CP 4.21: Subcutaneous Butterfly Placement

PURPOSE

The Community Paramedic (CP) works together with primary care providers to support patient self-care in the community whenever possible. In some cases, patients who require insertion or reinsertion of subcutaneous access for the purpose of administration of their own medications may request assistance from the CP through the normal process.  

POLICY STATEMENTS

The CP should demonstrate the attitudes, knowledge, and clinical skills necessary to provide safe and effective subcutaneous access for the purposes of administration of the patient’s own medications, most often in a palliative setting.

CPs can provide the initial or re-establishment of subcutaneous access to allow the patient to administer their own medications. It is expected that the CP will document the procedure, including all findings, report them to the primary care provider and collaborate with other health care team members to provide support as appropriate.

CPs must have successfully completed the required online education and undertaken a face-to-face education session with a CP Mentor or Paramedic Practice Educator (PPEd).

GUIDELINE

In response to a request for URGENT PRIMARY CARE SERVICE from a primary health care provider, and following standardized procedures for CP patient visits, the CP will:

• Assess the patient, obtain informed consent from patient or parent, prepare, and educate the patient and/or parent
• Review the indication for subcutaneous access establishment and identify a suitable site for insertion
• Insert a subcutaneous catheter and assess patency
• Document the procedure and any complications in Siren, reporting this information back to the primary care provider

PROCEDURE

1. Obtain service request.
2. Obtain and review patient’s health history and care plan prior to their scheduled appointment.
3. Explain the purpose of the procedure and obtain verbal consent prior to undergoing any procedure, including vital signs.
4. Perform physical examination as required, including vital signs.
5. Assess patient understanding of the procedure and discuss any concerns the patient may have prior to insertion
6. Gather equipment and supplies.
7. Following the Clinical Procedure Guide PR24: Subcutaneous Butterfly Placement (exception: CPs do NOT need to contact CliniCall prior to insertion), insert the catheter into one of the preferred injection sites:
   1. Upper arms
   2. Abdomen
   3. Anterior aspect of thighs
   4. Above scapula
   5. Subclavicular chest wall
8. Ensure access site is easily accessible, free of lesions, away from large vessels, joints and bones and away from edematous tissue which may alter medication absorption.
9. Assess site for redness, swelling, tenderness, leakage or discharge. If any of these are present, re-site the catheter.
10. Review possible complications with patient and verify patient understands when follow-up care from primary care provider would be required.
11. Document the visit and all assessments/treatments on your ePCR as per standard procedure.
12. Communicate with the primary care provider or healthcare team as noted on care plan or if any concerns arise.

DOCUMENTATION

In Siren:

• Use “Procedures” tab in Siren to access applicable buttons
• Select IV/IO/Arterial Access button
• Under “Type” select “Subcutaneous Procedure”

REFERENCES & SUPPORTING RESOURCES

1. BCEHS – Palliative Care Clinical Practice Guidelines
2. BCEHS – Subcutaneous Butterfly Placement