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" 0 1! js C # L p0 5 E 0 E 0 J 7$ J $ 0 0 J / 0 x # # , # # # # # E E 7( # # # E # # # # J # # # # # # # # # x : Hypodermoclysis Subcutaneous Hydration AUTHOR \* MERGEFORMAT H5MAPR0324Level IIIPurpose of the ProcedureThe purpose of this procedure is to provide guidelines for administration of subcutaneous hydration to the resident as ordered.
General GuidelinesVerify 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.
Equipment and SuppliesHypodermoclysis set with needle strip;
Isotonic solution bag;
Antiseptic skin cleaning solution;
Non-sterile gloves;
Transparent dressing; and
IV pole.
Steps in the Procedure
Steps in the Procedure (continued)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.
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.
DocumentationDocument the following in the residents 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 residents 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.
ReportingReport 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.
ReferencesMDS (CAAs)Section I; Section J; Section O; (CAA 14)Survey Tag NumbersF327Related DocumentsHydration Clinical Protocol
Resident Hydration and Prevention of DehydrationRisk of ExposureBloodBody FluidsInfectious DiseasesProcedure
RevisedDate:________________ By:__________________
Date:________________ By:__________________
Date:________________ By:__________________
Date:________________ By:__________________
2001 MED-PASS, Inc. (Revised October 2010)
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) PRS051 $ MED-PASS, Inc. and Heaton Resources ) Hypodermoclysis SUbcutaneous Hydration Title h ChT FT ProP ProT RD *PAGE *1*. ChT F309; F311 FT The purposes of this procedure are to provide comfort to the resident, to stimulate circulation, to relax the muscles, and to observe the resident's skin condition. ProP Giving a Backrub ProT Revised August 2002 RD
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