Subcutaneous Administration of Medications and Fluids by Nonprofessional Caregivers at Home

Campos, Luísa; León, Marta; Bastidas, Alirio; Consuegra, C.; Umbacia, María Alejandra; García, Andrea; Rodrígues, Danny; Bruera, Éduardo

doi:10.1089/jpm.2022.0107

Cited by 9 publications

(1 citation statement)

References 17 publications

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“…CAH has been given subcutaneously (hypodermoclysis) [ 42 , 49 – 51 ], intravenously [ 52 ], via nasogastric tube/gastrostomy, and rectally (proctoclysis) [ 46 , 47 ], in the home and similar settings. Importantly, non-professional carers (family) have been able to administer the CAH in these settings (when appropriate and with relevant training) [ 46 , 47 , 50 , 51 ]. All patients receiving clinically assisted hydration should be regularly reassessed.…”

Section: Resultsmentioning

confidence: 99%

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

Hayes,

Bruera,

Crawford

et al. 2024

Support Care Cancer

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Purpose The provision of clinically assisted hydration (CAH) in patients with advanced cancer is controversial, and there is a paucity of specific guidance and so a diversity in clinical practice. Consequently, the Palliative Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the use of CAH in patients with advanced cancer. Methods This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials, respectively. Results Due to the paucity of evidence, the sub-group was not able to develop a prescribed guideline, but was able to generate a number of “expert opinion statements”: these statements relate to assessment of patients, indications for CAH, contraindications for CAH, procedures for initiating CAH, and reassessment of patients. Conclusions This guidance provides a framework for the use of CAH in advanced cancer, although every patient requires individualised management.

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Section: Resultsmentioning

confidence: 99%

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

Hayes,

Bruera,

Crawford

et al. 2024

Support Care Cancer

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Ketamine subcutaneous continuous infusion for depressive symptoms at home: A case report beyond pain use

Simões,

Julião,

Calaveiras

et al. 2024

Pall Supp Care

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Objectives Ketamine has been widely used in refractory pain as an opioid adjuvant. Evidence suggests that ketamine can also have an essential role in easing depressive symptoms. Its rapid onset of action makes it a valuable choice in palliative care. Methods We present a case of a 70-year-old man with stage IV renal carcinoma and bone metastasis. The main symptoms included neuropathic pain, depression, and a persistent and severe desire for death. Results We started continuous subcutaneous infusion with morphine 30 mg and ketamine 100 mg/day. The dose of ketamine was incremented to the maximum of 250 mg/day. During the 28-day treatment, we observed an overall improvement in neuropathic pain, depressive symptoms, and other end-of-life psychological aspects of distress. Only minor psychological side effects were identified, which were controlled by using midazolam in the continuous subcutaneous infusion. Significance of results Some studies have already demonstrated the benefits of ketamine use in alleviating depression, using parental infusion or oral formulas, which are administered in hospice care. Our report enhances the benefit of the subcutaneous route for palliative patients cared for at home.

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Symptom management for people with advanced dementia who are receiving end of life care

Drummond,

Johnston

2024

Curr Opin Support Palliat Care

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Purpose of review This review aims to synthesise contemporary research on symptom management for people with advanced dementia who are thought to be in the final year of life. It highlights the unique challenges faced by palliative care and dementia care specialists, offering insights into the clinical decision-making required to support those with advanced dementia in various care settings. Recent findings Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Pain, breathlessness, and psychological distress are frequently mismanaged, which contributes to suboptimal care. Moreover, the unpredictable trajectory of dementia complicates the identification of end-of-life needs, which can result in fragmented care. Caregivers, both professional and family, struggle with managing complex symptoms, while family caregivers in home settings face added burdens in providing care without sufficient support. Summary Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.

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Subcutaneous Administration of Medications and Fluids by Nonprofessional Caregivers at Home

Cited by 9 publications

References 17 publications

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

Ketamine subcutaneous continuous infusion for depressive symptoms at home: A case report beyond pain use

Symptom management for people with advanced dementia who are receiving end of life care

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