The current evidence base for the feasibility of 48-hour Continuous Subcutaneous Infusions (CSCIs): a systematically-structured review.


Year:

Session type:

Theme:

James Baker1,Andrew Dickman2,Stephen Mason2,John Ellershaw2
1Royal Liverpool and Broadgreen University Hospitals NHS Trust,2Marie Curie Palliative Care Institute Liverpool

Abstract

Background

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 compromised1. At present, current practice is to limit syringe driver infusion time to a maximum of 24 hours as dictated by available chemical and microbiological 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 utilisation2.

This systematically-structured review following PRISMA guidelines aimed to examine and present the current evidence base for the stability of 48 hour multiple-drug syringes/CSCIs and/or use of them in current clinical practice.

Method

Three electronic databases (CINAHL, EMBASE, and MEDLINE) and the grey literature were searched with no time limits. Empirical studies published in English reporting data on the physicochemical stability of continuous subcutaneous infusions or solutions stored in polypropylene syringes were included. The full-text articles included in this review were assessed against a modified version of a data extraction template suggested by Hawker et al3.

Results

Ten studies were included in this review reporting the chemical compatibility and stability of 51 different combinations of 12 drugs Of the 51 combinations, 25 used drugs and concentrations relevant to UK clinical practice. All 51 combinations reported were assessed as being chemically compatible 48 hours at ambient temperatures (20-26°C). The greatest risk of clinically significant chemical degradation was observed with midazolam. Only one study reported the microbiological stability of the solution examined.

Conclusion

There 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.