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Discussion

HDC sites

Hi all! What is the policy on HDC site rotation? Like for example if someone is receiving pain medication say q3h via HDC, when should the site be rotated? Is there a certain policy on this?

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    what does HDC stand for?

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    HDC= hypodermoclysis. Love that it's coming back in popularity.

    http://www.aafp.org/afp/2001/1101/p1575.html

    My experience is that for both fluids and pain meds the site(s) are rotated every 3-7 days depending on how it's doing (edema, irritation, dressing patency, discomfort). It's important to remember that tubing change policy needs to be followed even if the site isn't being changed.

    Various policies:

    http://www.sglos-pct.nhs.uk/clinical/SubcutaneousInfusionv1.3July2010.pdf

    http://www.palliative.org/PC/ClinicalInfo/Clinical%20Practice%20Guidelines/PDF%20files/3A7%20Hypodermoclysis%20Admin%20Protocol%20for%20PC%20Patients.pdf

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    HDC stands for HypoDermoClysis, or clysis. It is a method of infusing isotonic fluids subcutaneously. When pain management is given subcutaneously, it is a subcutaneous infusion. Fluids and pain medication are absorbed by diffusion and perfusion across the cell membranes. Both are therapies given subcutaneously, but isotonic fluid administration is Hypodermoclysis. Fluids are limited to amount and tonicity with HDC, but it is ideal for prevention of dehydration and/or slow rehydration in the elderly and palliative care poplulation.

    Sites get rotated for subcutaneous infusion every 2-3 liters or 72 hours whichever comes first. Having worked with PCA given subcutaneously with hospice, I have found the site is not always rotated as frequently as that. Sites should be rotated when there is any redness or edema forming around the area. (That means that the fluid concentration is no longer disproportionate enough to absorb the fluid).

    PCA is given in a much smaller amount than fluids and at a higher concentration so that the fluid does not cause edema and is absorbed.

    Your facility should have a policy/procedure on this type of therapy, just as with every type of therapy performed.

    More information can be obtained in the Third ediciton of the book, Infusion Nursing: An Evidence Based Approach p. 516-517 by the Infusion Nurses Society.

    Hope this helps.

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