Continuous subcutaneous infusions

  1. 0
    Does your hospice provide continuous infusion in the patient home?
    What subcutaneous device do you use...SQ button, BF, Angiocath? Do you wait to receive a prepared solution and supplies from a pharmacy? Do the nurses prepare the initial infusion in the field and then replace with a pharmacy prepped solution? What is your turn around time for receiving infusions from your pharmacy from order to delivery? Is infusion service available on weekends and after hours?

    What type of delivery devices do you use, syringe drivers or CADD type systems?

    It seems that pharmacy laws are problematic for the nursing prep of SQ infusions in the home hospice setting. However, access to pharmacy services is a significant problem for rural and frontier hospices making delivery of care on that level very difficult.

    What work arounds is your agency using in order to meet the emergent palliation needs of your patients?

    Thank you for your thoughts and comments.
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  3. 10 Comments so far...

  4. 0
    We do not do these I don't know if it is the region I am in, but in 12 years and 3 companies I have seen it done 1-2 times and only in an impatient setting.
  5. 0
    Quote from jeannepaul
    We do not do these I don't know if it is the region I am in, but in 12 years and 3 companies I have seen it done 1-2 times and only in an impatient setting.
    How do you provide relief for your patients who have refractory symptoms not responsive to oral or transdermal meds? Do you have an inpatient unit that you admit to?

    Thanks.
    Last edit by tewdles on Feb 8, '13 : Reason: spelling
  6. 3
    Hi tewdles. I am very new to hospice nursing (as in only for the last few weeks!) but I have seen that we do use continuous infusion in the home pretty regularly with a pump (I believe the brand is Curlin). From what I've seen so far, once the order is placed, the pre-mixed bags and pump are delivered directly to the patient's home within four or five hours (even on the weekends). RN's start the infusion and we also change the SQ site every 3 days (and replace the bags as needed). This is a large non-profit hospice in a metro area. I am so glad that we have this option available for our patients---the relief from a continuous infusion with a bolus option is impressive. It is very important that we get the pump back when the patient passes---I'm told that the pumps are incredibly expensive. I've heard of calls coming from the funeral homes asking what it is and if we want it back....whoops!

    On a side note, I want to say thanks to this board for all of the hospice-related discussion. It really helped me to determine if I should make the change into hospice nursing. So far, I am absolutely loving it!
    Woogy, EquestrianRN, and tewdles like this.
  7. 0
    see above--duplicate post---sorry!
    Last edit by bgd70 on Feb 9, '13 : Reason: duplicate post
  8. 0
    Quote from bgd70
    Hi tewdles. I am very new to hospice nursing (as in only for the last few weeks!) but I have seen that we do use continuous infusion in the home pretty regularly with a pump (I believe the brand is Curlin). From what I've seen so far, once the order is placed, the pre-mixed bags and pump are delivered directly to the patient's home within four or five hours (even on the weekends). RN's start the infusion and we also change the SQ site every 3 days (and replace the bags as needed). This is a large non-profit hospice in a metro area. I am so glad that we have this option available for our patients---the relief from a continuous infusion with a bolus option is impressive. It is very important that we get the pump back when the patient passes---I'm told that the pumps are incredibly expensive. I've heard of calls coming from the funeral homes asking what it is and if we want it back....whoops!

    On a side note, I want to say thanks to this board for all of the hospice-related discussion. It really helped me to determine if I should make the change into hospice nursing. So far, I am absolutely loving it!
    Your experience with these infusions mirrors my early experience with them although we used a different brand (CADD).
    Currently we don't have that level of pharmacy support and we are trying to discover how we might still provide the service.
  9. 0
    Tewdles---this is the company that provides our pumps and infusions. Perhaps you could speak with them to find out if their services are available in your area? Coram - Infusion Services
  10. 0
    We (hospice house) and our field nurses use a CADD pump for subq infusions. During the week we have access to the outpatient pharmacy; weekends we use the hospital pharmacy. We tell the pharmacist what the MD has ordered and then program the pump, get it running ourselves, teach the pt and fam about basal and bolus rates. So far, it has worked well.
  11. 0
    We Also Use Cadd Pump for SQ infusions as well as IV infusions
  12. 0
    CADD 2 pump.
    No in field start, we get entire set up in about 6 hour turn around time.
    SQ button unless there's a port or access like PICC/midline already in place.

    Where you are rural, I would suggest having a field ekit for ivf starts or basic things you can switch back out with the pharmacy so they will not expire costing you money and you will not have issues with needing pharmacy access at odd hours for prescriptions.


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