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Next Reply: Re:SQ opioid infusion policy
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Post SQ opioid infusion policy
Author: hollimartinez
Date: Mar 12, 2008 12:58 pm
We are in the process of implementing 2 swing beds on one of our medicine floors to devote to palliative care patient and their families. We are interested in utilizing the SQ route for opioid administration, however, our hospital does not have a policy on this, thus does not support it's use.

Would those units/programs using this route for opioid infusion be willing to share their policy? Any assistance you all could share would be extremely appreciated.


Many thanks,
Holli Martinez MSN, APRN, FNP
University of Utah Palliative Care Services
Replies: order by [Date] [Author] [Subject]
Re:SQ opioid infusion policy (by sutton on 03/13/2008)
I would also be very interested in viewing policies for sq infusions. Thank you.
Re:SQ opioid infusion policy (by smuchka on 03/17/2008)
Here is our policy from The Medical College of Wisconsin/Froedtert Hospital in Milwaukee.
Purpose: To provide a consistent method of administration of analgesics subcutaneously.
Definitions: Analgesics via the SQ route are usually chosen when the patient cannot tolerate oral medications, when there is no functional IV available, and IV fluids are not needed. No more than 2cc IV fluid may be infused or be injected in one hour.
Equipment: Butterfly needle (25g - 27g)
Chloraprep
Tape
Transparent IV dressing
Gloves
PCA tubing and PCA machine

Procedure:
A. Verify order for analgesic therapy and order appropriate concentration of drug from pharmacy.
B. Explain procedure to patient and/or significant other and provide privacy if necessary.
C. Wash hands.
D. Attach butterfly needle to PCA tubing and the drug being used. Prime tubing and needle.
E. Don gloves.
F. Select site on anterior chest wall, leg, over scapula, abdomen, thighs, or outer upper arms that are free of lesions, edema, inflammation, bruises and veins.
G. Cleanse selected site with a Chloraprep.
H. With nondominant hand, pinch skin to evaluate SQ tissue. With dominant hand, insert needle, bevel down, into the SQ tissue at a 20-30 degree angle. Aspirate to ensure no blood return is present. If blood return present remove needle and start pro-cedure over at another site.
I. Secure needle and apply transparent dressing.
J. Loop IV tubing and secure with tape.
K. Label dressing with time, date and your initials.
L. Initiate pain flow sheet following PCA policy.
M. Observe site every 4 hours for excessive swelling, erythema, or displacement of needle.

References: Cope, D.G., Ezzone, S.A., Hogle, M.E., McCorkindale, D.J., Moran, A.B., Sanoshy, J.K., Winkelman, L.A., Camp-Sorrell, D. (Ed.). (2004). Oncology Nursing Society: Access Device Guidelines: Recommendations for Nursing Practice and Education. 2nd ed. Pittsburgh PA.

Posted by:
Sandra Muchka, RN, MS, APNP
Clinical Nurse Specialist, Palliative Care
Medical College of Wisconsin/Froedtert Hospital
Palliative Care Leadership Centers

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