Infusion Therapy – Central Venous Catheter: Hypodermoclysis SECTION: 25.09
Strength of Evidence Level: 3 __RN__LPN/LVN__HHA
PURPOSE:
To provide guidelines for the safe and effective administration of subcutaneous hydration for dehabilitated, geriatric or hospice patients experiencing dehydration.
CONSIDERATIONS:
1. Hypodermoclysis, the subcutaneous infusion of fluids is suitable for mildly to moderately dehydrated adult patients, especially the elderly.
2. The most frequent adverse effect is mild subcutaneous edema that can be treated by local massage or systemic diuretics.
3. Contraindications include patients:
a. Requiring large amounts of fluid.
b. At risk for pulmonary congestion or edema.
c. With clotting disorders.
4. Terminal cancer patients usually stop eating and drinking near the end of life. Many believe that dehydration is beneficial when a patient is dying, as it helps to prevent excessive oral secretions, difficulty breathing and edema. Many believe hypodemoclysis is an alternative to provide adequate hydration for comfort.
5. Administer fluid at continuous infusion rates ranging from 20-75 mL/hour; typical infusion rates include:
a. 40 mL/hour.
b. 80 mL/hour for 12 hours.
6. A bolus of 500 mL over 1 hour can be given if the patient is active.
7. Hyaluronidase, an enzyme that temporarily lyses the normal interstitial barrier, is used to enhance fluid absorption. Hyaluronidase is given as a bolus into the infusion site immediately before starting the infusion. Dosing of hyaluronidase is not well researched. Hyaluronidase is generally used when the infusion rate is more rapid.
8. Hypodermoclysis site can be maintained for up to 5 days. Always check site for inflammation and edema.
9. Common sites for hypodermoclysis infusion is the thigh. Other sites include the abdominal wall, back, thorax and arms.
EQUIPMENT:
Gloves
Solution bag
Tube with a drip chamber
21- or 23-gauge long-tube butterfly needle
povidone-iodine solution or alcohol skin preparation
Sterile occlusive dressing
Solution of 1/3 normal saline and 2/3 5% glucose
Hyaluronidase 150 USP units, as needed
PROCEDURE:
1. Explain the procedure to the patient.
2. Adhere to Standard Precautions.
3. Select the infusion site.
4. Wash hands.
5. Assemble fluid and tubing.
6. Prime line with selected fluid and hyaluronidase, using lidocaine if required.
7. Swab the site with povidone-iodine skin preparation solution using a circular motion, beginning at the center of the site. Allow at least one minute contact time. DO NOT touch prepared site again with fingers.
8. Insert needle, bevel up, into subcutaneous tissue at a 45- to 60-degree angle.
9. Secure needle and tubing with occlusive dressing.
10. Adjust fluid drip rate as prescribed.
11. Date and initial dressing; date and initial intravenous tubing.
AFTER CARE:
1. Educate patient and care giver regarding:
a. Signs and symptoms of infection and edema at site.
b. Fluid administration.
c. Management and site care.
2. Record procedure and patient’s response.
3. Document infusion fluid on medication chart.
4. DO NOT set drip rate to deliver more than 1 liter in 2 hours.
5. Check patient and infusion after 1 hour to ensure that the infusion site is correct; that there are no signs of edema, leakage, disconnection or fluid collection distal to the site; and that patient does not show signs of fluid overload.
6. If necessary, the infusion site can be massaged to enhance edema absorption.
7. Follow-up with physician as needed.
REFERENCES:
Medscape Nurses . Ask the Experts. Geriatrics for Advanced Practice Nurses. What Should I Know About Using Hypodermoclysis in Geriatric Patients?
Maren S. Mayhew, MS, ANP, GNP
http://www.medscape.com/viewarticle/413369
Hypodermoclysis: An Alternative Infusion Technique
Menahem Sasson, M.D.And Pesach Shvartzman, M.D.
Ben-Gurion University of the Negev, Be'er Sheva, Israel
Am Fam Physician. 2001 Nov 1;64(9):1575-1579.
http://www.aafp.org/afp/2001/1101/p1575.html