Fonzo-Christe Caroline, Vukasovic Caroline, Wasilewski-Rasca Anne-Florence, Bonnabry Pascal
University Hospitals of Geneva (HUG).
Palliat Med. 2005 Apr;19(3):208-19. doi: 10.1191/0269216304pm1006oa.
Survey of subcutaneous drug use and hypodermoclysis with a standardized questionnaire to 27 nursing teams and 52 physicians in a geriatric hospital department (404 beds). Evaluation of license status (CH, F, D and UK) and systematic literature review of 34 drugs used in the geriatric setting.
Subcutaneous route is used daily with drugs and fluids mostly for patients in palliative care (83%) or who are dehydrated (54%) when oral or IV administration is impossible (73%, 68% respectively). Morphine (98%), haloperidol (90%), furosemide (69%) and hydromorphone (56%) by bolus (36%) or slow injection over 5 min (82%) are the main drugs used and NaCI 0.9% (95%), and glucose 5%/NaCI 0.9% (31 %) are commonly used for rehydration. Among the 34 drugs reviewed, only 13 (38%) are licensed for subcutaneous use in CH, UK, F or D, and only, morphine (14 articles of 68) and rehydration (six articles) are evaluated in high level studies. Haloperidol and furosemide are used off-label and there are no well-designed studies supporting their subcutaneous use.
There is a lack of information on drugs widely used by subcutaneous route in the elderly. In that context, physicians carry responsibility for the prescription.
采用标准化问卷对一家老年医院科室（404张床位）的27个护理团队和52名医生进行皮下用药和皮下输液情况调查。评估药品许可状态（瑞士、法国、德国和英国），并对老年患者使用的34种药物进行系统文献综述。
皮下途径每日用于给药和补液，主要针对姑息治疗患者（83%）或无法进行口服或静脉给药（分别为73%、68%）的脱水患者（54%）。主要使用的药物包括吗啡（98%）、氟哌啶醇（90%）、呋塞米（69%）和氢吗啡酮（56%），给药方式为推注（36%）或5分钟缓慢注射（82%），常用的补液溶液为0.9%氯化钠（95%）和5%葡萄糖/0.9%氯化钠（31%）。在综述的34种药物中，只有13种（38%）在瑞士、英国、法国或德国获得皮下使用许可，只有吗啡（68篇文献中的14篇）和补液（6篇文献）有高水平研究进行评估。氟哌啶醇和呋塞米为超说明书用药，且没有设计良好的研究支持其皮下使用。
缺乏关于老年人广泛使用的皮下用药的信息。在此背景下，医生对处方负责。
