Hypodermoclysis Technique

Fluid
1. Normal Saline (most common)
2. One half NS (0.45%)
3. One third NS with two thirds 5% dextrose
4. D5W, D5-NS or D5-1/2NS
Additives
1. Medications (e.g. Morphine) not recommended
  1. No data on absorption
2. Potassium chloride
  1. May infuse 20 to 40 mmol/L safely
3. Hyaluronidase
  1. Enhances subcutaneous fluid absorption
  2. Lyses interstitial barrier for 24 to 48 hours
  3. Not necessary to prevent edema
  4. May cause discomfort and local reaction
  5. Dose
    1. Hyaluronidase 150 Units per Liter fluid
    2. Inject 75 Units at each clysis site

Ambulatory patients
1. Abdomen
2. Upper chest (above the Breast)
3. Over intercostal space
4. Scapula area
Bed-bound patients
1. Thighs
2. Abdomen
3. Outer upper arm

Wash hands
Assemble fluid and tubing, priming tubing with solution
Swab infusion site with Betadine preparation
1. Begin at site center, and spiral outwards
2. Allow at least 1 minute contact time
3. Avoid touching site with fingers
Insert needle SQ with bevel up at 45 to 60 degree angle
1. Avoid inserting too deep (Muscle infusion painful)
2. Avoid infusion if blood seen in tube on needle insert
Secure needle and tubing with Occlusive Dressing
Date and initial both dressing and tubing
Change needle and tubing every 1 to 4 days
Record infusion date and time on medication card
Check infusion site within 1 hour of start
1. Check solution, tubing, and needle for malfunction
2. Observe patient for signs of Fluid Overload
3. Confirm rate is not too fast (see Step 5 below)
  1. Discomfort may be indicator of too fast of rate
4. Observe for subcutaneous edema or leakage
  1. Infusion site may be massaged to reduce edema

Administer subcutaneously by gravity
Rate
1. Typically 1 ml/minute per site (1.5 Liters/day/site)
2. May be increased with use of hyaluronidase
May administer up to 2 separate sites
Do not administer more than 1 Liter in 2 hours
Alternative regimens
1. Administer 1-2 Liters over night
2. Administer 500 ml bolus over 1-2 hours tid
  1. Pretreat site with hyaluronidase 150 U qAM