How common is SQ hydration therapy?

[styRN]

It had been many years since I had seen it used, but one of our 'old-school' GPs (who's in his late 70's) began ordering it for hydration for palliative patients in our LTC facility within the last few months.

We set them up with an ISCI set and usually run them 1L q8-12h. I know it's really more of a comfort measure for the families, but it has become more common in the past few months with our medical director hopping on board and ordering it as well, with some regularity.

Just wondering how 'medieval' this is?

[leslie :-D]

'clysis' is often used in palliative care and from what i hear, often used in ltc settings.

it is used to rehydrate, supply nutrition or raise bp via the subcutaneous route.

i've seen it sometimes used for family requests in hospice, as a methods of appeasing concurrent anxieties.

other times it's used to restore lytes in hopes of reversing confusion in end-stage disease.

it's highly effective and non-invasive.

the worst adverse reaction i've seen is localized soft tissue swelling.

or sometimes, fluid overload, which also happens frequently in end-stage illness.

the old time nurses are very familiar with this method, as it was used quite often sev'l yrs ago.

it can be a great alternative to iv therapy.

leslie

[BJLynn]

I've seen it used lots in veterinary medicine as well. (I had a ferret with adrenal cancer and did sq hydration on him). Very effective from what I've seen in non-humans. I imagine it would have about the same effectiveness in humans too..! :)

[prmenrs, RN]

Geez, I did that as a student nurse. That's what Wydase was originally used for (I think). I did it on a pediatric pt.

A few years later I took care of a baby that an LMD from a neighboring county gave clysis to, only he used D10W. Can we say hyperkalemia? Things did not go well.

Also, big difference between humans and other mammals, eg., dogs, cats, ferrets--they have a lot more "play" between their hides and subcutaneous space, therefore much easier to give fluids that way.

[Noahm]

We give fluids to end state patients and people who are difficult to cannulate but not appropriate for a central line or any further intervention. We run a litre of fluids S-cut via a butterfly. I don't think it really does very much. You have to keep a close eye on the site!

[styRN]

earle58,

I am quite familiar with it, having used it almost two decades ago in palliative care, but haven't seen it since and was curious about its prevelance in cetain settings, and where it was being used geographically.

It's funny how some of the 'old' therapies become outdated then cycle back into use from time to time.

[RGN1]

We used it from time to time on the acute medical ward I worked on prior to my current job (only left Jan 2006 - so very recent & I've no reason to think they are not still using it to date).

It was used for elderly patients who were really hard to cannulate &/or were constantly pulling out their cannula (in the UK you are not allowed to use restraints of any type - bar cot sides & you have to complete a daily risk assessment form for those). We used a butterfly needle, secured with a transparent dressing, usually inserted somewhere around the top of the legs or buttocks. They were not always terminal patients & many did end up getting over their initial problems - quite often severe UTI's with dehydration & accompanying confusion were prime candidates for this therapy.

I've used it once in my current job but I can't remember why, except that the patient was definitely not terminal, I think she was just hard to cannulate.

[BJLynn]

Also, big difference between humans and other mammals, eg., dogs, cats, ferrets--they have a lot more "play" between their hides and subcutaneous space, therefore much easier to give fluids that way.

I know, but it was late and that was the only thing I could think of. There obviously is a huge difference. I was thinking about how the fluids would diffuse in an human in the sq layer, and I thought it would be a lot different than a four legged critter.

I try to learn something new everyday!

[Lacie, BSN, RN]

I've seen it used lots in veterinary medicine as well. (I had a ferret with adrenal cancer and did sq hydration on him). Very effective from what I've seen in non-humans. I imagine it would have about the same effectiveness in humans too..! :)

Lol, dont fret as it's the first thing that came to my mind also! I've been an RN for over 24 years primarily in critical care and have yet to use this on a pt but have on numerous animals as I also do animal rescue particularly with exotics. It's pretty standard in vet care.

[Pepper The Cat, BSN, RN]

We use it a lot on our elderly pts. Its not as effective as IV therapy, but it is effective. For pts with poor veins, or who are restless/confused it is better than IV because if they pull it out, it is easy to re-establish and doesn't cause as much harm as pulling out an IV - (no blood loss, etc). We usually run it at night, take it out during the day. We use a pump to make sure it runs at the correct rate.

[UKRNinUSA, RN]

I did it back in Scotland in the late 80's. Thanks for the flashback

[prmenrs, RN]

Elderly pts (not that I've seen a lot of them lately ) do have looser skin, so I guess it would be easier to do than an IV.

In babies, they used the area over the scapula.