Use of subcutaneous catheters (SC) in the domiciliary palliative healthcare programme at Fundación Santa Fe de Bogotá.
Uso del catéter subcutáneo (CS) en el programa de cuidado paliativo domiciliario de la Fundación Santa Fe de Bogotá.
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Introduction: Subcutaneous catheters (SC) represent a useful tool for facilitating the domiciliary management of patients suffering from oncological or chronic terminal disease. Materials and methods: The present study reflects the results of an ambidirectional registry which began to collect information about the domiciliary use of SCs in a population of patients who were in a palliative care (PC) program from July 2009 to December 2010. Included variables evaluated the demographic characteristics of the population, the indications and usage profile of SC and their related complications. Each event (placement of a SC) was independently recorded (even if it ocurred in the same patient). Results: A total of 140 interventions were made in 66 patients having a mean age of 64 years (+/-16). They were equally distributed according to gender; 71% of the subjects had a <50% Karnofsky index and only 16% were receiving active oncological treatment, this being more frequent in men (p >< 0.05) and those having less functional compromise (p < 0.05). The most frequent oncological diagnoses were gastrointestinal tumors (28%/42%), genitourinary tract tumors (12%/18%) and primary tumors of the head and neck (5%/8%). The main indication for placing a SC was the administration of opioid and non-opioid analgesics (87%), followed by the management of nausea and vomiting (32%). Mean time for using a SC was 15.8 days (+/-11), the most used site was the infraclavicular region (64%) and the main motive for installing them was to facilitate administering drugs (95%). The therapeutic objective was achieved in 92% of the cases; the end was not achieved in the remaining population due to the procedure being used for controlling tumoral dyspnea (4/5 cases of lung cancer). The complication rate was 35% amongst 128 evaluable cases. Adverse events were associated with the concomitant administration of chemotherapy and/or radiotherapy (p = 0.03), with the ongoing infusion of opioids (p = 0.03), when the main motive was analgesia (p = 0.006), and when SC lasted less than 15 days (p = 0.003). Conclusion: SC is an integral management strategy for patients who are receiving domiciliary PC, having a high benefit-to-risk ratio.
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Hays H. Hypodermoclysis for symptom control in terminal care. Can Fam Physician. 1985;31:1253-6.
Wood A. A new method for treating neuralgia by the direct application of opiates to painful points. Edinb Med Surg J. 1955;82:265.
Lipschitz S, Campbell AJ, Roberts MS, Wanwimolruk S, McQueen EG, McQueen M, et al. Subcutaneous fluid administration in elderly subjects: validation of an under-used technique. J Am Geriatr Soc. 1991;39(1):6-9.
Graham F, Clark D. The syringe driver and the subcutaneous route in palliative care: the inventor, the history and the implications. J Pain Symptom Manage. 2005;29(1):32-40.
Hussain NA, Warshaw G. Utility of clysis for hydration in nursing home residents. J Am Geriatr Soc. 1996;44(8):969-73.
O’Keeffe ST, Lavan JN. Subcutaneous fluids in elderly hospital patients with cognitive impairment. Gerontology. 1996;42(1):36-9.
Remington R, Hultman T. Hypodermoclysis to treat dehydration: a review of the evidence. J Am Geriatr Soc. 2007;55(12):2051-5.
Rochon PA, Gill SS, Litner J, Fischbach M, Goodison AJ, Gordon M. A systematic review of the evidence for hypodermoclysis to treat dehydration in older people. J Gerontol A Biol Sci Med Sci. 1997;52(3):M169-76.
Steiner N, Bruera E. Methods of hydration in palliative care patients. J Palliat Care. 1998;14(2):6-13.
Donnelly M. The benefits of hypodermoclysis. Nurs Stand. 1999;13(52):44-5.
Cerchietti L, Navigante A, Sauri A, Palazzo F. Hypodermoclysis for control of dehydration in terminal-stage cancer. Int J Palliat Nurs. 2000;6(8):370-4.
Frisoli Junior A, de Paula AP, Feldman D, Nasri F. Subcutaneous hydration by hypodermoclysis. A practical and low cost treatment for elderly patients. Drugs Aging. 2000;16(4):313-9.
Lybarger EH. Hypodermoclysis in the home and long-term care settings. J Infus Nurs. 2009;32(1):40-4.
Fonzo-Christe C, Vukasovic C, Wasilewski-Rasca AF, Bonnabry P. Subcutaneous administration of drugs in the elderly: survey of practice and systematic literature review. Palliat Med. 2005;19(3):208-19.
Radbruch L, Trottenberg P, Elsner F, Kaasa S, Caraceni A. Systematic review of the role of alternative application routes for opioid treatment for moderate to severe cancer pain: an EPCRC opioid guidelines project. Palliat Med. 2011;25(5):578-96.
Hernández B, López M, García R. Vía subcutánea. Utilidad en el control de síntomas del paciente terminal. Medifam. 2002;12(2):104-10.
Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial. Ann Intern Med. 1991;114(10):845-54.
McKee JM, Shell JA, Warren TA, Campbell VP. Complications of intravenous therapy: a randomized prospective study--Vialon vs. Teflon. J Intraven Nurs. 1989;12(5):288-95.
Gaukroger PB, Roberts JG, Manners TA. Infusion thrombophlebitis: a prospective comparison of 645 Vialon and Teflon cannulae in anaesthetic and postoperative use. Anaesth Intensive Care. 1988;16(3):265-71.
Camacho M. Strategy in oncology nursing for reducing complications relating subcutaneous catheters. Actual Enferm. 2009;12(2):29-33.
Ripamonti C, Zecca E, De Conno F. Pharmacological treatment of cancer pain: alternative routes of opioid administration. Tumori. 1998;84(3):289-300.
Centeno C, Hernansanz S, Flores LA, Rubiales AS, López-Lara F. Spain: palliative care programs in Spain, 2000: a national survey. J Pain Symptom Manage. 2002;24(2):245-51.
Bosch X. Spain launches national plan for palliative care. BMJ. 2000;320(7243):1162.
Milner PC, Harper R, Williams BT. Ownership, availability, and use of portable syringe drivers among hospices and home-care services. Public Health. 1989;103(5):345-52.
O’Doherty CA, Hall EJ, Schofield L, Zeppetella G. Drugs and syringe drivers: a survey of adult specialist palliative care practice in the United Kingdom and Eire. Palliat Med. 2001;15(2):149-54.
Ibor P, Adriá J, Marín M. Vía subcutánea: una vía de administración alternativa de medicamentos en asistencia domiciliaria a pacientes terminales. Colombia Médica. 2006;37:219-22.
Watanabe S, Pereira J, Tarumi Y, Hanson J, Bruera E. A randomized double-blind crossover comparison of continuous and intermittent subcutaneous administration of opioid for cancer pain. J Palliat Med. 2008;11(4):570-4.
Rocafort J, Centeno C. EAPC Review of Palliative Care in Europe. Milano: EAPC Press; 2008.
National Council for Hospice and Specialist Palliative Care Services. Artificial hydration for people who are terminally ill. Eur J Palliat Care. 1997;4:124.
National Health Service South Gloucestershire. V 1.3. Clinical Guidelines for subcutaneous infusion (hypodermoclysis). South Gloucestershire, United Kingdom: NHS; 2010.
Leno-González D, Leno-González J, Lozano-Guerrero M, Fernández-Romero A. Fundamentos de la administración subcutánea continua y en bolus en cuidados paliativos. Enferm Glob. 2004;3(2):1-12.
Pascual-López L, Sanmartin-Almenar A. Utilización de fármacos por vía subcutánea en cuidados paliativos. Sociedad Valenciana de Medicina Familiar y Comunitaria; 2009. Disponible en: (consulta del 12 de octubre de 2011).
Fernández-Tejedor D. Estudio de la utilización de la vía subcutánea en los pacientes ingresados en una unidad de cuidados paliativos. Rev Enferm CyL. 2010;2(1):2-8.
Centeno C, Rubiales A, Hernansanz S. Hidratación por vía subcutánea en pacientes con cáncer avanzado. Rev Med Univ Navarra. 2008;52(3):3-8.
Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-71.
Raad, II, Bodey GP. Infectious complications of indwelling vascular catheters. Clin Infect Dis. 1992;15(2):197-208.
Lee WL, Chen HL, Tsai TY, Lai IC, Chang WC, Huang CH, et al. Risk factors for peripheral intravenous catheter infection in hospitalized patients: a prospective study of 3165 patients. Am J Infect Control. 2009;37(8):683-6.
Mackillop WJ, Quirt CF. Measuring the accuracy of prognostic judgments in oncology. J Clin Epidemiol. 1997;50(1):21-9.
Knaus WA, Harrell FE Jr, Lynn J, Goldman L, Phillips RS, Connors AF Jr, et al. The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med. 1995;122(3):191-203.
Glare P, Virik K. Independent prospective validation of the PaP score in terminally ill patients referred to a hospital-based palliative medicine consultation service. J Pain Symptom Manage. 2001;22(5):891-8.
Sasson M, Shvartzman P. Hypodermoclysis: an alternative infusion technique. Am Fam Physician. 2001;64(9):1575-8.
Barua P, Bhowmick BK. Hypodermoclysis--a victim of historical prejudice. Age Ageing. 2005;34(3):215-7.
Mercadante S, Ferrera P, Girelli D, Casuccio A. Patients’ and relatives’ perceptions about intravenous and subcutaneous hydration. J Pain Symptom Manage. 2005;30(4):354-8.
Walker J, Lane P, McKenzie C. Evidence-based practice guidelines: a survey of subcutaneous dexamethasone administration. Int J Palliat Nurs. 2010;16(10):494-8.
(Anaes) Agence Nationale d’Accréditation et d’Évaluation en Santé. Recommandations pour la pratique clinique: Guide d’analyse de la littérature et gradation des recommandations. Paris; 2000.
