Subcutaneous Infusion of Fluids for Hydration or Nutrition: A Review

Abstract

Subcutaneous infusion, or hypodermoclysis, is a technique whereby fluids are infused into the subcutaneous space via small-gauge needles that are typically inserted into the thighs, abdomen, back, or arms. In this review, we provide an overview of the technique, summarize findings from studies that have examined the use of subcutaneous infusion of fluids for hydration or nutrition, and describe the indications, advantages, and disadvantages of subcutaneous infusion. Taken together, the available evidence suggests that, when indicated, subcutaneous infusion can be effective for administering fluids for hydration or nutrition, with minimal complications, and has similar effectiveness and safety to the intravenous route. Of note, subcutaneous infusion offers several advantages over intravenous infusion, including ease of application, low cost, and the lack of potential serious complications, particularly infections. Subcutaneous infusion may be particularly suited for patients with mild to moderate dehydration or malnutrition when oral/enteral intake is insufficient; when placement of an intravenous catheter is not possible, tolerated, or desirable; at risk of dehydration when oral intake is not tolerated; as a bridging technique in case of difficult intravenous access or catheter-related bloodstream infection while infection control treatment is being attempted; and in multiple settings (eg, emergency department, hospital, outpatient clinic, nursing home, long-term care, hospice, and home).

Supplemental Parenteral Nutrition: Review of the Literature and Current Nutrition Guidelines

“…A review by Caccialanza et al, including 3 authors of the study described earlier, details the several advantages of SC vs IV infusion of fluids for hydration or nutrition, including lower cost, ease of application, and lack of potentially serious complications such as infection. The authors suggest possible candidates for this therapy: patients with mild‐to‐moderate malnutrition when oral and/or enteral intake is not sufficient in situations when placement of an IV catheter is not desired, possible, or tolerated in patients at risk for dehydration when oral intake is not tolerated as a bridging technique in cases with difficult IV access or catheter‐related bloodstream infection while infection control treatment is in progress in alternate settings, such as home, hospice, and long‐term care, as well as in hospitals and emergency departments …”

“…Caccialanza et al note that products for SC infusion are available in countries outside of the United States, in some cases for >30 years, with no safety concerns. For use in the United States, clinical trials would be required before consideration of regulatory approval of such products.…”

“…47 The study suggested that SC administration of nutrition support might be a useful supplemental therapy in patients who do not require placement of an IV catheter. 47 A review by Caccialanza et al, 48 including 3 authors of the study described earlier, details the several advantages of SC vs IV infusion of fluids for hydration or nutrition, including lower cost, ease of application, and lack of potentially serious complications such as infection. The authors suggest possible candidates for this therapy:…”

Hipodermóclise Para Tratamentos Não Convencionais Em Pediatria: Revisão Integrativa

“…As vantagens destacadas para esta via de infusão são: maior comodidade ao paciente, à família e à equipe de saúde; técnica efetiva com uma punção não profunda; redução dos índices de infecção; boa tolerância por pacientes agitados; e, ainda, agilidade de realização em ambientes hospitalares, domiciliares, dentre outros (5)(6)(7) .…”

“…Tecnicamente, a execução da HDC compreende a inserção de cateter agulhado, o scalp (calibre 21 ou 23G) na pele, em ângulo de 45°, com o objetivo de atingir a hipoderme. Via de regra é realizada em regiões específicas do corpo, com maior quantidade de tecido adiposo, como: região externa do braço, escapular, anterior do tórax, abdominal e lateral da coxa (6)(7) . É sabido o fato de que em pacientes pediátricos os vasos sanguíneos estão com menores calibres, dificultando sua visualização e palpação, além de haver fragilidade capilar, sobretudo em crianças menores e/ou hospitalizadas devido a processos crônicos.…”