- Subcutaneous infusion is an alternative route for hydration and certain medications in select patient situations, involving infusion beneath the skin rather than intravenously. - It was a popular technique until the 1950s but then declined due to complications from improper use, poor patient selection, incorrect administration rates/fluids. - The document provides guidance on patient populations/conditions appropriate for subcutaneous infusion, recommended sites on the body, considerations for safe administration technique and monitoring.

1. Subcutaneous Infusion
AN ALTERNATIVE INFUSION ROUTE FOR HYDRATION & CERTAIN
MEDICATIONS AND SOLUTIONS IN SELECTED PATIENT SITUATIONS

2. CLYSIS, HDC, SUBCUTANEOUS HYDRATION
NO FLUSHING REQUIRED
“A WASHING OUT BENEATH THE SKIN”

3. TO TO WHOSE
IS
AND
ARE

4. POPULAR TECHNIQUE USED TO ADMINISTER FLUIDS & SOME MEDICATIONS UNTIL THE
LATE 1950’S WHEN THERE WAS A DECLINE IN SUBCUTANEOUS HYDRATION.
WAS A RESULT OF NUMEROUS COMPLICATIONS
DUE TO:
1. IMPROPER USE
2. POOR PATIENT SELECTION
3. INCORRECT RATES OF ADMINISTRATION
4. POOR CHOICES OF FLUIDS
IN IV
Therapies
IN Clysis Therapy

7. FOR THE FOLLOWING PATIENT POPULATION OR CONDITION(S):

10. APPROPRIATENESS OF THE
ORDER
MEDICATION ORDER

12. – MOST COMMON
SITE
ANTERIOR OR LATERAL THIGHS
REGION
OR REGIONS – USEFUL FOR
CONFUSED PATIENTS WHO ATTEMPT TO DISLODGE

15. INS STANDARD PRACTICE CRITERIA
ASPIRATE DEVICE PRIOR TO FLUID ADMINISTRATION FOR
ACCESS SITE SHOULD HAVE INTACT SKIN AND BE AWAY FROM
UMBILICUS AND BONY PROMINENCES
 SITE SHOULD BE ASSESSED FREQUENTLY AND ROTATED BASED
UPON: , ,

18. 7. CLEAN SELECTED SKIN SITE WITH ANTIMICROBIAL
SOLUTION FOR AT LEAST 30 SECONDS, USING
FRICTION, AND LET DRY COMPLETELY.

19. 7. REMOVE PROTECTIVE COVER FROM
SQ NEEDLE, BEING CAREFUL NOT
TO CONTAMINATE.
8. GRASP SKIN AT AROUND THE
SELECTED SITE WITH THUMB AND
FOREFINGER AND INSERT SQ
NEEDLE
(DO NOT TOUCH THE ACTUAL ANTICIPATED
SITE WITHOUT STERILE GLOVES)

20. ON THE ATTACHED
SYRINGE TO
RETURN.

22. ROTATE SITE BASED UPON:
EVERY 48 HOURS (OR SOONER IF S/SX OF COMPLICATIONS)
* INSERT NEW SITE AT LEAST 2 -3 INCHES AWAY FROM
PREVIOUS SITE

24. .

25. 1. AVOID EDEMA BY WATCHING FOR SIGNS OF FLUID ACCUMULATION IN TISSUES AROUND
INJECTION SITE; CHANGE SITE IF THIS OCCURS
2. OBSERVE FOR REDNESS OR IRRITATION AT THE INFUSION SITE WHEN HYALURONIDASE
IS USED, AS THERE IS A POSSIBILITY OF ALLERGIC REACTIONS.
3. OBSERVE FOR SIGNS OF FLUID VOLUME OVERLOAD DUE TO RAPID ABSORPTION OF
FLUID WHEN HYALURONIDASE IS USED.
4. OBSERVE FOR SIGNS OF INFECTION AT INJECTION SITE. ALWAYS USE STERILE TECHNIQUE
WHEN INSERTING OR REMOVING NEEDLE
5. WATCH FOR DISLODGEMENT OF NEEDLE AND DISCONNECTION OF TUBING.
6. IF SURROUNDING TISSUES SHOW SIGNS OF INFLAMMATION, CHANGE SITE
IMMEDIATELY. OBSERVE AS FOR IV SITE.

28. 2. YOUR PATIENT HAS AN ORDER FOR
HYPODERMOCLYSIS FOR MILD
DEHYDRATION. YOU HAVE INSERTED
YOUR SUBCUTANEOUS NEEDLE INTO YOUR
SELECTED SITE.
WHEN YOU ASSESSED FOR A BLOOD
RETURN, YOU WERE
.

29. 3. WHICH OF THE FOLLOWING IS
FOR
HYPODERMOCLYSIS?
A. PATIENT IS UNABLE TO TAKE
ADEQUATE FLUIDS ORALLY.
B. PATIENT HAS FLUID LOSS DUE TO
VOMITING OR DIARRHEA.
C. PATIENT HAS DIFFICULT/LIMITED
VENOUS ACCESS.
D. PATIENT IS SEPTIC AND AT RISK
FOR SHOCK.

30. 4. WHICH OF THE FOLLOWING DO YOU CONSIDER WHEN DETERMINING
WHETHER OR NOT YOU NEED TO ROTATE YOUR PATIENT’S SUBCUTANEOUS
NEEDLE SITE?
A. THE AMOUNT OF FLUID THAT HAS BEEN ADMINISTERED INTO “THAT” SITE
B. THE APPEARANCE OF THE SITE
C. IT IS FRIDAY AND YOU ARE OFF THE NEXT DAY
D. THE PATIENT’S COMFORT
E. THE LENGTH OF TIME THE SITE HAS BEEN USED

31. 5. FOR SAFETY PURPOSES, HYPODERMOCLYSIS INFUSIONS ARE ADMINISTERED ON
AN ELECTRONIC PUMP. TRUE OR FALSE
6. STUDIES SHOW THAT HYPODERMOCLYSIS INFUSIONS ARE AN ACCEPTABLE
WAY OF HYDRATING A PATIENT BUT THE ABSORPTION OF THE FLUID IS NOT
AS GOOD AS HYDRATION THROUGH AN IV. TRUE OR FALSE
7. IT IS ACCEPTABLE TO BOLUS A PATIENT 500-ML OVER 1-2 HOURS UP TO 3
TIMES PER DAY WITH THE USE OF HYALURONIDASE. TRUE OR FALSE

32. 8. WHAT IS THE RECOMMENDED MAXIMUM AMOUNT
OF VOLUME TO ADMINISTER PER SITE PER DAY?
A.3 LITERS
B. 1.5 LITERS
C.500-ML
D.1 LITER

34. WHAT WOULD YOU DO?
10. A PATIENT IS HAVE A HYPOGLYCEMIC
EVENT AND HAS PASSED OUT. THE
PROVIDER HAS ORDER D10 IV STAT BUT IV
ACCESS WAS NOT SUCCESSFUL. THE
PROVIDER ORDERS THE NURSE TO
ADMINISTER D10 THROUGH A
SUBCUTANEOUS INFUSION.
WOULD YOU DO IT? WHY OR WHY NOT?