title: Diluent choice for subcutaneous infusion: a survey of the literature and Australian practice.
abstract: Continuous subcutaneous infusion is a method frequently used in palliative care to manage patient symptoms. To deliver the dose required and prevent subcutaneous sites from becoming inflamed and painful, the drug is often diluted in a solution, most commonly sterile water for injection or sodium chloride. The use of sterile water for injection has been recommended for cyclizine yet beyond this example there appears to be limited clinical direction regarding diluent selection. Inconsistency or lack of guidelines can be problematic if a diluent that may enhance the effectiveness of a drug compared with an alternate is not used because of lack of knowledge or guidance. This investigation considered existing literature, drug databases and directories, and involved a survey of palliative care services to examine evidence and experience relating to diluent selection. A number of inconsistencies emerged in both the literature and practice. With the exception of five drugs for which only saline was recommended, there appeared to be an inclination to use water unless contraindicated. Given an increasing reliance on this method of symptom management, the absence of formal clinical evidence or recommendations and ambiguity in relation to the use of diluents highlights the need for these deficits to be addressed as quickly as possible.
authors.affiliation: Royal District Nursing Service (RDNS), Helen Macpherson Smith Institute of Community Health, 31 Alma Road, St Kilda, Victoria 3182, Australia. eflowers@rdns.com.au
authors.forename: Charne
authors.initials: C
authors.lastname: Flowers
authors.forename: Fiona
authors.initials: F
authors.lastname: McLeod
mesh_terms: D001315:Australia; D007262:Infusions, Intravenous / Q000379:methods*; D010166:Palliative Care; D012996:Solutions
chemical_list: D012996:Solutions