Cancer patients in Palliative Care: occurrences related to venipuncture and hypodermoclysis. / Pacientes oncológicos sob cuidados paliativos: ocorrências relacionadas à punção venosa e hipodermóclise.

OBJECTIVE: to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. METHOD: an observational, descriptive and multicenter study. The consecutive and non-probabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. RESULTS: the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). CONCLUSION: the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis.

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings.

AIMS AND OBJECTIVES: To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings. BACKGROUND: Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision-making and to follow a standard procedure may be relevant in clinical practice. DESIGN: Cross-sectional telephone survey, with closed-ended and open-ended questions designed specifically for this study. METHODS: Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open-ended questions. The article adheres to the STROBE guidelines for reporting observational studies. RESULTS: Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them 'always or almost always'. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they 'always or almost always' followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available. CONCLUSIONS: Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice. RELEVANCE TO CLINICAL PRACTICE: Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended.

Hipodermóclise como ferramenta terapêutica para o cuidado de enfermagem e saúde / Hipodermoclisis como una herramienta terapéutica para el cuidado de enfermería y la salud / Hypodermoclysis as a therapeutic tool for nursing care and health

RESUMO Introdução: a hipodermóclise é uma alternativa tecnológica utilizada na administração de fluidos dentro do espaço subcutâneo. Essa técnica se apresenta como uma estratégia terapêutica que contribui, não somente, para a administração de medicamentos e fluidos, como no auxilio ao estimulo da autonomia e autocuidado do indivíduo. Objetivo: identificar como a hipodermóclise vem sendo abordada na literatura. Métodos: trata-se de uma revisão integrativa, onde foi realizado um levantamento sobre artigos publicados nos bancos de dados da MEDLINE; BDENF; CUMED e LILACS, entre os anos de 2005-2015. Sendo utilizados para a busca os seguintes descritores: hipodermóclise; enfermagem; saúde. Conclusões: foram selecionados 11 artigos que deram origem a três categorias temáticas: 1) Terapia subcutânea, uma via alternativa para o cuidado em saúde; 2) Hipodermóclise: técnica, utilização e aplicabilidade; 3) Hipodermóclise: tecnologias em saúde e a equipe de enfermagem. Apesar da necessidade de novos estudos sobre a temática, a técnica de hipodermóclise representa uma alternativa terapêutica a assistência do cuidado de enfermagem e em saúde. Com comprovada eficácia clínica e a possibilidade da sua utilização tanto no ambiente hospitalar, como em domicílio, ressaltam-se questões referentes ao conforto, tolerância e comodidade do paciente(AU)

RESUMEN Introducción: hipodermoclisis es una tecnología alternativa utilizada en la administración de líquidos en el espacio subcutáneo. Esta técnica se presenta como una estrategia terapéutica que contribuye no solo a la administración de fármacos y fluidos, sino también en la ayuda a estimular la autonomía y auto-cuidado individual. Objetivo: identificar cómo se ha abordado la hipodermoclisis en la literatura. Métodos: revisión integradora, se realizó una encuesta de artículos publicados en las bases de datos de MEDLINE; BDENF; CUMED y LILACS, entre los años 2005-2015. Se utiliza para buscar en los siguientes descriptores: hipodermoclisis; enfermería; salud. Conclusiones: se seleccionaron 11 artículos que dieron origen a tres categorías temáticas: 1) La terapia subcutánea, una ruta alternativa para el cuidado de la salud; 2) Hipodermoclisis: técnica, el uso y aplicabilidad; 3) Hipodermoclisis: tecnologías en el personal de salud y de enfermería. A pesar de la necesidad de realizar más estudios sobre el tema, la técnica hipodermoclisis es una alternativa terapéutica a la asistencia para el cuidado de enfermería y la salud. Con eficacia clínica demostrada y la posibilidad de su uso tanto en el ámbito hospitalario como en casa, que hace hincapié en las cuestiones relacionadas con la comodidad, la tolerancia y la conveniencia del paciente(AU)

ABSTRACT Introduction: hypodermoclysis is an alternative technology used in fluid administration in the subcutaneous space. This technique is presented as a therapeutic strategy that contributes not only to the administration of drugs and fluids, as in aid to stimulate the autonomy and individual self-care. Objective: To identify how hypodermoclysis has been addressed in the literature. Methods: This is an integrative review, which was conducted a survey of articles published in the databases of MEDLINE; BDENF; CUMED and LILACS, between the years 2005-2015. It is used to search the following descriptors: hypodermoclysis; nursing; cheers. Conclusions: We selected 11 articles that gave rise to three thematic categories: 1) Subcutaneous therapy, an alternative route for health care; 2) Hypodermoclysis: technique, use and applicability; 3) Hypodermoclysis: technologies in health and nursing staff. Despite the need for further studies on the subject, the hypodermoclysis technique is a therapeutic alternative to nursing care assistance and health. With proven clinical efficacy and the possibility of its use both in the hospital environment, such as at home, they emphasize issues related to comfort, tolerance and patient convenience(AU)

A Prospective Study of Hypodermoclysis Performed by Caregivers in the Home Setting.

CONTEXT: Decreased oral intake is very common at the end of life. Dehydration can aggravate symptoms, such as fatigue, myoclonus, and confusion. Intravenous hydration at home can be logistically difficult and expensive. Hypodermoclysis is easy to provide and inexpensive; however, it is rarely used to provide hydration at the end of life in the home setting. OBJECTIVES: The purpose of this study was to determine if caregivers were capable of administering hypodermoclysis in the home hospice setting. METHODS: All caregivers underwent a 45-minute training session on hypodermoclysis administration and assessment of infusion site delivered by a specially trained nurse. Caregivers received daily calls and on-site evaluation on Day 8. RESULTS: A total of 21 patient/caregivers dyads were admitted to this preliminary study: 10 (48%) female patients and 16 (76%) female caregivers. All patients had advanced cancer, receiving hospice care at home. All caregivers who received training were able to start the infusion. The infusion was facilitated by gravity or weight. Side effects were minimal with one (5%) because of the care of the needle and leakage. CONCLUSION: This preliminary study suggests that subcutaneous hydration could be administered by caregivers at home with minimal burden, equipment, and technical support.

Hypodermoclysis: a literature review to assist in clinical practice.

The aim of this study was to analyze the information available in the literature about the drugs that can be administered through hypodermoclysis and the resulting impact that this information may have on the routine of the pharmacist working at a hospital. The study was based on a review of the literature. The results showed positive points of the procedure, but little specific information about medications such as routes of administration, standard dilutions, optimal doses, etc. Thus, it was possible to verify that there is no definite information as to the correct way to administer the drugs in this route, even though this is an effective and safe option, according to the literature. The lack of information has a negative impact on the support provided by the pharmacist to the nursing staff to ensure that the drug actually reaches its therapeutic goals safely.

Hypodermoclysis: a literature review to assist in clinical practice / Hipodermóclise: revisão de literatura para auxiliar a prática clínica

The aim of this study was to analyze the information available in the literature about the drugs that can be administered through hypodermoclysis and the resulting impact that this information may have on the routine of the pharmacist working at a hospital. The study was based on a review of the literature. The results showed positive points of the procedure, but little specific information about medications such as routes of administration, standard dilutions, optimal doses, etc. Thus, it was possible to verify that there is no definite information as to the correct way to administer the drugs in this route, even though this is an effective and safe option, according to the literature. The lack of information has a negative impact on the support provided by the pharmacist to the nursing staff to ensure that the drug actually reaches its therapeutic goals safely.

O objetivo desse trabalho, foi analisar, na literatura, as informações disponíveis sobre os medicamentos que podem ser administrados através da hipodermóclise e o impacto que a informação pode acarretar na rotina do farmacêutico dentro de uma unidade hospitalar. O estudo foi baseado em uma revisão de literatura. Os resultados encontrados, demonstraram pontos positivos do procedimento, porém foram localizadas poucas informações específicas sobre medicamentos, como métodos de administração, padrões de diluição, dose ideal etc. Dessa forma, foi possível verificar que não há informações definitivas quanto ao modo mais correto de se administrar as drogas por essa via, mesmo sendo esta uma opção eficaz e segura, conforme a literatura. A falta de informação impacta negativamente no suporte realizado pelo farmacêutico à equipe de enfermagem para garantir que o medicamento realmente alcance seus objetivos terapêuticos com segurança.

Effects of hydration in rats and mice with polycystic kidney disease.

Vasopressin and V2 receptor signaling promote polycystic kidney disease (PKD) progression, raising the question whether suppression of vasopressin release through enhanced hydration can delay disease advancement. Enhanced hydration by adding 5% glucose to the drinking water has proven protective in a rat model orthologous to autosomal recessive PKD. We wanted to exclude a glucose effect and explore the influence of enhanced hydration in a mouse model orthologous to autosomal dominant PKD. PCK rats were assigned to normal water intake (NWI) or high water intake (HWI) groups achieved by feeding a hydrated agar diet (HWI-agar) or by adding 5% glucose to the drinking water (HWI-glucose), with the latter group used to recapitulate previously published results. Homozygous Pkd1 R3277C (Pkd1(RC/RC)) mice were assigned to NWI and HWI-agar groups. To evaluate the effectiveness of HWI, kidney weight and histomorphometry were assessed, and urine vasopressin, renal cAMP levels, and phosphodiesterase activities were measured. HWI-agar, like HWI-glucose, reduced urine vasopressin, renal cAMP levels, and PKD severity in PCK rats but not in Pkd1(RC/RC) mice. Compared with rat kidneys, mouse kidneys had higher phosphodiesterase activity and lower cAMP levels and were less sensitive to the cystogenic effect of 1-deamino-8-d-arginine vasopressin, as previously shown for Pkd1(RC/RC) mice and confirmed here in Pkd2(WS25/-) mice. We conclude that the effect of enhanced hydration in rat and mouse models of PKD differs. More powerful suppression of V2 receptor-mediated signaling than achievable by enhanced hydration alone may be necessary to affect the development of PKD in mouse models.

A randomized clinical trial of recombinant human hyaluronidase-facilitated subcutaneous versus intravenous rehydration in mild to moderately dehydrated children in the emergency department.

BACKGROUND: Alternative treatment of dehydration is needed when intravenous (IV) or oral rehydration therapy fails. Subcutaneous (SC) hydration facilitated by recombinant human hyaluronidase offers an alternative treatment for dehydration. This clinical trial is the first to compare recombinant human hyaluronidase-facilitated SC (rHFSC) rehydration with standard IV rehydration for use in dehydrated children. OBJECTIVE: This Phase IV noninferiority trial evaluated whether rHFSC fluid administration can be given safely and effectively, with volumes similar to those delivered intravenously, to children who have mild to moderate dehydration. METHODS: The study included mild to moderately dehydrated children (Gorelick dehydration score) aged 1 month to 10 years. They were randomized to receive 20 mL/kg of isotonic fluids using rHFSC or IV therapy over 1 hour and then as needed until clinically rehydrated. The primary outcome was total volume of fluid administered (emergency department [ED] plus inpatient hospitalization). Secondary outcomes included mean volume infused in the ED alone, postinfusion dehydration scores and weight changes, line placement success and time, safety, and provider and parent/guardian questionnaire. RESULTS: 148 patients (mean age, 2.3 [1.91] years]; white, 53.4%; black, 31.8%) were enrolled in the intention-to-treat population (73 rHFSC; 75 IV). The primary outcome, mean total volume infused, was 365.0 (324.6) mL in the rHFSC group over 3.1 hours versus 455.8 (597.4) mL in the IV group over 6.6 hours (P = 0.51). The secondary outcome of mean volume infused in the ED alone was 334.3 (226.40) mL in the rHFSC group versus 299.6 (252.33) mL in the IV group (P = 0.03). Dehydration scores and weight changes postinfusion were similar. Successful line placement occurred in all 73 rHFSC-treated patients and 59 of 75 (78.7%) IV-treated patients (P < 0.0001). All IV failures occurred in patients aged <3 years; rHFSC rescue was successful in all patients in whom it was attempted. Both treatments were well tolerated. Clinicians rated fluid administration as easy to perform in 94.5% (69 of 73) of the rHFSC group versus 65.3% (49 of 75) of the IV group (P < 0.001). Parents/caregivers were satisfied or very satisfied with fluid administration in 94.5% (69 of 73) of rHFSC-treated patients and 73.3% (55 of 75) of IV-treated patients. CONCLUSIONS: In mild to moderately dehydrated children, rHFSC was inferior to IV hydration for the primary outcome measure. However, rHFSC was noninferior in the ED phase of hydration. Additional benefits of rHFSC included time and success of line placement, ease of use, and satisfaction. SC hydration facilitated with recombinant human hyaluronidase represents a reasonable addition to the treatment options for children who have mild to moderate dehydration, especially those with difficult IV access. ClinicalTrials.gov identifier: NCT00773175.

Hypodermoclysis: renewed interest in an old technique.

Dehydration is a common problem in elderly patients, often resulting in hospitalization. Intravenous administration of fluids can correct dehydration but poses other risks and problems. Subcutaneous administration of fluids, termed hypodermoclysis, offers an alternative method for rehydrating patients, and it is beginning to gain favor among practitioners in the long-term care setting because of its ease of use and minimal risk of side effects.

Severe hemorrhage from a hypodermoclysis site.

Hypodermoclysis, or subcutaneous infusion of fluids, is an alternative means of administration of fluid. It is sometimes used in older patients in whom there is difficulty achieving intravenous access, or who are entering the terminal stage. It is considered a relatively low-risk procedure. We report a case where a patient's death may have resulted from its use.