Development of an evidence based pediatric subcutaneous rehydration "hypodermoclysis" protocol for mildly dehydrated children with a history of difficult venous access.

BACKGROUND

Establishing peripheral intravenous access in children who present to a hospital setting with mild to moderate dehydration is often challenging. These children may not require hospitalization especially when unable to tolerate rehydration orally. An alternate access option for rehydration therapy is hypodermoclysis, commonly referred to as subcutaneous rehydration (SCR), where fluids can be infused and absorbed through the subcutaneous tissue. Unlike achieving peripheral vascular access, subcutaneous needle insertion is not complex and results in minimal venous attempts and discomfort for the child. Additional advantages of SCR include minimal patient and parent anxiety, shorter emergency room visits, and fewer admissions for rehydration purposes alone.

METHODS

Using the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care®, an expert panel of clinicians synthesized evidence to develop and successfully implement a children's hospital guideline for SCR.

RESULTS

The SCR procedure was successfully utilized 23 times in the first year after implementation. Female patients accounted for 52% of the SCR recipients with 100% of patients having known difficult venous access. Mean patient age was 3.5 years; 30% of the cohort were infants. No complications were noted in 48% of the cases. Complications identified were minor and consistent with previously published studies. Clinician's feedback and family and patient's level of satisfaction with SCR were uniformly positive (95% of responses with either somewhat or extremely satisfied).

CONCLUSION

Implementing SCR as a standard of care was successful in rehydrating children, decreasing overall number of venous attempts, and preserving vessels for future health care needs. MeSH Keywords: Child, Evidence-Based Practice, Hypodermoclysis, Infant, Newborn, Infusions, Subcutaneous, Rehydration.