SUBCUTANEOUS FLUIDS

The management of unwell older people who have poor venous access, or who are unable to tolerate intravenous cannulation, presents a common and difficult challenge for clinicians in many specialities. Whilst the use of subcutaneous infusions (hypodermoclysis) is commonplace in a palliative care environment and elderly medical ward, its use, particularly outside of hospice and acute hospital (medical centre) settings, remains rather variable. 

Hypodermoclysis has been an alternative option to the traditional intravenous route for over 50 years. This method involves the insertion of a 21 or 23 gauge butterfly cannula under aseptic conditions into subcutaneous tissue. As subcutaneous tissue tends to diminish peripherally and increase in central areas as part of the ageing process, the abdomen, scapula or thighs are all prime sites for administration of subcutaneous fluids. Once the cannula is inserted, it is attached to a giving set and connected to a bag of parenteral fluids, commonly infused over a 24 h period. The standard practice is to use Saline 0.9%.

Indications:

-Mild dehydration, used as a supplement as the amount of fluid per 24 hours is restricted.

-Acute episode: mild infection, vomiting, diaorrhea, temporary confusion, prevention of pressure sores or/and an adequate fluid intake cannot be maintained.

Contraindications:

-Existing fluid restrictions.

-Diuretic therapy.

Fluids must be gravity fed by drip stand giving set (like Sof-set or Graseby) and calculate drip rate, not infused using a pump.

Sof-set

Equipment needed:

-Fluids for infusion

-Standard administration set

-Drip stand

-Transparent adhesive dressing (opsite, tegaderm)

-Sharp bin

-Sterile field

-Gloves and apron

-Anti-microbial swabs

-Butterfly needle/Sof-set

-Signed direction to administrate and all recorded on the kardex

-Fluid balance chart

Palliative Care

Portable infusion pumps are used in palliative care to deliver a continuous subcutaneous infusion of medication over 24 hours in order to maintain symptom control.
A patient is unable to take medication orally due to:
-Persistent nausea and/ or vomiting.
-Dysphagia.
-Bowel obstruction or malabsorption.
-Reduced level of consciousness, such as in the last days of life.

The McKinley syringe driver is one of the most used, instructions of use can be found in this webpage: http://www.mckinleymed.co.uk/training/t34/index.php

Source: 

http://qjmed.oxfordjournals.org/content/97/11/765.full

Subcutaneous fluids training, provided by Belfast Health and Social Care Trust

http://www.palliativecareguidelines.scot.nhs.uk/