UMEM Educational Pearls

Title: Hypodermoclysis - I missed the vein on purpose

Keywords: rehydration, fluid management (PubMed Search)

Posted: 11/4/2022 by Rachel Wiltjer, DO
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Subcutaneous Fluid Administration for Rehydration

An old school technique (described in the 1800’s) that fell out of favor but still has applicability - primarily in pediatrics although it has been explored for use in geriatrics and mass casualty events (due to ease and speed of use)
Most appropriate for stable but mildly to moderately dehydrated patients who need rehydration, are not tolerating PO, and in whom an PIV is difficult to establish (this should not replace an IO in a critically ill child)
Either a small gauge angiocath or butterfly can be used for access
Most common area to access in younger children is between the shoulder blades, although the lateral abdomen, thighs, or outer upper arms can be used as well; the site must have adequate subcutaneous tissue (can test by pinching between the fingers)
Subcutaneous catheter placement is generally quite easy, however care should be taken with securing the catheter as there will be expected swelling at the area which can cause dislodgement or discomfort
Mild erythema may also occur at the site of administration
Injection of hyaluronidase (150 U) at the site being used increases the volume that can be administered as well as speed of absorption (hospitals may carry this product for treatment of severe PIV infiltration events)
It is not necessary to have hyaluronidase to utilize subcutaneous fluid administration, but improves efficiency and efficacy
Fluids administered should be isotonic and can be administered at 20 mL/kg over an hour – this can be repeated as necessary

References

Caccialanza R, Constans T, et al. Subcutaneous Infusion of Fluids for Hydration or Nutrition: A Review. Journal of Parenteral and Enteral Nutrition. 2018; 42 (2): 296-307

Spandorfer PR. Subcutaneous Rehydration. Pediatric Emergency Care. 2011; 27 (3):230-236.