Subcutaneous administration/morbidly obese

[Darknights]

Hi,

I found a subcutaneous butterfly (I don't know what you call them in the U.S) inserted in the centre of a large abdo flap on an extremely morbidly obese patient. It was placed there for prn administration of morphine, particularly before transfers were attempted. I commented that perhaps the upper chest or arm would be better placement. Nursing staff said there was no difference between absorption from the subcutanous region of a morbidly obese pt than any other pt.

I've attempted to find information about this but there seems to be a lack of actual studies done on it. There are some suggestions the subcutaneous route shouldn't be used in a morbidly obese pt due to erratic and delayed absorption. Does anyone know if there is anything definitive about this?

[iluvivt, BSN, RN]

Did the patient getting adequate pain relief with the catheter in this location? That will give you the most accurate information for the patient as well as accounting for the other factors that affect pain relief.This is called hypodermoclysis and is actually a very old method for administration of IV fluids and certain medications. Yes an individuals circulation may not be as good in excessively "fat" areas especially when you first initate the infusion. I tend to pick the lower quadrants and the thigh. Its not an area of practice with a lot of studies since it is a tried and true method with low risk for complications.

[Darknights]

She was a difficult case. When she moved in bed she screamed. If we touched her she screamed. So we told her she'd have to get herself up as she knew what she could tolerate. We administered the morphine and she immediately slowly got up. She was concentrating so hard on getting out of bed and standing up she didn't seem to notice or experience pain. We knew the morphine wouldn't have had a chance to even start to work within those few minutes though.

We actually use hypodermoclysis a lot. Our ward has many elderly patients and over summer in the outback we get many admissions due to dehydration. Recent studies suggest it is a great mode of rehydration for mild to moderate dehydration in the elderly. It is certainly much easier to keep a butterfly in a patient's back than to save an IVC on their arm.

We also administer many drugs for all our palliative patients via a butterfly, left insitu normally for a week. We avoid areas that are oedematous, or ascites, and don't use the thigh when they are close to dying as the mottling of their legs indicates circulation is compromised.

[iluvivt, BSN, RN]

They do make special little sets for this and they are very handy. I am sure you know that you can also use a small IV catheter