The current evidence base for the feasibility of 48-hour continuous subcutaneous infusions (CSCIs): A systematically-structured review

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.

Utilizzo di farmaci per via sottocutanea nel paziente terminale. Una breve revisione

“…L'obiettivo della revisione sistematica di Baker et al [23] era di cercare evidenze scientifiche sulla stabilità di soluzioni farmacologiche oltre le 24 ore. Sono stati inclusi 32 studi sperimentali riportanti compatibilità e stabilità di 32 combinazioni di farmaci. Quelli più frequentemente inclusi negli studi erano Aloperidolo, Morfina, Midazolam e Desametasone.…”

Filling Gaps on Stability Data: Development, Validation and Application of a Multianalyte UHPLC-DAD Method to Determine the Stability of Commonly Administered Drugs in Different Carrier Solutions Used in Palliative Care

“…CSCI applications further minimize pricking events which improves the compliance among patients and their relatives [5]. However, there are limited data about the chemical compatibility over at least 24 h of application [6]. [5].…”

“…[5]. However, there are limited data about the chemical compatibility over at least 24 h of application [6].…”