Hypodermoclysis – SUbcutaneous Hydration



|Hypodermoclysis – Subcutaneous Hydration H5MAPR0324 |Level III |

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|Purpose of the Procedure |The purpose of this procedure is to provide guidelines for administration of subcutaneous hydration to the |

| |resident as ordered. |

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|General Guidelines |Verify with state Nurse Practice Act as to RN/LPN scope of practice regarding this procedure. |

| |Hypodermoclysis is a method of hydration that does not require an intravenous catheter for delivery. |

| |Hypodermoclysis involves using small needles to deliver isotonic fluids (0.9 NS, lactated ringers, D5W) slowly |

| |into the subcutaneous tissue. |

| |This system is designed for short-term, preventative hydration or for mild dehydration. |

| |Hypodermoclysis is NOT for antibiotics, narcotics, or fluids with electrolytes (KCL, magnesium, etc.). |

| |Sites for needle placement are the abdomen, stomach, and front or side of thighs. Less commonly used sites are the|

| |upper arms or upper back shoulder area. |

| |The fluid is infused into the subcutaneous tissue where it is absorbed slowly. While the fluid is absorbed, a |

| |fluid wheal will form. This is normal and is not an infiltration of fluids. |

| |Hypodermoclysis reduces the chance of the following complications associated with intravenous therapy: |

| |Fluid overload, CHF; |

| |Phlebitis; and |

| |Infections. |

| |Physician order should include: |

| |Type and quantity of isotonic fluid; |

| |Rate (determined by type of delivery set); and |

| |Length of treatment. |

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|Equipment and Supplies |Hypodermoclysis set with needle strip; |

| |Isotonic solution bag; |

| |Antiseptic skin cleaning solution; |

| |Non-sterile gloves; |

| |Transparent dressing; and |

| |IV pole. |

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|Steps in the Procedure |Review physician order. |

| |Explain procedure to resident. |

| |Assemble fluid and kit. |

| |Wash hands. Don non-sterile gloves. |

| |Prime tubing including attached needle set until all air is removed. |

| |Do sterile site preparation and allow to air dry. |

| |Pinch up skin or flatten skin. Insert needle strip flat into skin. |

| |Secure needle strip to skin using transparent dressing. Tape tubing to skin. |

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|Steps in the Procedure (continued)| |

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| |continues on next page |

| |Date dressing and tubing. |

| |Start fluid and adjust flow rate. Make sure that resident is comfortable. |

| |Monitor for fluid wheal formation. This is affected by metabolism rate of resident. |

| |If necessary, the site may be lightly massaged to help fluid absorption. |

| |Observe for any signs of peripheral edema (not the fluid wheal), leakage or fluid overload. Monitor for line |

| |disconnection from skin. |

| |If the site needs to be changed, the whole set including needles are changed as one piece. Contact pharmacy for |

| |new set. No new order is needed. |

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|Documentation |Document the following in the resident’s medical record upon insertion: |

| |Procedure; |

| |Type of fluids; and |

| |Dressing and tubing. |

| |Document the change date on the medication administration record. |

| |Document the following in the resident’s medical record every shift: |

| |The type of fluid being infused, location of needle placement, type of antiseptic used to clean skin; |

| |Intake and output totals; |

| |Time fluid bag was started and discontinued; |

| |Condition of skin where needles are inserted, any leakage, peripheral edema (not fluid wheal), statement from |

| |resident regarding how they are tolerating the treatment; |

| |Date and time of tubing and needle strip site change and reason for changing site (leakage, skin irritation, 72 |

| |hour site change); and |

| |Any communication with physician about problems, laboratory values. |

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|Reporting |Report to physician or supervisor any information about treatment. |

| |Report to oncoming shift nurses the type of treatment, needle insertion site, any complications, and any objective|

| |information concerning treatment. |

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|References |

|MDS (CAAs) |Section I; Section J; Section O; (CAA 14) |

|Survey Tag Numbers |F327 |

|Related Documents |Hydration – Clinical Protocol |

| |Resident Hydration and Prevention of Dehydration |

|Risk of Exposure |Blood–Body Fluids–Infectious Diseases |

|Procedure |Date:________________ By:__________________ |

|Revised |Date:________________ By:__________________ |

| |Date:________________ By:__________________ |

| |Date:________________ By:__________________ |

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