Subcutaneous Catheter Device – Insuflon™

Equipment

• Insuflon™ catheter, with dressing supplied

• 2% chlorhexidine/70% alcohol swab

• Blue medication tray

If required:

• Oral sucrose (up to 18 months of age)

• Local anaesthetic cream (e.g. Emla™ if >37 weeks of age)

• Transparent occlusive dressing (e.g. Opsite, Tegaderm)

• Gauze

• ‘Buzzy bee’ (Refer to the guideline for use of the buzzy bee)
  

Procedure

1. Explain the procedure to the child (if age appropriate) and parents/caregivers

2. Select an appropriate insertion site where there is adequate subcutaneous tissue

Commonly used areas include:

Areas to avoid include:

• Skin folds or areas where clothing may rub or constrict the flow of medication in the indwelling subcutaneous device

• Skin that is oedematous, obviously bruised or hard, red, broken or swollen, or infected

• Directly over a tumour or areas that have recently been irritated or irradiated

• Over a bony area or joint

3. If required, apply Emla™ cream on the selected insertion site and cover with a transparent occlusive dressing. Leave for a maximum of 60 minutes prior to insertion.

4. Remove Emla™ cream and transparent occlusive dressing from the site with gauze.

5. Perform hand hygiene and prepare a clean tray with the equipment listed above.

6. Check that the Insuflon™ package is undamaged and within the expiry date. Open the package, and pull the paper lid to remove Insuflon™ and dressing.

7. Perform hand hygiene and put on a pair of non-sterile gloves.

8. Clean the selected insertion site with an alcohol swab and allow skin to dry. For patients sensitive to chlorhexidine/alcohol wipes – clean skin with soap and water.

9. Remove the protection cap on Insuflon™ by pulling the cap while holding on the orange catheter hub between the thumb and the index finger. Attach the cap in the rear of the grip. NB: If infant is under 18 months of age, use distraction techniques or administer oral sucrose immediately prior to insertion. Refer to the guideline for sucrose administration.

10. Pinch the skin at the site of insertion.

11. Hold the Insuflon™ with the bevel up. In one quick smooth movement, insert the full the length of Insuflon™ catheter into subcutaneous tissue at a 20-45⁰ angle to the skin.

NB: Use the Buzzy Bee if required during insertion.

NB: The catheter can peel backwards on the metal needle if the skin is penetrated too slowly. If this occurs, remove and dispose the Insuflon™, and repeat with a new one.

12. Release the skin. Hold the orange catheter hub firmly and slowly pull the needle out, leaving the Insuflon™ catheter in place.

NB: Do not reinsert the needle if catheter is withdrawn or displaced. Remove the catheter and repeat with a new Insuflon™.

13. Place the needle in the yellow sharps bin.

14. Secure the Insuflon™ by applying the supplied dressing from the catheter end first. Ensure the insertion site is visible through the plastic window of the dressing and the hub is open to air.

15. Write date of insertion on the dressing.

16. Complete appropriate documentation.

17. An additional transparent occlusive dressing may be used to further secure the Insuflon™, however the hub should remain uncovered and the insertion site must be visible.

Medication Administration via Insuflon™

Equipment

• Medication to be administered subcutaneously

• 1x 18G needle for drawing up

• 1x 26G needle for subcutaneous administration (maximum recommended length of the needle for injection is 10.5mm)

• 1mL syringe

• 2% chlorhexidine/70% alcohol swab

• Blue medication tray

Procedure

1. Explain the procedure to the child (if appropriate) and parents.

2. Ensure that the medication is recommended for subcutaneous use and charted correctly on the medication chart
   NB: Insuflon™ should be used for subcutaneous bolus/push only, NOT infusion.

3. Perform hand hygiene and clean the blue medication tray thoroughly with an antiseptic wipe.

4. Using the aseptic, non-touch technique (ANTT), assemble equipment and draw up medication in the 1mL syringe with the 18G needle.

5. Using ANTT, remove the 18G needle and replace with the 26G needle for subcutaneous administration.

6. Clean the hub of the Insuflon™ thoroughly with a chlorhexidine/alcohol wipe and allow hub to dry.

7. Insert the needle, bevel side facing up, into the Insuflon™ hub. The needle must penetrate the hub membrane by at least 3mm and not more than 8mm.

8. Administer the medication slowly over at least 30 seconds to reduce irritation. Consider involving the play specialist and/or using distraction techniques or the buzzy bee as appropriate.

9. While administering, observe the Insuflon™ insertion site for any blanching or redness. These signs may indicate that the Insuflon™ at this site is no longer appropriate for use.

10. Remove and dispose of needle in a sharps bin post-administration.

11. Document the administration in the medication chart.

Other considerations

• When two or more subcutaneous medications are to be administered each medication should have a dedicated Insuflon™). The Insuflon™ devices should not be placed in the same area – it is recommended that each are placed on a different limb or opposite sides of the abdomen.

• It is unnecessary to flush the catheter before or after medication administration as the dead space is 0.0075mL. If more than 10% of the medication is lost in the dead space volume, consult medical staff and pharmacist prior to administration.

• Routine administration of Emla prior to medication administration via Insuflon™ should not be required.

Management and other considerations

• Every Insuflon™ insertion site should be assessed

  • once daily for potential complications

  • prior to every subcutaneous administration of medication via Insuflon™

  • post every subcutaneous administration of medication via Insuflon™

• Insuflon™ is to be changed every 7 days or more frequently if complications occur

• Potential complications (reasons for early replacement) may include:

  • Unusual pain, redness, discomfort, swelling, or inflammation at insertion site

  • Kinked or blocked Insuflon™ catheter

  • Difficulty/stiffness in injecting medication into the hub

  • Exudates from the insertion site

  • Bruising and bleeding

  • Loose adhesive dressing causing withdrawal of catheter from subcutaneous tissue

• Some medications may require more frequent replacing of Insuflon™

  • Clexane™ – may increase bruising or bleeding at the site

    • For smaller infants, consider inserting two Insuflon™ in different sites and rotating the administration between them to minimise the risk of significant bruising at the site.

  • Ketamine – may cause redness and irritation at the site

• Some medications may cause pain at the site while injecting (e.g. G-CSF, Clexane™)

  • Applying pressure at the site of insertion following the administration of Clexane™ via Insuflon™ may reduce pain and minimise bruising.

Removal guide

Insuflon™ should not be removed for a minimum of 15-30 minutes post-administration of subcutaneous medication. Consider involving the play specialist and/or using distraction techniques or the buzzy bee.

Equipment

• Bandaid or transparent occlusive dressing

• Gauze

• Blue medication tray

Procedure

1. Explain the procedure to the child (if appropriate) and parents.

2. Perform hand hygiene and clean the blue medication tray thoroughly with an antiseptic wipe.

3. Open the gauze pack on the blue tray and perform hand hygiene again before wearing non-sterile gloves.

4. Using ANTT, gently peel off the Insuflon™ dressing from the catheter end while placing a small amount of pressure on the orange wings of the Insuflon™.

5. Withdraw the Insuflon™ catheter from the insertion site in one quick, smooth movement.

6. Apply gauze over the site if required.

7. Apply a bandaid or transparent occlusive dressing on the site.

8. Consider applying an absorbent dressing on the site if an increased amount of exudate is observed from the site.

9. Complete appropriate documentation.