Hypodermoclysis Technique

Aka: Hypodermoclysis Technique

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II. Step 1: Prepare Equipment

  1. Solution bag (see Step 2 below)
  2. Tube with drip chamber
  3. Long-tube butterfly needle 21 to 23 gauge
  4. Betadine or Alcohol swabs
  5. Sterile Occlusive Dressing

III. Step 2: Select Solution

  1. Fluid
    1. Normal Saline (most common)
    2. One half NS (0.45%)
    3. One third NS with two thirds 5% dextrose
    4. D5W, D5-NS or D5-1/2NS
  2. Additives
    1. Medications (e.g. Morphine) not recommended
      1. No data on absorption
    2. Potassium chloride
      1. May infuse 20 to 40 mmol/L safely
    3. Hyaluronidase
      1. Enhances subcutaneous fluid absorption
      2. Lyses interstitial barrier for 24 to 48 hours
      3. Not necessary to prevent edema
      4. May cause discomfort and local reaction
      5. Dose
        1. Hyaluronidase 150 Units per Liter fluid
        2. Inject 75 Units at each clysis site

IV. Step 3: Select infusion site

  1. Ambulatory patients
    1. Abdomen
    2. Upper chest (above the Breast)
    3. Over intercostal space
    4. Scapula area
  2. Bed-bound patients
    1. Thighs
    2. Abdomen
    3. Outer upper arm

V. Step 4: Needle insertion

  1. Wash hands
  2. Assemble fluid and tubing, priming tubing with solution
  3. Swab infusion site with Betadine preparation
    1. Begin at site center, and spiral outwards
    2. Allow at least 1 minute contact time
    3. Avoid touching site with fingers
  4. Insert needle SQ with bevel up at 45 to 60 degree angle
    1. Avoid inserting too deep (Muscle infusion painful)
    2. Avoid infusion if blood seen in tube on needle insert
  5. Secure needle and tubing with Occlusive Dressing
  6. Date and initial both dressing and tubing
  7. Change needle and tubing every 1 to 4 days
  8. Record infusion date and time on medication card
  9. Check infusion site within 1 hour of start
    1. Check solution, tubing, and needle for malfunction
    2. Observe patient for signs of Fluid Overload
    3. Confirm rate is not too fast (see Step 5 below)
      1. Discomfort may be indicator of too fast of rate
    4. Observe for subcutaneous edema or leakage
      1. Infusion site may be massaged to reduce edema

VI. Step 5: Monitor Volume and Rate

  1. Administer subcutaneously by gravity
  2. Rate
    1. Typically 1 ml/minute per site (1.5 Liters/day/site)
    2. May be increased with use of hyaluronidase
  3. May administer up to 2 separate sites
  4. Do not administer more than 1 Liter in 2 hours
  5. Alternative regimens
    1. Administer 1-2 Liters over night
    2. Administer 500 ml bolus over 1-2 hours tid
      1. Pretreat site with hyaluronidase 150 U qAM

VII. References

  1. Fainsinger (1994) J Pain Symptom Manage 9:298-302 [PubMed]
  2. Farrand (1996) Br J Hosp Med 55:690-2 [PubMed]
  3. Ferry (1999) J Am Geriatr Soc 47:93-5 [PubMed]
  4. Hussain (1996) J Am Geriatr Soc 44:969-73 [PubMed]
  5. Mansfield (1998) Nurs Stand 13:56-62 [PubMed]
  6. Sasson (2001) Am Fam Physician 64(9):1575-8 [PubMed]

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