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Short subcutaneous infusions for symptom control in palliative medicine
  1. Paul Howard1,2,
  2. Sandra Clawson3,4 and
  3. John Curtin1,2
  1. 1Earl Mountbatten Hospice, Newport, Isle of Wight, UK
  2. 2Palliative Care Team, Isle of Wight NHS Trust, Newport, UK
  3. 3Pharmacy, Earl Mountbatten Hospice, Newport, UK
  4. 4Pharmacy, Isle of Wight NHS Trust, Newport, Isle of Wight, UK
  1. Correspondence to Dr Paul Howard, Earl Mountbatten Hospice, Newport, Isle of Wight, UK; paul.howard1{at}


Objectives To investigate the efficacy and safety of short subcutaneous infusions (SSCIs) for refractory symptoms in the palliative setting.

Methods A retrospective chart review of SSCIs in a single palliative care centre over an 18-month period. All clinical notes, medication administration records and infusion monitoring documentation were examined to ascertain therapeutic aim, efficacy and tolerability.

Results 111 patients received one or more SSCIs, 28 in the community and 83 in the inpatient hospice (21% of all admissions). SSCIs were used for a wide variety of reasons including loading doses (to achieve steady state and, thus, symptom relief, sooner), as required doses (for medications too irritant to give as bolus SC injections) and regular maintenance doses (where continuous subcutaneous infusion (CSCI), were unnecessary). 84 single drug SSCIs types and 51 admixtures SSCIs types (2 or more medications) were given. One infusion was poorly absorbed, but SSCIs were otherwise well tolerated.

Conclusions SSCIs appear to be a promising additional option for administering medicines that are too irritant or large in volume for SC bolus injection. For medications with longer half-lives (eg, phenobarbital, valproate, levetiracetam), SSCI loading doses would be expected to achieve steady state and, thus, symptom relief, sooner than CSCIs alone.

  • Drug administration
  • Hospice care
  • Pharmacology

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  • Contributors PH, SC and JC jointly conceived developed clinical guidelines describing the approach; PH collected and analysed the audit data; PH, SC and JC jointly wrote the manuscript. First author: PH, coauthors: SC ad JC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.