Authors (including presenting author) :
Ng LY(1), Law TL(1), Kong TYK(1), Kwong MC(1), Lai BK(1)
Affiliation :
1) Palliative care(nursing), Central Nursing Division, Queen Elizabeth Hospital
Introduction :
Subcutaneous infusion is a well-established method for symptom management in palliative care(PC). However, its implementation in non-PC environments remains limited. Integrating this practice can significantly benefit patients needing PC service (Broadhurst et al.). In response to this gap, the nursing guidelines on the management of subcutaneous infusion were established in May 2023 within the Kowloon Central Cluster (KCC). Workshops focusing on insertion techniques and related nursing care were conducted. This initiative aims to enhance symptom management, improve patient comfort, reduce complications associated with intravenous therapy, and promote the integration of PC practices across various healthcare settings.
Objectives :
The primary goal of the workshops is to enhance nurses' competencies in acute care settings regarding subcutaneous cannula insertion and related care. This training aims to improve symptom control and promote comfort for patients shared care by PC nurses through effective medication and hydration delivery while minimizing risks associated with intravenous therapy and catheter-related infections. This is especially relevant for end-of-life patients with compromised vascular access.
Methodology :
From July 2023 to December 2024, six workshops were conducted quarterly. Each session included lectures on essential knowledge about subcutaneous infusion, followed by multiple-choice questions (MCQs) to assess participants' understanding. Skill demonstrations and assessments were integral to the program, with nurses guided in performing subcutaneous cannula insertions under the supervision of palliative care nurses for patients requiring symptom control or rehydration.
Result & Outcome :
A total of 103 nurses from various departments participated in the workshops. All participants successfully passed the MCQ and skill assessments. Since the workshops began, 30 patients received subcutaneous opioid infusions for pain and dyspnea management. Of these, 26 had cannulas inserted by ward nurses under supervision, while 4 were inserted by trained ward nurses. The infusion duration ranged from 0 to 22 days, with a mean of 3.8 days. No catheter related complications were reported; 29 patients have since passed away, and 1 transitioned to hospice after weaning off opioids. With established guideline, workshops and practices, healthcare professionals can ensure high-quality care for end-of-life patients and promoting a shared care model within acute hospitals. In summary, the integration of subcutaneous infusion into non-palliative care settings not only enhances symptom management and patient comfort but also reduces complications and improves overall care coordination.
