Note: This guideline is currently under review.  

This guide was created as part of the Clinical Guideline (Nursing): Subcutaneous Catheter devices; Management of Insuflon ™ and BD Saf-T-Intima™ devices

Equipment

• Medication to be administered as ordered on the patient’s Medicine Chart (MR690/A)
• Appropriate sized syringe for drawing up medication
• 19G (drawing up) needle
• 27G (or smaller) needle
• 1ml syringe
• Alcohol swab
• Sharps container

NB: Ensure all medications given are recommended for subcutaneous use
Medications should be administered as per the Royal Children’s Hospital Medication Management Procedure http://ww2.rch.org.au/policy_rch/index.cfm?doc_id=6570

Procedure

1. Perform hand hygiene and assemble equipment
2. Utilise an aseptic technique and non sterile gloves (if indicated) for medication preparation and administration
3. Draw up medication as ordered in accordance with the Royal Children’s Hospital Medication Management Procedure http://ww2.rch.org.au/policy_rch/index.cfm?doc_id=6570
4. Remove the 19G (drawing up) needle and replace with a 27G (or smaller) needle for administration of medication
5. Explain the procedure to the child (if appropriate) and parents/caregivers
6. Clean the hub of the Insuflon™ with an alcohol wipe and allow to dry
7. Insert the needle fully into the Insuflon™ hub whilst rotating gently
8. Administer the medication slowly over 30 seconds, to prevent irritation
9. Observe the insertion site whilst administrating medication ( look for signs of blanching or redness as examples, may indicate that site is no longer appropriate for subcutaneous medications)
10. Remove the needle and syringe post administration of medication
11. Dispose of needle and syringe in a puncture-resistant, leak-proof sharps container
12. Complete appropriate documentation; all medications administered should be documented on the patient’s Medicine Chart (MR690/A)

Flushing medication

• As the dead space volume of the Insuflon™ catheter is approximately 0.0075 ml, it is unnecessary to flush the Insuflon™ before or after use
• If the Insuflon™ is to be removed post administration of subcutaneous medication, a minimum of 15-30 minutes should occur

Other considerations

• Some medications medications may cause pain at the site whilst injecting (as examples GCSF and heparin). Consider:
  • gently rubbing/”tickling” the site whilst administering the medication
  • applying ice to the site for 5 minutes prior to injecting the medication
  • distraction techniques for the patient such as blowing bubbles may also be appropriate
  • the application of Angel/Emla cream prior to injecting the medication via the indwelling subcutaneous catheter device should not be required

• When two different subcutaneous medications are to be administered, it is recommended that two different Insuflon™ devices are inserted (ie a separate Insuflon™ should be used for each medication). The two Insuflon™ devices should not be placed in the same areas, for example it is preferable that each Insuflon™ should be placed on a different limb, or alternatively opposite sides of the abdomen

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