Intermittent subcutaneous injections for symptom control in hospice care: a retrospective investigation

An alternative route to oral medications used by some hospice programs is intermittent injections of medications using an indwelling subcutaneous butterfly needle. The nurse places the infusion sets and instructs caregivers on medication administration. Although this method has become more common in hospice care, it has not received much attention in part because of a lack of data to support its efficacy. This study describes the use of intermittent subcutaneous medications for symptom relief in a home hospice program. A chart review was conducted of the 191 patients who received medications by this route during three calendar years; 77% had cancer. The average duration of hospice care was 25 days; on average, intermittent subcutaneous medications were instituted 4 days prior to the patient's death. The main indications for this route were inability to swallow/somnolence (65%), and pain unresponsive to oral medication (19%). Symptoms to be controlled by this method were pain (88%), anxiety (72%), and dyspnea (4%). Morphine was used most frequently for pain, and Ativan was used most frequently for anxiety. Side effects from the medications and problems with this route of administration were rarely reported, thereby supporting the practicality of this method in hospice care. These results form the foundation for a prospective study that is documenting staff, patient, and caregiver variables that impact on the effectiveness and manageability of this method of symptom management in hospice care.