Ambulatory infusion devices in the continuing care of patients with advanced diseases

Until recently, patients who required hydration or parenteral administration of narcotics or antiemetics remained in hospitals until death. The period of admission, which varied between days and months, resulted in a decreased quality of life for the patient and family. With the development of portable infusion pumps, patients with these needs can now be safely discharged home for long periods of time, thereby significantly reducing the cost of medical care and improving quality of life for patients and families. The demonstration that the subcutaneous route is safe and effective for the administration of narcotics, antiemetics, and fluids has made home discharges particularly easy and simple. New devices even allow patients to self-administer extra doses of narcotics when needed. Each institution needs to carefully consider the different infusion devices available before starting a home parenteral administration program. The most important factors to consider are cost, health professional education, patient and family education, a system of monitoring in the home and safety. The high cost of portable pumps and supplies are a major obstacle for the establishment of large programs for home parenteral drug administration. More research is needed to better characterize the pharmacokinetics of different drugs when administered subcutaneously, and to develop simpler and more effective portable infusion devices. The results of this research will have a major impact on the quality of life of patients and their families.