Help with Starting a subcutaneous PCA

[KarangRN]

I hope these are not stupid questions but here goes hehe:

When starting a subcutaneous infusion, can you use both a regular IV catheter and the butterfly IV catheter?

At our facility we have both the BD Insyte Autoguard IV start catheter and the BD Safety Intima (butterfly). Keep in mind that we do not have a specific policy for subcutaneous infusions but only a broad infusion policy from our pharmacy. We have an end of life resident at our facility and we are having some difficulty controlling her pain (she is currently on fentanyl patch 175mcg and roxanol 1m qhour prn). The idea for SUBQ PCA came up and I want to have as much information as possible before we cross this bridge with the IDT.

My second question is that comes from the literature that I have read when priming a subcutaneous infusion. You cannot prime the Autoguard until you retract the needle and you cannot prime the Safety Intima until you unscrew and pull the needle with the safety device. How do you prime these sets with either IVF such as NS or morphine sulfate if you are doing SUBQ PCA infusions? Is it ok to have some air in the line prior to attaching the IV tubing with the Safety Intima butterfly catheter before starting the infusion?

I've started tons of peripheral IV's in frail and elderly residents. Is it more or less difficulty than that?

Thank you! Any information would be appreciated.

[morte, LPN, LVN]

what you need is a Huber needle, a needle that has a 90' bend....commonly used to access ports, also used for subcutaneous access....good luck

[KarangRN]

Thank you, its been a while since we've had someone with with a portacath but I know we have some huber needles in our IV cart.

[morte, LPN, LVN]

i think they come in different lengths....if the patient is very thin, you prob want the shortest you can get, good luck

[shrinky]

They are really easier to start than an IV but the needle we have used is made specifically for use with subq infusion devices and we usually get them from the infusion company that mixes our drugs and supplies the infusion pump. They are very thin, tiny needles that you can insert into the thigh or abdomen and I've used them in the arm for infusion. How are you getting the meds and are you using a pump for the PCA infusion? We have usually changed the site every three days but that may be the policy of our infusion company. The needles have an adhesive around the wings to help hold them in place as well as a tegaderm over the needle to secure it to the site. Is the patient able to push the button to request the med or will this be a continuous infusion? Hope this helps.:typing

[KarangRN]

The plan is for continuous infusion.

At this point we have the resident on around the clock routine Roxanol and Ativan in addition Fentanyl patch increased to 200mcg and it seems to be keeping her a lot more comfortable. I'm having our pharmacy order those SQ needles in case we do go down that road I'll be ready and have the equipment available.