The Art of Painless Infusions
With proper patient training, site reactions could become a rare occurrence. When adverse effects do occur, patients can experience redness, irritation, leakage, itching, pain, and discomfort.
At RMS, we believe that these reactions could be avoided by using a complete constant pressure system. With the right pieces in place, the patient can experience a comfortable sub-q infusion experience, every time.
Here are 5 key tips to sub-q patient success, from RMS:
1. Selecting the correct flow Rate
Selecting the correct RMS Precision Flow Rate Tubing™ is important when starting SCIg therapy. It may take some trial and error to find which flow rate works best for you/your patients. Patients who experience site reactions may want to try a slower flow rate tubing set.
2. Selecting the proper needle length
If the selected needle is too short and the opening is too close to the dermis, irritation and leaking at the site may occur. The opening of the needle should be well within the sub-q tissue.
Needle length should be determined according to how much sub-q tissue a patient has. 9 mm and 12 mm needles tend to work well with average sized patients (as shown in the image below); while 6 mm needles may be needed for very thin adults and children. Similarly, larger patients may require 14 mm needles. Make sure needles are dry at time of insertion, as leaking needles can cause irritation to the site.
See Swedish study for more info on needle length.
3. Establishing drug volume per site
Volume per site is a key factor to consider, especially because every body-type is different. Patients with more adipose or fatty tissue will be able to accept Ig easier. Thinner patients may experience longer infusion times and more substantial site reactions. You must weigh the volume per site against the subcutaneous tissue you have available to work with. Many times, spreading the volume out to more sites will help keep volume per site low and can eliminate site reactions. RMS HIgH-Flo needles come in 1-6 site sets.
4. Choosing the best site location
The abdomen is the most common place to infuse, but the upper buttocks/side of upper hips, the outer side of the thighs, and the back of the upper arms are also sometimes used. It is important that the site(s) you choose have a good amount of sub-q tissue.
Some medications require that sites be 2+ inches apart, and that needles are inserted at a 90° angle. If and how to rotate infusion sites should be a subject for discussion between the patient and healthcare provider. You may achieve better results by periodically returning to sites that have worked well in the past.
The dressing used also makes a difference. 3M Tegaderm™ dressing releases easily from the skin when removed properly. To release the adhesive, pull and stretch it out horizontally parallel to the skin. Any redness to skin should be only temporary.
5. Inserting needle(s) dry
Be sure to insert your subcutaneous needles dry. IgG or alcohol on the needles tends to irritate the skin. When priming the needle set, make sure to stop the flow about 2″ short of the needle(s).
See study done by Diplomat for more info on dry priming.