Hypodermoclysis

Hypodermoclysis

Hypodermoclysis (HDC) is a medical procedure employed for symptomatic treatment and for electrolyte and fluid replacement through the subcutaneous administration of fluids and medication.

Based on the situation of the patient being treated, the physician will direct the quantity, dosage, rate of flow and the type of medication or solution that will be administered. These details depend on the patient’s health condition and on the treatment they need to follow. Also, the flow rate depends on the patient’s fluid requirements, the dosages employed and on the tissues’ absorptive ability. Once the patient’s condition has been fully assessed, the supervising physician will provide all the necessary details for the procedure.

In situations where the medicines / fluids employed during Hypodermoclysis are not being properly absorbed, the supervising health care professionals need to check the absorption site frequently, applying warm compresses; also, the infusion rate may need to be slowed down and the solution may be infused with a pump. In some situations, bolusing the fluid in small volumes may help, if the solution does not contain any added medication. If none of the above solves the problem, dividing the volume into two infusion sites may help. In some cases, the patient’s need for hydration may be re-evaluated.

It is necessary to mention that this procedure may not be applied under certain circumstances, or that in some cases the patients may require special attention. For example, it should be noted that persons who are taking diuretics while undergoing Hypodermoclysis need review. Also, HDC is contraindicated to patients suffering from thrombocytopenia.

The pharmacist should be notified at any time the infusion rate is increased or decreased, as well as if the procedure is discontinued. They need to be aware and prepare the solution for administration in time, so that there are no delays in the administration of the fluids or medication.

Hypodermoclysis Description

As part of the Hypodermoclysis preparation stage, the entire administration set needs to be flushed, along with the winged infusion set, after thoroughly washing your hands with soap and water. The individual and their family need to be explained the Hypodermoclysis procedure in detail so make sure they are familiar with it.

In order to administer the fluids, first wash your hands thoroughly with water and soap and equip gloves. Choose the administration site and the direction of the needle; the most common sites include the supra scapular area, the upper chest (be careful to avoid axilla and breast tissue as administration in these regions may cause increased discomfort while also resulting in decreased absorption; however, in the chest area, you may choose any direction for the needle), the abdomen or the upper thighs. If you choose a site on the abdomen, make sure that it is not too low, generally below the umbilicus, as this may cause scrotal edema. The needle should be directed laterally in order to prevent any grabbing or pinching when the patient bends or sits. If the site is chosen on the upper thigh, you must make sure that the patient’s mobility will not be impeded or you must choose a different location. Also, if you choose the site too high, there is a risk for scrotal edema. Generally you should check with the patient in order to see if he or she has any preferences regarding the site and needle direction. It should be noted that the upper arms may not be used for Hypodermoclysis at any time.

After the administration site and the needle direction have been determined, cleanse the site with alcohol solution and allow the skin to dry before inserting the winged infusion set. The needle should be positioned in the subcutaneous space where it should move freely; however, make sure that the needle does not penetrate too deep (IM) which may become painful and cause bleeding, but should also not be too superficial as this may cause pain and leakage. Pinch tissue between thumb and index tissue. Insert the needle into the tissue at a 45 degree angle with the bevel up. The insertion is facilitated by inserting the needle at the base of the pinch. Attach the administration set to the tubing of the infusion set, and adjust the flow rate as appropriate.

Hypodermoclysis Related Medication

Typically, Hypodermoclysis is employed for administration of normal saline solutions (0.9% Sodium Chloride solutions), solutions containing 5% Dextrose and 0.9% Sodium Chloride, 2/3: 1/3 solutions containing 3.33% Dextrose and 0.3% Sodium Chloride and lactated ringers. In case the patient is administered large volumes of solutions, these must contain electrolytes. Under no circumstances should a patient be administered the following medication through Hypodermoclysis: antibiotic medication, Digoxin, Pamidronate, phenytoin or Diazepam, or any other medicines deemed inappropriate. For a full list of compatibilities and recommendations it is best to check with the pharmacy.

There are some complications that may appear as a result to Hypodermoclysis. These include edema at the infusion site, redness and irritation, infections, needle dislodgement or fluid overload. In the case of local edema, the patient’s state needs to be monitored and if the edema increases or persists for more than 8 hours, it is best that the procedure is discontinued and restarted in another site. If the patient presents redness or irritation at the site of the infusion, it is possible that he or she is experiencing a hypersensitivity reaction to the needle or to the solution. Monitor as appropriate and if the situation does not improve, remove the needle. If an infection develops at the site, the infusion must be discontinued and the needle must be removed. Using a new administration set, restart the procedure in another site, and treat the infection as needed. Needle dislodgement requires the application of gauze dressing over the site and restarting the procedure in a new site.

For systemic complications such as fluid overload, the patient will require close monitoring for edema (especially feet, pelvis and genitalia) and the infusion rate needs to be slowed or discontinued. The supervising health care professional needs to be notified of this immediately. At all times, before starting Hypodermoclysis with a certain solution, check the expiry date and any other specifications that may be available on the product information leaflet. Once opened, a solution bag should only be hung for 24 hours. If after that time there is any solution left in the bag, discard according to the specifications and open a new bag as needed.