Hipodermóclise: Revisão Sistemática Da Literatura

Abstract

Introdução: A Terapia Subcutânea, também chamada de Hipodermóclise, ainda é pouco discutida e utilizada. Essa técnica consiste na administração de soluções na hipoderme, camada mais profunda da pele, cuja vascularização é similar à que se observa nos músculos. Objetivo: Analisar a produção científica indexada nos periódicos nacionais relacionados ao uso da terapia subcutânea na assistência de Enfermagem. Materiais e Métodos: Optou-se pela revisão sistemática de caráter exploratório com abordagem qualitativa. Realizou-se a busca de estudos em periódicos nacionais publicados nos últimos seis anos, na base de dados da Literatura Latino-Americana em Ciências de Saúde (LILACS) e na Scientific Eletronic Library Online (SciELO). Como os dados sobre o assunto são escassos, utilizou-se o buscador Google acadêmico para incluir publicações do Instituto Nacional do Câncer (INCA). Adotaram-se os termos "hipodermóclise", "terapia subcutânea" e "cuidados paliativos". Resultados: Os estudos analisados resultaram nos seguintes agrupamentos: indicações e contraindicações; vantagens e desvantagens; locais indicados para punção; medicamentos e fluidos utilizados; e a execução da técnica para a punção. Evidenciou-se que a Terapia Subcutânea é um recurso importante para os pacientes em cuidado paliativo. Ela pode contribuir para promoção da qualidade de vida desses doentes. Os riscos são mínimos, os efeitos colaterais são raros, reversíveis e de pouca importância clínica; as vantagens desta via superam suas possíveis desvantagens. Conclusões: A técnica facilita a alta hospitalar do paciente, favorecendo o cuidado no domicílio, é de fácil aplicação e manipulação e possui baixos custos. No entanto, são necessárias pesquisas para consolidar o uso desse procedimento no Brasil, considerando que há carência de estudos nessa área.

Nursing knowledge and practices regarding subcutaneous fluid administration

“…This lack of knowledge may be associated with a lack of discussion on the subject in schools (15) , a fact that needs to be reviewed, because nursing team knowledge allows reflection on the importance of its role in using this method as a therapeutic resource. Theoretical and practical knowledge about SC therapy can minimize mechanical and tissue trauma, provide comfort, and reduce stress and pain from repeated and unsuccessful punctures for the infusion of fluids and drugs (8) . Change of puncture site every two days.…”

“…A study conducted in Paraná (3) showed that only 0.02% of the patients used hypodermoclysis at the institution. Therefore, it is necessary to consider that drug administration is one of the care functions performed, most times, by the nursing team; consequently, it is essential to disseminate information to and train this team (8) . Hypodermoclysis is considered a simple, safe, and effective practice for hydroelectrolytic replacement and/or drug therapy in patients who require clinical treatment in a hospital or home setting (1)(2)(3)22) .…”

“…Due to the scarcity of studies and scientific publications that encourage its use, some advantages, even incipient ones, have been presented in order to make the adoption of this practice feasible in health services, including low cost (inexpensive materials when compared to other types of punctures; costs for maintenance of the IV route are about four times greater (17) ), simplicity of insertion of the peripheral catheter, ease of administration and maintenance, and possibility of early hospital discharge (due to its effectiveness, safety, and ease of home management). It also provides comfort, convenience, and autonomy to the patient, as well as minimal risk of local or systemic complications (1,3,8,22) . Additionally, the technique has the lowest degree of limitation due to the differentiated options of puncture sites (preferably distant from the joints) and low incidence of infection, favoring a greater acceptance by patients, their families, and the health team (6,8,23) .…”

“…It also provides comfort, convenience, and autonomy to the patient, as well as minimal risk of local or systemic complications (1,3,8,22) . Additionally, the technique has the lowest degree of limitation due to the differentiated options of puncture sites (preferably distant from the joints) and low incidence of infection, favoring a greater acceptance by patients, their families, and the health team (6,8,23) . Furthermore, it is the best route for safe and effective administration of opioids, with fewer adverse events, by reducing the fluctuation of these drugs' plasma concentrations.…”

“…The vascularization of the SC tissue accounts for around 6% of the cardiac output and reaches lower serum concentrations, but with a longer action time, and higher than that of the IV and IM routes. As a result, pre-systemic clearance by the liver is avoided, resulting in a stable drug serum concentration, preventing undesirable side effects due to plasma peaks (8) . SC therapy encompasses not only the replacement of fluids, but also medicines that were prescribed for this route, such as antimicrobials and analgesics, among others.…”