A prospective,within-patient comparison between metal butterfly needles and Teflon cannulae in subcutaneous infusion of drugs to terminally ill hospice patients

Abstract

We performed a prospective study of hospice in-patients requiring a syringe driver (SD), to determine the site duration and tolerability of metal butterfly needles compared to Teflon cannulae. Using patients as their own control, prescribed medications were divided equally between two SDs (Graseby MS16a), for delivery over 24 h. A butterfly infusion (Flo-safer™, 25 gauge) was connected to one SD and a Teflon cannula (Abbocath® -T, 24 gauge), to the second. These were inserted subcutaneously (sc) on opposite sides of the body at comparable sites; oedematous, broken or painful sites were excluded. SD sites were examined at 4-hourly intervals. The study was terminated when both devices had required resiting. Needle and cannula times were compared using the Wilcoxon signed rank test. Thirty patients entered the study, 13 males and 17 females, mean age (standard deviation): 70 (11) years. Thirteen patients completed the study. Nine patients died and eight patients discontinued the study before both needle and cannula had been resited. All 30 patients are included in the analysis. The time from insertion to resiting of the cannula was significantly longer than the needle: P<0.0002, median (range) 93.5 (22.8-263.5) h versus 42.8 (7.5-162.3) h, respectively. The cost of the needle versus cannula is £1.93 versus £2.51, respectively. Teflon cannulae have a median life span twice that of metal butterfly needles and are a cost-effective alternative for administration of medications by sc infusion in terminally ill patients.

Keywords

metal butterfly needle subcutaneous Teflon cannula terminal care

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References

Johnson I , Patterson S . Drugs used in combination in the syringe driver — a survey of hospice practice. Palliative Med 1992; 6: 125–130.

O'Doherty CA , Hall EJ , Schofield L , Zeppetella G . Drugs and syringe drivers: survey of specialist palliative care practice. Palliat Med 2001; 15: 149–154.

Roberts CJC , Keir S , Hanks G . The principles of drug use in palliative medicine. In Doyle D , Hanks GWC , MacDonald N (eds). Oxford textbook of palliative medicine, second edition. Oxford: Oxford University Press, 1998.

Dawkins L , Britton D , Johnson I , Higgins B , Dean T . A randomised trial of winged vialon cannulae and metal butterfly needles. Int J Palliat Med 2000; 6: 110–116.

Macmillan K , Bruera E , Kuehn N , Selmser P , Macmillan A . A prospective comparison study between a butterfly needle and a Teflon cannula for subcutaneous narcotic administration. J Pain Symptom Manage 1994; 9: 82–84.

Youssef MS , Atkinson RE . Comparison of Teflon cannulas and metal needles for subcutaneous infusion in terminal care: a pilot study. Br Med J 1990; 300: 847–847.

Lichter I , Hunt E . Drug combinations in syringe drivers. NZ Med J 1995; 108: 224–226.

Ventafridda V , Spoldi E , Caraceni A , Tamburini M , De Conno F . The importance of continuous subcutaneous morphine administration for cancer pain control. Pain Clinic 1986; 1: 47–55.

Currow D , Cooney N . Comparison of metal versus vialon subcutaneous catheters in a palliative care setting. Palliat Med 1994; 8: 333–336.