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Subcutaneous Rehydration - Hypodermoclysis

Hypodermoclysis is the subcutaneous administration of isotonic infusates to correct short-term fluid and electrolyte balances and is often referred to simply as “clysis”.  

What is Hypodermoclysis

Hypodermoclysis is the subcutaneous administration of isotonic infusates to correct short-term fluid and electrolyte balances and is often referred to simply as “clysis”.  It has recently begun to regain recognition as a safe and effective alternative to intravenous fluid hydration in the mild to moderately dehydrated patient, particularly in the areas of palliative care and long-term care. Hypodermoclysis is easy to establish and maintain and has fewer complications than intravenous hydration. The medication hyaluronidase can be injected as a spreading agent to facilitate subcutaneous fluid absorption. Clysis has the potential to help reduce the $1 billion annual US cost of avoidable hospitalizations for dehydration.

Dehydration is a serious acute condition in older adults associated with significant morbidity and mortality. Hypodermoclysis can provide an alternative to intravenous (IV) rehydration of older adults.

Evidence indicates that hypodermoclysis is effective as IV rehydration of older adults with mild to moderate dehydration. The literature cites advantages of hypodermoclysis over IV hydration, including the same number of or fewer complications, cost savings, greater patient comfort, and less nursing time to start and maintain the infusion. 1

With many of the studies on clysis being performed outside of the US mainly in Erupe, Asia and Canada; despite the reported advantages it is unclear why this simple method of rehydration is not implemented more in the US. 2

Treatment Of Elderly During Heat-Waves

Geriatric patients were more often treated in hospitals for dehydration in the last years resembling a rising burden for health systems. Elderly people are more vulnerable for dehydration during heat waves especially when there are complicating factors like febrile episodes or multiple medications. In private care situations as in homes for elderly, strategies have to be implemented in Germany to prevent hospital admissions in the case of transient dehydration. By this a rise of costs and a waste of resources should be diminished. 3

Resources
1 Lybarger, E. (2009) Hypodermoclysis in the Home and Long-term Care Settings. Journal of Infusion Nursing. 32(1), p.40-44.
2 Hypodermoclysis to Treat Dehydration: A Review of the Evidenc Authors Ruth Remington PhD, RN,Todd Hultman PhD, RN http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1532-5415.2007.01437.x/
3 Schnürle, J. (2015) Subcutaneous rehydration for efficient treatment of elderly people during heat-waves. Deutsche Medizinische Wochenschrift. 140(11), p.827-30. [Article in German]. http://www.ivteam.com/intravenous-literature/subcutaneous-rehydration-for-the-treatment-of-elderly-during-heat-waves/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Ivteam+%28IVTEAM%29
To learn more about Hypodermoclysis consider taking our 1.5 contact hour course “Reducing Hospitalization with Hypodermoclysis”
This instructional course has been designed to provide information regarding the use of hypodermoclysis, also known simply as clysis, to achieve rehydration in patients who might otherwise require hospitalization. Dehydration is a common occurrence, especially in the older population. Clysis is an optimal means of administering non-emergent subcutaneous parenteral fluids in a familiar, comfortable environment.

“Clysis” or subcutaneous rehydration intervention is cost-effective, easy to administer, and safer than intravenous rehydration, but many nurses are unfamiliar with the therapy. This course will prepare the licensed nurse to provide this valuable intervention, thereby decreasing the risk of hospitalization with its associated risks and costs.


Objectives

Upon completion of this course, the participant will be able to:
  1. Identify at least 3 factors that contribute to dehydration in the elderly.
  2. Define hypodermoclysis.
  3. Describe the advantages, disadvantages, indications, and contraindications of hypodermoclysis.
  4. Describe the appropriate sites, solutions, volumes and rates for hypodermoclysis.
  5. Describe the procedure for hypodermoclysis administration.
  6. State at least 3 potential complications of hypodermoclysis.

Curriculum

Chapter 1
Dehydration
Scope of Problem
Contributing Factors
Signs and Symptoms
Assessment
Chapter 2
Hypodermoclysis Introduction
Advantages
Disadvantage
Indications
Contraindications
Use in Terminally Ill Patients
Chapter 3
Infusion Parameters
Sites
Solutions
Volume and Rate
Hyaluronidase
Chapter 4
Administration
Equipment
Procedures
Chapter 5
Complications
Systemic Complications
Local Complications
Chapter 6
Communication and Documentation

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