Skill 17

Continuous Subcutaneous Infusion

The continuous subcutaneous infusion (CSQI or CSCI) route of medication administration is used for selected medications (e.g., opioids, insulin). The route is also effective with medications to stop preterm labor (e.g., terbutaline [Brethine]) and to treat pulmonary hypertension (e.g., treprostinil sodium [Remodulin]) (Box 17-1). One factor that determines the infusion rate of CSQI is the rate of medication absorption. Most patients can absorb 3 to 5 mL/hr of medication (Infusion Nurses Society [INS], 2011ab; Justad, 2009).

Box 17-1

Benefits Associated with Pain Management Delivered by Continuous Subcutaneous Infusion

▪ Benefits patients with poor venous access.

▪ Provides pain relief to patients who cannot tolerate oral pain medications.

▪ Allows patients greater mobility.

▪ Onset of action takes about 20 minutes.

▪ Better pain control than IM injections.

▪ Costs are almost half of costs associated with IV infusions.

IM, Intramuscular; IV, intravenous.

Modified from Ellershaw J, Wilkinson S: Care of the dying, ed 2, Oxford, 2010, Oxford University Press.

Use a small-gauge (25 to 27) winged butterfly intravenous (IV) needle or special commercially prepared Teflon cannula to deliver medications. Use the needle with the shortest length and the smallest gauge necessary to establish and maintain the infusion.

Use the same anatomical sites as for subcutaneous injections (see Skill 71), as well as the upper chest. Site selection depends on a patient’s activity level and the type of medication delivered. Always avoid sites where the pump’s tubing could be disturbed. Rotate sites used for medication administration at least every 2 to 7 days or whenever complications such as leaking occur (INS, 2011ab).