Continuous subcutaneous infusions (CSCIs) in palliative care

Queensland Health, 2021 Wilcock A, 2020

Continuous subcutaneous infusions (CSCIs) are useful for patients requiring frequent intermittent subcutaneous dosing to manage their symptoms. CSCIs are achieved by using a small portable pump (often referred to as a syringe driver) that delivers a drug solution from a syringe through a subcutaneous cannula, generally over 24 hours. Healthcare professionals should be familiar with the device(s) available to them. Advice on how to use CSCI pumps is available from most specialist palliative care and district nursing services. Advantages and disadvantages of using a CSCI in palliative care are included in Advantages and disadvantages of using a continuous subcutaneous infusion (CSCI) in palliative care.

Table 1. Advantages and disadvantages of using a continuous subcutaneous infusion (CSCI) in palliative care
Advantages	Disadvantages
continuous delivery of drugs for symptom management	patient and carer fear that it is a last resort
increased patient comfort by decreasing the need for repeated intermittent injections	training is needed for healthcare professionals, patients and carers
ability to give a combination of drugs using one device	occasional technical problems, such as a flat battery or a leaking connection
can be used in the community	potential to take away a patient’s sense of control because they are unable to manage their own medications
patient mobility—the lightweight device can be worn in a holster	mobile patients may find it inconvenient to carry the device
convenience—the syringe is usually filled once daily	showering or bathing can be difficult because the device needs to be kept dry

Before starting a CSCI, it is important to describe its use to the patient and carer. Explain that a CSCI is an effective method of administering drugs continuously to manage symptoms and it should not be perceived as a ‘last resort’.

When starting a CSCI, it will take some time for the drug to take effect. Intermittent doses of the drug may be required for symptom management in the first 4 to 6 hours of infusion.

For a patient previously taking regular doses of an oral modified-release opioid, an overlap with the CSCI is needed to ensure continuity of analgesia. It is generally recommended that the CSCI be started 4 hours before the due time of the next dose of modified-release opioid. This timeframe may vary depending upon the clinical situation. Contact the local specialist palliative care service for individual patient advice.