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The Resurgence of an Old Hydration Technique - Hypodermoclysis

With the hot days of summer approaching- keeping our elderly hydrated becomes critically important. Often an acute illness affects the ability of an elderly client or resident to keep up with the demands of sufficient water intake by mouth and rehydration via another means become necessary. Anyone who has attempted an IV catheter insertion on an elderly dehydrated patient is very familiar with the frustration and often the impossibility of the task. Due to the fact of very difficult cannulations on dehydrated individuals, we are seeing a resurgence of an old technique of rehydration called Hypodermoclysis or sometimes simply called “clysis”.

This strange sounding technique is actually a simple, easy, cost effective method of rehydrating with subcutaneous fluids.  With clysis an insertion of a catheter subcutaneously is all that is required and is the rehydration technique used in many long term care facilities and home health agencies across the country to prevent a hospital admission for IV placement and hydration.  Reducing unnecessary hospitalizations is a major focus in the health care industry today and many facilities are finding clysis as a great tool in their arsenal of hospital prevention strategies.  

The History of Hypodermoclysis

Subcutaneous fluid administration has been in use since the 1940’s and was popular during the 1950’s, but was largely replaced with the introduction of intravenous administration techniques. Many will recognize Hypodermoclysis as the method used by many veterinarians today for the rehydration of mild to moderately dehydrated animals. 

Administration Methods

With clysis, fluid is infused through a small gauge needle or catheter inserted into any of various sites.  Clysis sites are typically the same sites used for subcutaneous medication injections and would include:
  • Posterior upper arm
  • Upper chest, avoiding breast tissue
  • Subscapular area
  • Flank
  • Anterior or lateral thigh
  • Abdomen, at least 2 inches from the navel
There are limitations of clysis as only limited amounts of fluids may be administered.  The generally accepted volume and rate limits are:
  • Up to 1.5 liters/day in one infusion site (62ml/hr)
  • Up to 3 liters/day using 2 infusions sites (124ml/hr total)
The clysis infusion is generally administered by gravity at a constant rate. However, it is acceptable to administer 500 ml boluses over one to two hours, three times per day, with the use of hyaluronidase.  Hyaluronidase is an enzyme that increases the absorption and dispersion of subcutaneous solutions and other injected drugs. 

Generally, the literature states that the appropriate solutions that may be infused subcutaneously are isotonic solutions containing sodium chloride. However more recent studies have included solutions of D5W, Ringers, Lactated Ringers and solutions containing potassium chloride as acceptable solutions for clysis use.

The Advantages/Disadvantages of Clysis

  • Lower costs; fewer re-sites, less equipment required, less staff time
  • More comfortable than IV administration
  • Less likely than IV administration to cause pulmonary edema or fluid overload
  • Simple insertion, less distressing than IV insertions
  • May be administered in any  care setting
  • Does not cause thrombophlebitis
  • Not associated with septicemia or systemic infections
  • No danger of intravenous clot formation, and clotting of IV catheter
  • Limited volume of solution that may be administered
  • Edema at infusion site
  • Possible local reaction

Clysis is cost-effective, easy to administer, and safer than intravenous rehydration, but many nurses, nurse practitioners and even physicians are unfamiliar with the therapy.  With the many advantages of this rehydration technique, it may be beneficial for facilities to take steps to educate their staff in this simple method of rehydration. 

To learn more about Hypodermoclysis  see our course Reducing Hospitalization with Hypodermoclysis

Pedagogy blog written by Capra Dalton, RN. Capra Dalton is our CEO and author of Pedagogy online continuing education courses.

Capra Dalton, Registered Nurse, has more than 26 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant.

As the CEO, Capra is responsible for all operational aspects of Pedagogy, including education course content, author recruitment, and management. She is a member of the Infusion Nurses Society (INS), the National Association for Practical Nurse Education and Services (NAPNES), and the Council of Practical Nurse Educators (COPNE), and presented at a recent Texas Health Care Association convention on “Nurses Meeting the Changing Needs of LTC Residents - IV’s and PICC Lines.” Capra received her nursing education from Lamar University in Beaumont, Texas.

Capra has an avid interest in holistic healing, nutrition, herbs, and alternative therapies for the treatment of disease in humans as well as animals. She and her husband, Patrick, live near Tyler, Texas, with their two teenage daughters, three dogs, and a cat on a ranch complete with horses, chickens, vineyard, orchards, and a 4,000 square foot organic garden.

Visit us at http://pedagogyeducation.com to learn more. 

Posted: 7/22/2013 10:52:54 AM
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