Note: This guideline is currently under review.

This guide was created as part of the Clinical Guideline (Nursing): Subcutaneous Catheter devices; Management of Insuflon ™ and BD Saf-T-Intima™ devices

Equipment

• Appropriate size syringe for drawing up medication(s)
• 19G (drawing up) needles
• Vial of Water for Injection or 0.9% Normal Saline – used to dilute medication as required, check for drug compatibilities
• Appropriate size luer lock syringe that is compatible with the pump device being used. For the majority of patients a 10ml luer lock syringe will be sufficient. Compatible syringes for Niki T 34 syringe driver include 10ml Braun Omnifix or a 30ml Braun Omnifix
• 75 cm minimum volume extension tubing
• Red cap
• Sharps container

NB: Medication to be administered as ordered on the patient’s Medicine Chart (MR690/A) please note that more than one drug may be added to the same syringe, please see drug compatibilities for guidance at http://www.appm.org.uk/10.html

Ensure all medications given are recommended for subcutaneous use.

Medications should be administered as per the Royal Children’s Hospital Medication Management Procedure http://ww2.rch.org.au/policy_rch/index.cfm?doc_id=6570
Review the symptom management plan provided by the Palliative Care Team if appropriate.

Procedure

1. Perform hand hygiene and assemble equipment
2. Utilise an aseptic technique and non sterile gloves (if indicated) for medication preparation and administration 
3. Draw up medication as ordered in accordance with The Royal Children’s Hospital Medication Management Procedure http://ww2.rch.org.au/policy_rch/index.cfm?doc_id=6570
4. Attach the luer lock syringe containing medication and diluent to a 75cm minimum volume extension tubing. Do not use smart sites
5. If using a NikiT34 pump follow instructions for priming of line (following the steps as outlined in Day 1for a new infusion or change in medication type or dose
6. Prepare and explain the procedure to the child (if appropriate) and parents/caregivers
7. Clean the injection port with an alcohol wipe and allow to dry. Remove the red cap from the straight arm of the BD Saf-T-Intima^TM and attach primed line to the BD Saf-T-Intima™. Do not use smart sites
8. If changing the syringe with no dose change, please follow steps as outlined in Day 2,3 of the instruction sheet, the minimum volume extension line does not need to be changed
9. Observe the insertion site whilst commencing the infusion ( look for signs of blanching or redness as examples, which may indicate that the site is no longer appropriate for subcutaneous medications)
10. Ensure there is a red cap on the Y injection port of the BD Saf-T-Intima™. Do not use smart sites
11. Dispose of any waste in the appropriate containers
12. Complete appropriate documentation; all medications administered should be documented on the patient’s Medicine Chart (MR690/A)

Other considerations

• The dead space volume of the BD Saf-T-intima™ catheter is approximately 0.25 mls. Please note that it will take approximately 30 minutes for the medication to reach the patient; it may be necessary to give bolus/breakthrough doses of medications during this period.
• When using the BD Saf-T-Intima™ catheter for a continuous infusion, connect the line of the infusion directly to the straight arm of the BD Saf-T-Intima™ and a red cap on the Y injection port. Do not administer breakthrough/bolus doses via this BD Saf-T-Intima™ once the infusion has commenced. Do not use smart sites
• If a BD Saf-T-Intima™ is inserted for a continuous infusion, it is recommended that a second BD Saf-T-Intima™ is inserted to use for breakthrough/bolus doses. The two BD Saf-T-Intima™ should not be placed in the same areas, for example it is preferable that each BD Saf-T-Intima™ should be placed on a different limb, or alternatively opposite sides of the abdomen
• It is best practice to use one BD Saf-T-Intima™ site exclusively for continuous infusion and another BD Saf-T-Intima™ site for breakthrough doses
• Ongoing assessments includes at least four hourly observations of the BD Saf-T-Intima^TM insertion site for potential complications.

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