CONTROLLING PAIN: Is continuous subcutaneous infusion a good route for pain medication?
Yvonne D'Arcy MS, CNS, CRNP

October 2010 
Volume 40  Number 10
Pages 59 - 60
  PDF Version Available!

MARY PETERS, 65, has metastatic cancer that's spread throughout her abdomen. Because of a small-bowel obstruction, she can no longer take her oral analgesics and is experiencing significant pain from her cancer. (She rates it as a 7 on a 0-to-10 pain intensity rating scale, where 10 is the worst pain imaginable.) An enteral feeding tube isn't an option because of recurrent bowel obstructions. Vascular access is very limited and her one functional central venous access device is being used for parenteral nutrition. Although she used fentanyl transdermal patches in the past, they didn't control her pain as well as oral morphine.For this patient with limited vascular access and recurring bowel obstructions, opioid administration via a continuous subcutaneous infusion (CSI) is a good option for pain relief. Safe, effective, and cost-efficient, CSI is becoming an attractive pain management option for patients requiring hospice and palliative care. (See Why CSI?)Patients (and family members when indicated) can be taught to administer CSI and monitor the access site for complications. This article will describe CSI, identify appropriate candidates for CSI analgesia, and discuss proper technique for CSI administration.CSI is a type of patient-controlled analgesia. A small butterfly-type needle is inserted subcutaneously and an opioid is infused using a programmable electronic infusion device. The administration set and pump must be clearly labeled subcutaneous infusion to prevent anyone from mistaking the infusion for an I.V. line.1 The infusion device should have a lockout interval feature, bolus dosing options, and appropriate clinical safety alarms.1 The amount of fluid infused is small—typically 2 to 3 mL/hour.2–4The medication enters the patient's bloodstream by flowing through the spaces between cells in the capillary walls.3 This painless process is facilitated by perfusion, diffusion, hydrostatic pressure, and osmotic pressure.4Subcutaneous

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