Week 22 – Question of the Week: Can you give an IV without IV access, or, Have you tried hypodermoclysis?

Week 22: 2011-10-12 (non-consecutive weeks) 

Suppose your child has vomited for days and is too weak to walk. The grid is down and the hospital is closed, their generator having run out of fuel. You have no idea where to find a doctor or nurse.

However, you have dutifully prepared, purchasing IV fluids, tubing, and needles for just such an occurrence. Just one thing, though . . . you’ve never given an IV and are scared to death to try.

Is there any other way to administer IV fluids, perhaps something a bit easier?

The answer is yes, via subcutaneous fluid administration (hypodermoclysis). Unfortunately, most doctors are as unfamiliar with the technique as patients may be. Our veterinary friends are more likely to have experience with this fluid replacement therapy.

Even nurses often find it difficult to find a vein in an elderly and/or dehydrated patient. Fortunately, it is possible to treat mild to moderate dehydration by infusing fluids (saline solution) just below the skin (sub=under; cutaneous=skin).

My question today is: who has tried this technique? What success have you had? What advice can you offer?

Please submit questions and comments in the block below to share with our readers, and refer to the articles below for additional information.

CLICK LINKS below for additional information

Subcutaneous fluid administration for cats, illustrated

Using subcutaneous fluids to rehydrate older people: current practices and future challenges

Subcutaneous fluid administration, human

Subcutaneous fluid infusion in a long-term care setting

Hypodermoclysis: An Alternative Infusion Technique

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
This entry was posted in Cholera, Dehydration, Diarrhea, Medical archives, Question of the Week, Slide show, Stockpiling medical supplies, Vomiting, Weight loss and tagged , , . Bookmark the permalink.

10 Responses to Week 22 – Question of the Week: Can you give an IV without IV access, or, Have you tried hypodermoclysis?

  1. DrJohn says:

    Au contraire, imho rectal and abdominal administration of fluids is far behind clysis in terms of desirability. I don’t know anyone who has used either technique for hydration. But that is just my opinion.

    • pa4ortho says:

      I totally agree with you on desirability. I would take clysis over abdominal or rectal in trying to maintain hydration over time. Lower risk than abdominal. Less messy and uncomfortable than rectal. In terms of speed of infusion, the larger surface area of the abdomen or colon absorb faster, that was the focus of the list. —


  2. DrJohn says:

    I’ve done clysis on kids. No IV access, and cutdowns messy and subject to complications. Intraosseous the new rage, but clysis much easier and safer if you have a little time and not doing a resuscitation.

    I heartily recommend it. And, by the way, no special equipment needed. Just put in a 20 or two and push aliquots of fluid.

  3. pa4ortho says:

    Think in terms of what gets fluid in fastest, in general.

    central line IV best
    peripheral IV
    PO fluids (safest)
    intra-abdominal (high risk infection)
    rectal (dang messy)


  4. Dr C says:

    Over almost 40 years of veterinary medical practice I’ve had regular occasion to administer subcutaneous (SQ) fluids to a variety of animals from exotic pet snakes to routine dogs/cats. This is a relatively straightforward technique since most species have very loose skin with lots of SQ space.

    Everything but 50% glucose is relatively safe (i.e. LRS, Ringers, Saline, 5% dextrose in saline). Large volumes can be administered in a relatively short period of time through a variety of needle sizes (18 ga for pets is usual) and administering warm fluids causes less discomfort. Fluid volumes vary with the amount of dehydration and usually if there is significant dehydration the pet is admitted for IV fluid admin in the hospital. Some pets need the fluid rehydration from mild vomiting and/or diarrhea to assist in hastening recovery or for long-term renal disease support.

    Locations vary, but generally the area caudal to the crest of the scapulae is very suitable and further caudal if more volume is needed. The average cat can handle 300 ml and large breed dogs 500-600 ml. These fluids can be “spiked” with Vitamin B12 without adverse consequences to replace losses or stimulate appetite.

  5. pa4ortho says:

    Clysis, or infusion into the sub-q layers, is an alternative that is best used as a 2nd or third line intervention in specific scenarios.
    It is slow but effective in humans; it is much more effective in cats and dogs due to the loose subcutaneous layers.

    To do clysis specific needles are available. They usually have more than one needle to distribute the fluid over a larger area.
    A 20 or 22 gauge butterfly in the sub-Q layer taped in place works. If you can port it, then more then one needle is good to increase flow.

    Unlike your pets, you cannot push a large bolus into the sub-q layer on a typical human without pain. Usualy we do this to gravity or infusion syringe pump in small kids.

    Some uses of clysis:
    -nursing home type – can’t swallow, too confused to swallow, debilitated patient to maintain hydration
    -no IV cath available in a patient with high water loss with an irritated bowel, cholera etc…
    – infant, again with no IV site or apropriate cath

    Limitations of clysis: slow rates of infusion; slow absorbtion of meds; risk of celulitis

    I have only used it a few times as other methods are usually more apropriate.
    Many of these patients can be managed better with PO fluids from a camel back, or by teaspoon; flavored water improves compliance.

    I have infused fent via clysis in a hospice patient using a portable baxter syringe pump with good effect. Onset and clearence are delayed compared to IV. You have to titrate based on effect as each person and infusion site will be different. Also, as peripheral circulation decreases in severe dehydration and shock states, the uptake is delayed. If you then resucitate, a large reservoir of narcotic suddenly becomes available.


  6. Chris MD says:

    Still standard practice in veterinary medicine, in not that distant past was standard in peds. A bit more painful that standard IV, but just as effective. There are a number of meds that cannot be given by this route, but if we are just talking fluids, klysis is a perfectly acceptable route of administration.

  7. Mike M, APRN says:

    Yes, I have. I had a German shepherd who needed daily rehydration and my Vet who has cared for my animals for many years and who knows I am an Advanced Practice Nurse showed me how to do it. I also work with an RN who has done this many years ago in a rural clinic when IV access could not be obtained. I was skeptical until I did it the first time. I adminstered 500 cc normal saline sub-Q expecting a large hematoma; of course none formed. If I could not get an IV access I would not hesitate to use the Sub-Q method if fluids where needed. The distinct advantage is not having to be able to locate and access a vein.

    On another note I have assisted with the reverse of this. I was shown how to do an abdominal parcentesis (remove abdominal fluid from acities) by an Oncologist. After using only percussion ( no ultrasosund or CT used) to locate the fluid, he inserted an an 18-gauge IV catheter and IV tubing and drained the fluid and sent the patient home.

    • Doc Cindy says:

      When I worked in Kentucky I did a thoracentesis on a home-bound patient with recurrent pleural effusion.

      TEOTWAWKI needn’t mark the end of all procedures. We will just have to rely on clinical skills and sound judgment rather than technology.

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