impossible, making it necessary to resort to other ways. The subcutaneous way represents an alternative option in these situations, as it is a simple, safe, and easy to use technique. The objective of this paper is to contribute towards the good use of this technique and, therefore, to a better control of symptoms, describing the techniques, the advantages and disadvantages of its use in Palliative Care, indications and contraindications, potential complications, insertion sites and technique, subsequent care, as well as the most widely used types of administration and drugs

Documento de consenso sobre el tratamiento con infusión subcutánea continua de insulina en el medio hospitalario / Position statement on continuous subcutaneous insulin infusion in the hospital setting

En España hay un número creciente de personas con diabetes tipo 1 tratadas con la terapia de infusión subcutánea continua de insulina (ISCI), pero no hay directrices nacionales sobre cómo manejar la terapia con bomba de insulina en el ámbito hospitalario. El Grupo de Nuevas Tecnologías de la Sociedad Española de Diabetes ha revisado la literatura y varias directrices internacionales y propone un documento de consenso sobre el manejo de la terapia con bomba de insulina para los pacientes hospitalizados. El documento contiene recomendaciones sobre las indicaciones, las contraindicaciones y los requisitos necesarios para el mantenimiento de la terapia con ISCI en el hospital. Esta revisión proporciona una guía para el manejo de pacientes ISCI en entornos especiales, tales como la sala de urgencias, cirugía, parto y para pacientes pediátricos. Por último, el grupo propone un conjunto de documentos necesarios para establecer una política ISCI en el hospital. En conclusión, la terapia con ISCI se puede utilizar con seguridad en el hospital en pacientes seleccionados después de haberse implementado un protocolo estandarizado

There is an increasing number of people with type 1 diabetes treated with continuous subcutaneous insulin infusion therapy (CSII) in Spain, but there are no national guidelines on how to manage insulin pump therapy in the hospital setting. The Group on New Technologies in Diabetes of the Spanish Diabetes Society has reviewed the literature and several international guidelines, and proposes a consensus document on the management of insulin pump therapy for inpatients. The document contains recommendations on indications, contraindications and the requirements needed to maintaining CSII therapy. This review provides a guide for the management of CSII patients in special settings such as the emergency room, surgery, delivery, and for pediatric patients. Finally, the group proposes a set of documents needed to establish a CSII policy in the hospital. In conclusion, CSII therapy can safely be used in the hospital in selected patients after the implementation of a standardized protocol

[Subcutaneous rehydration in patients in terminal phase of dementia]. / Subkutánní rehydratace u pacientu s terminální fází demence.

BACKGROUND: Dehydration among seniors is not rare. It is both medical and nursing problem, leading to many complications. Attention is paid to ways of rehydration among seniors in terminal phase of dementia. Aim to evaluate frequency of complications due to subcutaneous rehydration in patients with terminal phase of dementia and to evaluate nurses opinion in relation to this method of rehydration. METHODS: Observational study has been designed in women psychogeriatric wards, Mental hospital Kromeríz, from June 2012 - December 2013, evaluating frequency of complications due to subcutaneous rehydration - local oedema, local infection, local erythema (60 patients group) and evaluating nurses opinion in relation to this method of rehydration (18 nurses group). METHODS: observation, interview. RESULTS: No complications of subcutaneous dehydration was found in 58 cases (96.6%), in 1 case local oedema (1.7%) and in 1 case (1.7%) local erythema manifested. Nurses reported effortles-sness of subcutaneous rehydration together with sparing of their working time and comfort to a patient in comparison with intravenous rehydration therapy. CONCLUSION: Subcutaneous rehydration seems to be an appropriate method of rehydration in patients with terminal phase of dementia.

Innovations in subcutaneous infusions.

Parenteral drug delivery is an essential part of patient care. The subcutaneous (SC) route is easily accessed, is more cost-effective, and provides increased convenience for the patient than the other parenteral methods. The pharmacokinetic profile of medications delivered SC reflect bioavailabilities similar to intravenous (IV) delivery. The coadministration of human recombinant hyaluronidase with SC medications enhances the maximum concentration and time to maximum concentration to more closely mimic drugs delivered by the IV route. Pharmaceutical companies are studying and successfully developing new formulations of current medications for delivery via the SC route.

Subcutaneous immunoglobulin replacement therapy: ensuring success.

Subcutaneous immunoglobulin (SCIg) infusions are an option for patients requiring immunoglobulin therapy. Nurses are uniquely positioned to advocate for patients and to teach them how to successfully manage their infusions. The purpose of this review is to describe SCIg therapy and to provide teaching instructions as well as creative tips to ensure treatment success.

Intravenous versus subcutaneous access for palliative care patients.

The subcutaneous route for medication administration can prove highly effective both in terms of reliability and clinical outcomes. It is also well tolerated by patients for whom the enteral route is not an option. This extended feature comment reviews the advantages and disadvantages of both the intravenous and subcutaneous routes of medication administration for patients requiring palliation.

A comparison between intravenous and subcutmaneous immunogobulin.

Multifocal motor neuropathy (MMN) is a rare immune-mediated disease that presents with predominantly distal motor weakness in one or more limbs without sensory loss. Symptoms may give riseto functional impairment and consequently may affect quality of life. High-dose intravenous immunoglobulin's therapy (IVIg) is the current mainstay treatment, however, subcutaneous immunoglobuli(SCIg) is emerging as a viable alternative. The purpose of this study was to explore the patients' experience of SCIg and ascertain if those receiving it had an improved quality of life and treatmentsatisfaction compared to those receiving IVIg. Using a mixed method approach this paper will present its findings and key implications for clinical and research practice are considered. The results from this study suggest that home SCIg therapy may prove a more desirable treatment option than IVIg for a proportion of MMN patients.

Subcutaneous infusion in palliative care: the neria soft infusion set.

Patients approaching the end of their life may be unable to tolerate the administration of oral medication owing to their underlying disease and/or symptoms, such as nausea and vomiting. Subcutaneous infusion is an alternative route of administration that offers a number of advantages over oral and intravenous routes. This product focus article provides an overview of subcutaneous infusion, including how the selection of the most appropriate infusion device can greatly contribute to the overall comfort of the patient. This in turn minimises the potential for premature device loss, which can lead to repeated insertion procedures for the patient, increases the potential for infection, and has resource implications. The article then describes the recently developed neria soft infusion set, as well as providing case studies of its use.

Chelation therapy for iron overload: nursing practice implications.

Many diseases of the blood are treated with blood transfusion therapy. Chronic transfusions can cause iron overload, and, if untreated, can cause end-organ damage. Chelation therapy provides a way of treating iron overload and minimizing its adverse effects. Nurses need to understand that iron overload is a consequence of chronic blood transfusion, and they need to know what effects it has on end organs and what treatment options are available.

The nurse's role in administration of intravenous immunoglobulin therapy.

Intravenous immunoglobulin is a valuable therapeutic agent for many patients with primary immune deficiency disorders and for some with secondary immunodeficiency, and its use has expanded to other areas such as neurologic, hematologic, and infectious disorders. Nurses administer the majority of immunoglobulin. This article discusses indications for various immunoglobulin products available, potential adverse reactions, routes of administration, and the important role of the nurse in the administration of immunoglobulin.

The experiences of school nurses caring for students receiving continuous subcutaneous insulin infusion therapy.

Diabetes mellitus is the most common metabolic disorder in childhood. Today, children with diabetes are receiving new technologically advanced treatment options, such as continuous subcutaneous insulin infusion (CSII) therapy. School nurses are the primary health caregivers of children with diabetes during school hours. Therefore, it is important to determine their perceptions, resources, and resource needs when caring for students with continuous subcutaneous insulin infusion or insulin pump therapy. This study uses a phenomenological approach to examine the experiences of school nurses caring for students receiving insulin pump therapy. Eleven school nurses were interviewed using semistructured taped interviews. The nurses' responses indicated that they were "scared" when first caring for students with continuous subcutaneous insulin infusion therapy. However, they were able to work through their fear by using their resources and gaining more knowledge and hands-on experience with insulin pumps. The data also revealed that school nurses who were able to learn the language of continuous subcutaneous insulin infusion therapy and successfully deal with pump problems developed trusting and knowing relationships with students, teachers, and parents.