Preventing and controlling skin irritation
- Changing the site daily
- Ensure the needle is bevel down
- Reducing the concentration of irritant drugs
- Changing irritact drugs to non-irritant drugs e.g. cyclizine to haloperidol
- Giving irritant drugs separately, PR or IM (levomepromazine can be given as a single daily injection)
- Using Saline rather than water as a diluent (apart from cyclizine)
- Using a small teflon cannula instead of a butterfly needle
- Adding hyaluronidase 1500 units to infusion
- Adding dexamethasone to the infusion, in a dose appropriate to the patients clinical condition. To add dexamthasone, the diamorphine should be made up with as much water as volume calculation allows. Other additions are then made. Dexamethasone is then drawn slowly into the syringe which is inverted a few times to mix.
- Placing a GTN patch over the site of the infusion.
- Placing the needle 1/M, rather than S/C.
© Dr. Eileen Palmer, Dr John Howarth Palliative Care for the Primary Health Care Team (2004) Quay Books ISBN 1856422291