SubQ route for PCA?

[jonear2, RN]

I work in med surg and even with palliative care pts our PCA pumps are always administered IV. Recently my FIL was placed in inpatient hospice and today he was given a PCA pump with the medication being delivered subq. I asked the nurse and she said that she wasnt sure why but that she thought only hospice did this. I was just curious what the thought process is behind the subQ route. I am very interested in Hospice care as a possible future specialty for myself. Any thoughts would certainly be appreciated.

[doodlemom]

If a patient is in the home setting, it is nearly impossible to maintain a peripheral IV. In the hospital when a peripheral line goes bad, you can call the IV team and have a new one placed right away. If an IV site goes bad at home, the nurse has to come out and place another one. Imagine an IV site going bad and going out to replace it and then being called out to the patients home in another few hours because the new one went out. Imagine having to do this when you've got 3-4 other patients that you were needing to see today. Unless a patient has a central line, it is very common in hospice to use a subq site. It's not quite as quick as IV, but it is very effective. I too had never seen this done before I starting working in hospice care.

[RN4hospice]

Hospice promotes comfort by managing pain and uncomfortable symptoms with the most effective, non-invasive techniques. RARELY is an IV route used, due to poor venous access as the illness progresses. SubQ routes are very effective to manage pain when the patient is unable to take oral medications, and other routes of administration is not an option. Our hospice has actually inserted a SubQ butterfly to administer pain medication in a pain crisis, when there was no time to initiate a PCA. You just have to be careful with the amt. of medication (in ml's) that is administered per dose since it is subQ.

[leslie :-D]

subq is the route of choice, esp when po is no longer a viable route.

with veins become progressively torturous and so, inaccessible, subq has proven to be reliable, less invasive (than iv, im) and well tolerated.

leslie

[jonear2, RN]

Thank you all so much for the info. It makes total sense. Thank God his pain is being so well controlled. So far the experience at this hospice has been wonderfully supportive for my fiance and his mother. Again much love to all of you who answered.