subQ narcotics?

[khine2mn80]

i 've just came across this subQ morphine injection and its strange to me cos we never give it in this route (in singapore). just wanted to know is it very common in the us? and whats the normal dosage then? thanks

[MsPiggy]

Thanks for all the links NRSKaren! My DIL is in end stage ovarian ca and having lots of pain control issues, just forwarded the links to my son. Hopefully he can discuss this option with her Dr and it might help her get some better pain control.

Ms.P

[NRSKarenRN, BSN, RN]

I'd try fentanyl/Duragesic patches first....if not helping then SQ MSO4 or Dilaudid very helpful. Helped my MIL in her last stage after 10yr battle with Ovarian CA. Hope it helps!

[rehab nurse]

cant remember the manugacturer, however there is a device designed to accomplish this....has a huber needle, with adhesive disc....and a valve, with luer access.....usually placed in the abd fat....good luck

in my area, this is what we refer to as a "button", and yes, i've placed them myself. no different than giving an insulin injection as far as placement of the neeedle/disc, and you just prime the very thin tubing (like iv tubing but very thin) with morphine. however, it's been several years since i've seen this.

we do have liquid morphine, also subq vials available and i have given that subq morphine within the last year to one or two pts.

mainly, people who are on PO meds in my area, but we do, on occ, get hospice pts who have no room anywhere else, as a last resort, and i just actually had one the other day. these pts are on roxanol.

[clemmm78, RN]

Palliative care here. We give morphine and dilaudid S/c all the time. Patients have a patent butterfly and we inject that way. Also versed (medaz) and a myriad of other meds.

It's the only non-PO route we use.

[leslie :-D]

Palliative care here. We give morphine and dilaudid S/c all the time. Patients have a patent butterfly and we inject that way. Also versed (medaz) and a myriad of other meds.

It's the only non-PO route we use.

precisely.

in hospice, we use iv as an absolute last resort.

there's so much out there today; and our pharmacy is so creative in concocting a plethora of meds that can be applied topically, po, rectally-pts have so many routes of administration that there's really no reason to give a med that would hurt or feel invasive.

leslie

[ginger58, ASN, RN]

In palliative care we do a lot of IV narcotics if the pt has an IV. If they don't then we use sublingual morphine if possible. If no IV access then SQ and if a pt is dying an needing frequent pain meds then we will run it continuous SQ infusion. The dose of Morphine or Dilaudid is the same as IV but the the solution is more concentrated for SQ. We have a max of 2 mLs an hour for SQ. I feel that IM injections are unnecessary if the drug can be given another route.

[Megsd, BSN, RN]

I gave SC morphine in clinical this quarter. My partient was a teeny little lady one day post-op who had been stuck and stuck and stuck and each one had blown, so at this point even the IV team couldn't get an IV in her, so they ordered a central line. She was in terrible pain from surgery and the central line person wouldn't be up for hours so we got an order for SC morphine.

[rgroyer1RNBSN, BSN, RN]

In the small hospital I worked in for awhile we had the older docs and they preferred using the subq and IM routes but this is a common practice for the older docs they used to give pain meds this way all the time, and did you know theres also codiene available for subq injection, theres also talwin (pentozocine). I still work there prn every once in awhile in the er and on med surg heck I just gave a subq injection of codiene the other day on med surg to a guy who just had an appendectomy. And to the one whos gen surg floor doesnt give any IV-P how the hell do you guys give meds to a code blue or an emergency.

[Patti 2nd gen RN]

I have worked both inpatient med-surg and now on a rehab unit--as an RN I can give IV push narcotics, the LPN's either get one of us to help, or give it via slower IVPB--As for SC--yes--have given it often--not only in the dying though--sometimes just as a 'boost' until their po med kicks in, or unitil it arrives, as we don't have in-house pharmacy, and a limited supply of med alternatives in our 'back-up'--SC hurts less than IM, and lasts longer, I think d/t less blood vessels--also we have done SC hydration in the elderly who have no more IV access left, or who are less likely to pull something out of their belly than their arm--after a few minutes, they don't feel the needle anymore...

[RNinRubySlippers, BSN, RN]

We use sc meds all the time in palliative patients. why poke them? Iv is not always appropriate adn often swallowing is impaired. What else would you do? Why on earth would we give IM's? HOw awful to give IM's to pall pts and cause them more pain? I dunno, maybe I am newer and this is all I know, but wow, I am suprized more ppl havent sseen this!

Hope you get a chance to see how wonderful it is for patients!

:)

[Rabid Badger, BSN, RN]

I've done morphine, dilaudid SC frequently. Most commonely in the case of dying/palliative patients who require frequent pain control, where an IV is not feasable, and in the interest of saving the patient the pain of frequent pokes.

In the hospital where I did my senior practicum, we set up a SC site inserting a 24g IV cathelon, and an IV extension set. 0.5 cc flush before and after each med injection. Sites need to be change q3d or as needed. At this hospital SC sites are set up using a butterfly.

They're also handy for giving versed and nozinan in a palliative pt in crisis who needs to be snowed.