Waikato DHB Palliative Care Guidelines

16. Subcutaneous administration of medications

16.1 Subcutaneous bolus medications

If oral medication is not tolerated, consider regular or intermittent subcut injections (via Saf-t-intima™) or a subcut infusion.

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Indications

Severe nausea and/or vomiting.
Dysphagia.
Severe oral lesions.
Unconscious or sedated patient.
Non-absorption of oral drugs.
Uncontrolled symptoms with oral medications.

Doses – as per individual drug profiles.

Link to hospital policy on subcutaneous infusions

16.1 Subcutaneous bolus medications

See also Prescribing of Opioids

While titrating medications subcut boluses may be prescribed prn.

These should be given via the side port of the Saf-t-intima™ .

Boluses being given as breakthrough medications while a pump is running can be given slowly via the side port of the Saf-t-intima™. Do not flush before or after the bolus. The pump does not need to be stopped while the bolus is given.

If intermittent boluses are being given via Saf-t-intima™ where no infusion is running, a flush of 0.3mls of saline should follow the medications to ensure the entire drug enters the subcut space. If more than one drug is being given at the same time, one bolus following all medications is
sufficient.

If patients have a continuous infusion running and are also requiring several intermittent boluses of medications (ie: more than 3-4 per day), it is preferable to have a butterfly inserted for the administration of breakthrough boluses – this allows more effective absorption of both the infusion
and bolus medications.

Information last reviewed: June 2009	Please foward any enquiries about this document to haggars@waikatodhb.govt.nz
Next review date: July 2010	For Palliative Care advice, please call 8691 or the specialist on-call.

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