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Pediatric Palliative Care at Home: A Prospective Study on Subcutaneous Drug Administration
Isabel García-López1, Lourdes Chocarro-González2, Irene Martín-Romero2
1Pharmacy Department (I.G-L., I.M-R.), Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Insights
In pediatric palliative care, subcutaneous drug administration, primarily continuous infusions of morphine and midazolam, is effective for symptom control. However, insertion-site induration is a common complication, particularly with higher infusion rates.
Area of Science:
- Palliative Care
- Pediatric Medicine
- Pharmacology
Background:
- Subcutaneous drug administration is established in adult palliative care.
- Limited scientific literature exists on its application in pediatric palliative care.
Purpose of the Study:
- To document the experience of a pediatric palliative care unit (PPCU) with home-based subcutaneous drug administration for symptom management.
Main Methods:
- Prospective observational study over 16 months.
- Included 15 pediatric patients receiving home-based subcutaneous treatment.
- Analyzed demographic, clinical variables, and treatment details.
Main Results:
- 54 subcutaneous lines were inserted, primarily in the thigh.
- Morphine and midazolam were the most common drugs, administered via continuous infusion.
- Insertion-site induration was the main complication (46.3%), linked to higher infusion rates.
Conclusions:
- Subcutaneous route is feasible for pediatric palliative care symptom control.
- Induration is a key complication requiring further study for prevention.
- Optimized management strategies are needed to minimize subcutaneous line complications.
Context:
The subcutaneous route is a useful alternative for drug administration in palliative care. Although there is scientific evidence on its use in adult patients, the literature in pediatric palliative care is almost nonexistent.
Objectives:
To describe the experience of a pediatric palliative care unit (PPCU) with in-home subcutaneous drug administration symptom control.
Methods:
Prospective observational study of patients receiving home-based subcutaneous treatment administered as part of a PPCU treatment regimen over 16 months. Analysis includes demographic and clinical variables and treatment received.
Results:
Fifty-four different subcutaneous lines were inserted in the 15 patients included, mainly in the thigh (85.2%). The median time of needle in situ was 5.5 days (range: 1-36 days). A single drug was administered in 55.7% of treatments. The most frequently used drugs were morphine chloride (82%) and midazolam (55.7%). Continuous subcutaneous infusion was the predominant administration route (96.7%), with infusion rates oscillating between 0.1 mL/h and 1.5 mL/h. A statistically significant relationship was found between the maximum infusion rate and induration onset. Of the 54 lines placed, 29 (53.7%) had an associated complication requiring line removal. The primary cause for removal was insertion-site induration (46.3%). Subcutaneous lines were mainly used to manage pain, dyspnea, and epileptic seizures.
Conclusion:
In the pediatric palliative care patients studied, the subcutaneous route is most frequently used for administering morphine and midazolam in continuous infusion. The main complication was induration, especially with longer dwell times or higher infusion rates. However, further studies are required to optimize management and prevent complications.
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