Having to take shots of a blood thinner injected under the skin (subcutaneously = s.c.) once or twice daily for prolonged periods of time can be bothersome and uncomfortable. Use of a once weekly exchanged s.c. port, called Insuflon, can make it easier for a number of patients.Three groups of patients are typically treated with longer-term injections of blood thinners: (a) patients with cancer patients who had a clot, (b) patients who have developed a new clot in spite of warfarin therapy, and (c) pregnant women who had a clot or who are at risk for clots. Blood thinners used s.c. are Lovenox® (Enoxaparin), Fragmin® (Dalteparin), Innohep® (Tinzaparin), Arixtra® (Fondaparinux) and unfractionated heparin.
The number of needle sticks can be decreased by using a s.c. port, called Insuflon, to administer the drug. This device is the same as the one used by individuals with diabetes for giving insulin s.c.. Insuflon is a small, plastic catheter/port that can be placed by the patient s.c. with a needle once every seven days. The catheter is secured to the body with an adhesive bandage and is small enough to be discrete and not hinder daily activities. The blood thinner can then be injected through the port, without having to stick the skin. Thus, there is no pain and discomfort with the blood thinner injection. These ports have gained a huge acceptance among patients with diabetes for injection of insulin.
Not all that much has been published about the use of these ports in patients on s.c. blood thinners. However, a recently completed study of 21 patients showed that absorption of low molecular weight heparin was reliable when given via the once weekly exchanged Insuflon port [ref 1]. And patients liked it: The majority of patients (83 %) expressed satisfaction with the port and stated that they would like to continue to use it [ref 1]. Also, a number of pediatric hematologists have used these ports for years to give s.c. blood thinners to children, as children are particularly jumpy when it comes to once or twice daily s.c. injections [ref 2].
Administration Instructions and Animated Tutorial
Further information on the port, including pictures and a nice animated instruction video on how to use it can be found here.
How to Get an Insuflon Port
To get an Insuflon port you need a prescription. Once your physician provides this, you have two options how to obtain the device:
1. The simplest is to contact either of the Home Delivery Suppliers listed below. They will process your prescription, bill your insurance, and ship directly to you. Home Delivery Suppliers:
- Advanced Diabetes Supply, a division of Northcoast medical; go to their website or call toll free: 1-866-422-4866.
- Edgepark Medical Supplies, go to their website or call toll free: 1-800-321-0591.
- Manufacturer Representative from Intra Pump Infusion Systems: go to their website or call toll free: 1-866-211-7867
2. Alternatively, the Insuflon port may be made available through CVS Pharmacy, but it is by special order. You can contact the manufacturer representative Robin McDowell below for assistance with this route.
If you have any problems obtaining the Insuflon device, you can contact Robin McDowell, Intra Pump Infusion Systems, directly at 630-845-7867 or email her at email@example.com.
Does Insurance Pay for the Insuflon Port?
Insuflon ports should be covered under the treatment plan of your insurance company. As insurance plans and contracts and providers differ throughout the country, billing methods can vary. Generally it is billed using the ‘HCPCS’ code A4211. The NDC# is 08423.1621.26. On occasion, insurance may cover under the DME part of your insurance plan. In this case the ‘HCPCS’ code is E1399. Sometimes a ‘Letter of Medical Necessity’ from your physician may be helpful if at first insurance denies coverage.
As I find the method of a once per week needle stick attractive for patients on longer-term s.c. blood thinners, and as absorption of the blood thinner into the blood stream when using the Insuflon device is reliabile [ref 1], I have no hesitations recommending the use of the device to patients I see. However, the port might not be a good choice for the patient with cancer who is receiving strong chemotherapy that makes the white cell count go down, which then puts the patient at risk for infection.
- Moll S et al. Once weekly subcutaneous ports for the administration of low molecular weight heparin: a prospective pharmacodynamic study. J Thromb Thrombolys 2011,31:375 (abstract).
- Dix D et al. The use of low molecular weight heparin in pediatric patients: a prospective cohort study. J Pediatrics 2000;136:439-445.
Disclosures: Intra Pump provided Insuflon ports free of charge for the 21 patient study referenced above [ref 1]. They did not provide any additional financial support. I have not received consulting fees / honoraria from Intra Pump.
Last updated: May 8th, 2014
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