Using the subcutaneous route in clinical practice
Keywords:
subcutaneous route, hypodermoclysis, palliative careAbstract
Chronic and palliative patient care must be comfort-centred,
and reduction of suffering must be an effective care goal. In this
clinical context, an alternative to the oral route, for administration
of drugs and fluids is required, in order to reduce suffering and
inpatient admissions. Subcutaneous administration of fluids and
drugs is an excellent choice, often still ignored in our country. In
this article we review the main benefits and characteristics of the
use of the subcutaneous route.
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References
Singer PA, Martin DK, Kelner M. “Quality end of life care: patients’ perspectives “ JAMA 1999; 281:163-168.
Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA., “Factors considered important at the end of life by patients, family, physicians and other care providers “ JAMA 2000; 284:2476-2482
Powis J, Etchels E, Martin DK, MacRae SK, Singer PA, “Can a “good death” be made better? A preliminary evaluation of a patient-centred quality improvement strategy for severely ill in-patients”, BMC Palliative Care 2004 in www.biomedcentral.com
Direcção Geral da Saúde, 2004, “Programa Nacional de Cuidados Paliativos “– Circular Normativa de 13.7
Mantz M, Crandall L., “Palliative care crises in the community: a survey “, J of Palliative Care 2000;16 (4 ); 33-38.
Saunders Y, Ross JR, Riley J, ”Planning for a good death: responding to unexpected events”, BMJ 2003;327:204-206.
Twycross R “Cuidados Paliativos “, Lisboa, Climepsi 2003 2ª edição
Kuhl DR, Verma AK, da Silva JH, “Diuretic effects of subcutaneous furosemide in human volunteers: a randomized pilot study” The Annals of Pharmacotherapy 2004;38:544-549.
Bruera E, Legris M, Kuehn N, Miller M “Hypodermoclisis for the administration of fluids and narcotic analgesics in patients with advanced cancer”, J Pain and Symptom Management 1990;5:218-220.
Steiner N, Bruera E “Methods of hydration in palliative care patients” J of Palliative Care, 1998;14(2):6-13.
Davis MP, Walsh D, LeGrand SB, Naughton M “Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions” Support Care in Cancer, 2002;10(2):117-138.
Storey P, Hill HH, StLouis RH, Tarver EE, “Subcutaneous infusions for control of cancer symptoms“, J Pain and Symptom Management 1990;5:33-41.
Graham F, Clark D, “The syringe driver and the subcutaneous route in palliative care: the inventor, the history and the implications”, J Pain and Symptom Management 2005; 29 (1):32-40.
Pascual López L, Armiñana AP, Saéz AR, “Utilización de la via subcutánea para el control de síntomas en un centro de salud”, Atención Primaria, 2001;28(3)185-187.
Ellershaw J, Wilkinson S, ed., “Care of the dying, a pathway to excellence“,Londres, Oxford University Press 2003.
Marques C, Nunes G, Ribeira T, Santos N, Teixeira R. “Terapêutica subcutânea em cuidados paliativos”; Rev Port Clín Geral, 2005; 21:563-568.
Galvão C, “Utilização da via subcutânea no doente idoso e terminal”; PGMedicine 2005; 23(2).
Barbosa A e Neto IG, ed. Manual de Cuidados Paliativos, Lisboa 2006
Dickman A, Littlewood C, Varga J, “The syringe driver: continuous subcutaneous infusions in palliative care “, Londres, Oxford University Press 2002.
Twycross R, Wilcock, Charleswort S, “Palliative care Formulary“, 2002, Radcliff Medical Press in www.palliativedrugs.com (consultado em Janº 2007).
Doyle D, Hanks GWC, Cherney N, Calman K (eds.), “Oxford Textbook of Palliative Medicine “, Londres, Oxford University Press, 3ª ed.- 2004.
Roemer-Bécuwe C, Vigano A, Romano F, Neumann C, Hanson J, Quan HK, “Safety of subcutaneous clodronate and efficacy in hypercalcemia of malignancy: a nouvel route of administration”, J Pain Symptom Management 2003;26(3):813-818.
Gandhi JS, Patel V, “Delivery of fluids by the subcutaneous route”, Postgraduate Med J 2000;76:453.
Lee L, Headland C, “Administration of as required subcutaneous medications by lay carers: developing a procedure and leaflet“, International Journal of Palliative Nursing 2003; 9(4):142-149.
Macmillan K, Bruera E, Kuehn N, Selmser P, Macmillan A, “A prospective comparison study between a butterfly needle and a Teflon canula for subcutaneous narcotic administration”, J Pain Symptom Management 1994;9(2):82-84.
Ross JR, Saunders Y, Cochrane M, Zeppetella G “A prospective, withinpatient comparison between metal butterfly needles and Teflon cannulae in subcutaneous infusion of drugs to terminally ill hospice patients”, Palliative Medicine 2002;16(1):13-16.
Torre MC “Subcutaneous infusion: on-metal cannulae vs metal butterfly needles”, BR J Community Nurs 2002;7(7):365-369.
Dugas R, “La voie sous-cutanée; une alternative utile en soins palliatifs“, Canadian Family Physician, 2001 Fev., vol 47, 266-267.
Centeno C, Bruera E, “Subcutaneous hydration with no hyaluronidase in patients with advanced cancer” J Pain and Symptom Management 1999 May; 17(5):305-306.
Bruera E, Neumann CM, Pituskin E, Calder K, Hanson J “A randomized controlled trial of local injections of hyaluronidase versus placebo in cancer patients receiving subcutaneous hydration”, Ann Oncol 1999;10(10):1255-1258.
Reymond L, Charles MA, Bowman J, Treston P, ”The effect of dexamethasone on the longevity of syringe driver subcutaneous sites in palliative care patients”, Med Journal Austral 2003;178:486-489.
Herndon CM, Fike DS, “Continuous subcutaneous infusion practices of United States Hospices“, J Pain and Symptom Management 2001; 22:1027-1034.
Verma A, da Silva J, Kuhl DR, “Diuretic effects of subcutaneous furosemide in human volunteers: a randomized pilot study “, The Annals of Pharmacotherapy “ 2004; 38: 544-549.
Regnard C, Hockley J. “A guide to symptom relief in palliative care“, Londres, Radcliff Medical Press 5ª ed. 2004.
Walker P et al. “Subcutaneous administration of cefepime”; J Pain Symptom Management, 2005; 30(2).
Gonçalves JF, Alvarenga M, Silva A, “The last forty-eight hours of life in a Portuguese palliative care unit: does it differ from elsewhere?” J Palliative Medicine 2003; 6(6):895-900.
Pavis H, Wilcock A, “Prescribing of drugs for use outside their licence in palliative care: survey of specialists in the United Kingdom”, BMJ 2001;323 (7311):484-485.
Association for Palliative Medicine and The Pain Society, “The use of drugs beyond licence in palliative care and pain management “; Londres 2002
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