ABSTRACT
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
Subject(s)
Female , Humans , Male , Insulin Infusion Systems/classification , Insulin Infusion Systems/supply & distribution , Infusions, Subcutaneous/methods , Infusions, Subcutaneous/nursing , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/genetics , Therapeutics/nursing , Therapeutics/standards , Spain/ethnology , Insulin Infusion Systems/standards , Insulin Infusion Systems , Infusions, Subcutaneous/psychology , Infusions, Subcutaneous/trends , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/pathology , Therapeutics/instrumentation , Therapeutics/methodsABSTRACT
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.
Subject(s)
Hyaluronoglucosaminidase/administration & dosage , Infusions, Subcutaneous/nursing , Infusions, Subcutaneous/trends , Diffusion of Innovation , Humans , Hyaluronoglucosaminidase/pharmacokineticsABSTRACT
Giving fluids via the subcutaneous route is a safe and effective technique for the prophylaxis and for the treatment of dehydration. Side effects occur rarely when using this access route compared to the intravenous route, which has a much higher rate of side effects. Subcutaneous infusions can be used to treat inpatients in a hospital setting, in nursing homes, and in patients living at home. One great advantage of the subcutaneous route is that it is not necessary to have a physician to prepare a subcutaneous line, which can also be performed by trained nursing staff. Agitated patients who frequently pull out their lines themselves are a group where the subcutaneous route is particularly useful. Subcutaneous infusions can avoid the necessity for admission of geriatric patients to a hospital.
Subject(s)
Dehydration/therapy , Infusions, Subcutaneous/methods , Infusions, Subcutaneous/trends , Aged , Aged, 80 and over , Fluid Therapy/methods , Germany , HumansABSTRACT
Introducción: la HP (hipertensión pulmonar) es una enfermedad poco prevalente (15 casos por 1 millón de habitantes), pero se trata de un proceso grave con una mortalidad muy elevada. El tratamiento se hace con treprostinil administrado por vía subcutánea. El principal efecto secundario que presenta es dolor e inflamación en el punto de infusión, obligando en muchos casos a la retirada del tratamiento. Presentamos un caso clínico de un paciente de 46 años diagnosticado de hipertensión pulmonar secundaria a VIH, que acude en tratamiento con treprostinil subcutáneo y que refirió intenso dolor en la zona de punción (zona abdominal periumbilical) los primeros días (4-5) de la infusión, con una intensidad muy severa (VAS 9-10) que le obligó a estar encamado. Planteamos la posibilidad de tratamiento con parche de capsaicina 8% (Qutenza®) de forma experimental, indicando al paciente su uso fuera de ficha técnica (off-label) y firmando el consentimiento informado. Se realiza tratamiento previo durante una hora con crema EMLA, según protocolo, se delimita la zona abdominal periumbilical (lugar de punción) y se administra parche durante una hora. Se observa posteriormente eritema en la zona de administración, sin más incidencia. Buena tolerancia del tratamiento y alta a domicilio. No existen publicaciones actualmente que hayan estudiado el uso de parche de capsaicina para tratar el dolor relacionado con la infusión de treprostinil s.c., por ello consideramos relevante la experiencia de este caso clínico. De este modo, creemos que, aunque pendiente de la validación por ensayos clínicos, el tratamiento con parches de capsaicina 8% (Qutenza®) podría ser una alternativa válida a tener en cuenta en el control analgésico de los pacientes en tratamiento con treprostinil s.c., logrando de este modo la adherencia a dicho tratamiento y que más pacientes puedan beneficiarse de teprsotinil para el tratamiento de la HP (AU)
Background: PH (Pulmonary Hypertension) is a low prevalence disease (15 cases per 1 million inhabitants), but is nevertheless a serious process with high mortality. Treprostinil is a new drug for the PH treatment, it is a prostacyclin with a half-life of 2-3 hours, which permits subcutaneous administration with rapid absorption and 100% bioavailability. The issue with treprostini is the high rate of drop-outs due to pain at the injection site. Aims: to reduce the rate of drop-outs due to pain at the injection site with the use of Treprostinil Methods: we searches in PubMed and Tripdatabase, fore terms, "capsaicin", "qutenza", "treprostinil", and "pulmonary hypertension", finding no related publication. The treatment with capsaicin 8% patch, was performed for one hour, according to the protocol, the peri-umbilical abdominal area (injection site) was delimited and the patch administered for one hour. Resul ts: erythema at the administration site was subsequently observed, albeit with no further incidents. Good treatment tolerance and discharge. In the control after 1 month, the patient reported changing the injection site to the treated area with a very striking reduction in pain (VAS 2-3) that enabled him to lead a normal life. The patient's satisfaction is very high, and he requires no coadjuvant or rescue treatment. At the 3-month control, the patient continues with the same level of analgesia Conclusions: capsaicin 8% patch could be a valid alternative to be considered in the analgesic control of patients on treatment with subcutaneous treprostinil (AU)
