Subcutaneous Administration of Medications
If oral medication is not tolerated or unable to be given, consider regular or intermittent subcutaneous injections (via an Insuflon™ or Saf-t-intima™) or a subcutaneous infusion.
See Giving Subcutaneous Bolus Medication For Symptom Management In Palliative Care.
- Severe nausea and/or vomiting
- Severe oral lesions
- Unconscious or sedated patient
- Non-absorption of oral drugs
- Uncontrolled symptoms with oral medications
Doses – as per individual drug profiles.
Compatibilities as per Syringe Driver Compatibility Chart.
Subcutaneous infusions are commonly used in palliative care, either in patients who are unable to take or tolerate oral medications, or during the terminal phase. If starting an infusion, consider which drugs are best included, as it can be a good way of reducing the tablet burden.
Subcutaneous Bolus Medications
- While titrating medications subcutaneous boluses may be prescribed regularly 4 – 6 hourly and/or prn. These should be given via the side port of the Saf-t-intima™ or via an Insuflon™.
- Boluses being given as breakthrough medications while an infusion is running can be given slowly via the side port of the Saf-t-intima™ and NO flush need be given before or after the bolus. The infusion does not need to be stopped while the bolus is given.
- If intermittent boluses are being given via Saf-t-intima™ where no infusion is running, a flush of 0.3 ml of saline should follow the medications to ensure the entire drug enters the subcutaneous space. If more than one drug is being given at the same time, one bolus following the last medication is sufficient.
- If intermittent boluses are being given via an Insuflon™ NO flush is required.
- If patients have a continuous infusion running and are also requiring several intermittent boluses of medications (i.e., more than 3-4 per day), it is preferable to have an Insuflon™ inserted for the administration of breakthrough boluses – this allows more effective absorption of both the infusion and bolus medications.
Note: Cyclizine must not be given as a subcutaneous bolus – it must be given in an infusion as it causes skin irritation and abscess formation.
Topic Code: 4151