Pediatric sub-Q rehydration therapy (hypodermoclysis)

meanmaryjean, DNP, RN · Jun 26, 2015

Holy Flashback Batman! We used to do this on inpatients in the 70s! Can't help you with anything current, but back in the Dark Ages, it was highly effective. Back then, the only IVs were steel needles. Keeping an IV in long-term (i.e. over 12 hours) was a nightmare. With the advent of flexible angiocaths, this procedure largely disappeared.

I know, I'm a fossil.......

Bobjohnny · Jun 27, 2015

Might sound a little out there, but the big place for literature on SubQ rehydration is Veterinary Medicine. They use it all the time. Unfortunately, I know this doesn't really help with getting you information on doing it with pediatric patients. Have you checked Cochrane?

klone, MSN, RN · Jun 27, 2015

Yeah, I was just going to chime in and say that I used to do this all the time with my cat (sanctioned by her vet) who had renal failure and would suffer regularly from dehydration.

freki, ADN, RN · Jun 27, 2015

Yeah I've been reading the history on this and it's very interesting! Sounds like subq was kind of the gold standard until flexible angiocaths and then it just went away.

But from the reading, there's a lot of renewed interest specifically because of the hyaluranidase. I've seen demonstrations of 1liter in 30 min without much site swelling at all. And it seems to me that if a momma can hold a kid and get a subq infusion between the shoulder blades they'll be much less fussy and parents will be happier.

Lâ™¡vER · Jun 27, 2015

I'm curious what prompted you looking into this? We generally have no issue getting iv's on kids, and if we go the iv route, 99% of the time we are drawing blood anyways so they are getting a poke regardless. I have done the subq hydration successfully with my ferrets, but this is another issue entirely.

To be fair, I have no idea what hyaluranidase is. I will go Google now :)

brownbook · Jun 27, 2015

Same as others, vets use it.

I was told by nursing teachers, (I was a student in the early 80's) that this was done in skilled nursing facilities. Maybe there would be some literature in geriatric nursing or even hospice nursing?

prmenrs, RN · Jun 28, 2015

I actually did it when I was a senior nsg student--in 1968!! Yeah, I know, don't look @ me in that tone of voice!

I think these days, the docs would more likely use an Intraosseous infusion (Medscape: Medscape Access) than clysis.

You may use a Wydase injection @ the site to help the cell walls absorb the fluid. Be very careful to use an isotonic solution. We had a baby admitted to NICU ~early 70s w/a K+ of 8.something. Not good for your heart. Pediatrician had given 50 ml of D10 suprascapular.

I know the procedure can be useful, but I would rather try everything else possible 1st.

Hypodermoclysis: An Alternate Infusion Technique - American Family Physician

ThrowEdNurse, BSN, RN · Jun 28, 2015

I worked my way through nursing school as a vet tech. We always did this for animals as a standard of practice.....cat and dogs do have stretchy skin and are so less dramatic than people. Which is why I think it would be an awesome technique for the elderly....behind biceps and to the chest wall....right?

Guest219794 · Jun 28, 2015

Same as others, vets use it.
I was told by nursing teachers, (I was a student in the early 80's) that this was done in skilled nursing facilities. Maybe there would be some literature in geriatric nursing or even hospice nursing?

We just saw a pt from a NH with subq ivf. First time any of us had seen it. The patient had good veins, so we had no idea why this was happening.

Although your instructor may have said that this is done in skilled nursing facilities, this was apparently from an unskilled nursing facility.

Pt came in with an IVF rate of 6 ml/hr. Apparently, somebody misplaced a zero, and the mistake was repeated by subsequent nurses. I am hard pressed to call those nurses skilled.

We are talking about registered nurses who did not question 6 ml/hr as a maintenance infusion. To quote The Who "Hope I die before I get old....

IVRUS, BSN, RN · Jul 10, 2015

A couple of things MUST be in place before this should be a consideration. #1. Your patient has to have enough SQ tissue that you can pinch an inch on. If the child is so thin, and pinching isn't possible, this modality isn't for them. #2. The ordered solution must be isotonic or near isotonic. This isn't for IVAB. #3. This should only be considered as a treatment modality for mild to moderate dehydration. If they are severly dehydrated, choose a different route.

Hyaluronidase does not increase absoprtion on everyone, and at $100.00 a bottle, many people don't use it.

Greenclip · Jul 10, 2015

I used to work in the inpatient rehab unit of a large hospital. We used it. It is easy and very effective. Most of our patients, by the time they came to us, either had a PICC or no IV access (a few would have ports). A lot of rehab patients are elderly. If they get dehydrated, which can happen very quickly, hypodermoclysis is a great option. Get 500 or a liter in them and then you can start an IV. Or sometimes that little kick was all they needed.