Abstract
BackgroundA continuous subcutaneous infusion (CSCI) is an effective method of multiple drug administration commonly encountered in end of life care when the oral route is compromised. At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. However, the ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation.AimTo examine and present the current evidence base for the stability of 48-hour multiple-drug CSCIs in current clinical practice.DesignA systematically-structured review following PRISMA guidelines.Data sourcesThree electronic databases and the grey literature were searched with no time limits. Empirical studies reporting data on the chemical stability of continuous subcutaneous infusions or solutions stored in polypropylene syringes were included.ResultsTwenty-one empirical studies were included in this review reporting chemical compatibility and stability of 32 discrete combinations of twenty-four drugs tested at a variety of different drug concentrations. The majority of combinations reported were assessed as being chemically compatible. The greatest risk of clinically significant chemical degradation was observed with midazolam. Only one study reported the microbiological stability of the solution examined.ConclusionsThere is currently limited evidence for the physical, chemical and microbiological stability of solutions for continuous subcutaneous infusion over a period of 48 hours. More stability data is required before the use of 48-hour CSCIs can be evaluated for use within clinical practice.
Highlights
With one third of all patients in UK District General Hospitals expected to be in last year of life, end-of-life care is considered one of the key domains of care[1]
A continuous subcutaneous infusion (CSCI) is an effective method of multiple drug administration commonly encountered in end of life care when the oral route is compromised
More stability data is required before the use of 48-hour CSCIs can be evaluated for use within clinical practice
Summary
With one third of all patients in UK District General Hospitals expected to be in last year of life, end-of-life care is considered one of the key domains of care[1]. In the United Kingdom, current practice for the administration of drugs by CSCI is to limit infusion time to a maximum of 24-hours, as a result of the limited availability of chemical and microbial safety data. This has been acknowledged by the Commission on Human Medicines (CHM) who have proposed that research to develop authoritative national guidance be commissioned, and the National Patient Safety Agency’s recommendation that ward-prepared infusions be limited to 24-hour infusion duration[7]. Current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical stability data. The ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation.
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