Subcutaneous Infusion or Hypodermoclysis: A Practical Approach

Abstract

The aim of this practical review was to revalidate subcutaneous infusion or hypodermoclysis in the older subject and to set out its indications and limitations, its contraindications, and its techniques and methods of surveillance. Hypodermoclysis is an effective technique for the prevention or cure of moderate dehydration, although it cannot be used in place of intravenous infusion in cases of severe dehydration. Hypodermoclysis is simple and safe. It is the least aggressive of infusion techniques and thus avoids hospital, admission and reduces health costs. Infusion of a solution of amino acids can also limit the consequences of low protein intake for a short period of time, but it will not cure severe malnutrition. The many advantages and the few disadvantages of this technique should encourage its wider use in geriatrics. SUBCUTANEOUS INFUSION OR HYPODERMOCLYSIS: A PRACTICAL APPROACHSubcutaneous infusion or hypodermoclysis was first used to overcome dehydration in pediatric patients.' However, the complications, such as pain, sepsis, and shock -which were, in fact, most often linked to practical errors -meant that it was almost abandoned in the 1950s.'The risk of dehydration is a common problem in older patients, both at home and in institution^.^ Warren et a1.4 reported that 7% of all acute admissions of older patients were associated with dehydration. Moreover, 25% of febrile older patients in nursing homes suffer from dehydration, sometimes fatally, because fluid intake is lower than the amount required, and referral to an acute unit is often necessary.' Berger stated in 1984 that in nursing homes, instigating subcutaneous infusion is often preferable to calling an ambulance.6 A recent study confirmed that effective hypodermoclysis, which is achieved in 71% of patients, reduces the need for transfer, and hence costs, ~ubstantially.~ Lipschitz's study validated the subcutaneous administration of fluids by demonstrating that a saline infusion labeled with tritium and technetium was absorbed as effectively subcutaneously as by the intravenous routea8 Dardaine et aL9 reported the metabolic and hormonal effects induced by a glucose/saline solution (5% glucose solution containing 4 g NaCI) administered by intravenous and subcutaneous routes. The smaller and delayed metabolic and hormonal changes From the 'Service de GCriatrie, HBpital de Valence, 26953 Valence Cedex 9, and tI-16pital de I'Ermitage, CHU dc Tours, 37081 Tours Cedcx 2, France.

Hipodermóclise Em Pacientes Oncológicos Sob Cuidados Paliativos

“…Na literatura, os locais indicados para a punção subcutânea são: região infraclavicular; região infraescapular; região abdominal (flanco); face anterior, interna ou externa da coxa; região anterior e externa dos braços (deltóide) (12)(13) . Essas regiões admitem um volume bem acima do tolerado pela técnica tradicional de injeção subcutânea, que seria de até dois mililitros.…”

“…As soluções melhor toleradas são as isotônicas e as hidrossolúveis, por serem menos irritantes e apresentar menor risco de acumulação; soluções muito ácidas ou básicas podem aumentar o risco de precipitação ou irritação (17) . Estudos demonstram que a solução glicosada a 5% é isenta de riscos (13) .…”

“…Entretanto, outros autores citam que é possível a administração de até 1.500 ml/dia em cada sítio de punção, sendo aceitáveis dois sítios, totalizando 3.000 ml em 24 horas, quando necessário (10,13) . Cabe ao enfermeiro avaliar e observar, periodicamente, o local da punção, a fim de evitar complicações decorrentes do excesso de volume de líquido administrado por essa via.…”

Recombinant Human Hyaluronidase-Enabled Subcutaneous Pediatric Rehydration

“…Literature supports the use of subcutaneous fluid administration for the management of mild/moderate dehydration, 15,19,29,42 with some studies noting severe dehydration as a contraindication to this route of administration. 42,43 This pilot study is the only recent trial evaluating subcutaneous fluid administration in children and, consistent with current usage in adults, patients presenting with moresevere dehydration were excluded.…”

“…42,43 This pilot study is the only recent trial evaluating subcutaneous fluid administration in children and, consistent with current usage in adults, patients presenting with moresevere dehydration were excluded.…”