A comparison of intravenous and subcutaneous hydration in elderly acute stroke patients

Challiner, Yvonne; Jarrett, David; Hayward, Melissa J.; Al-Jubouri, Mohammad; Julious, S. A.

doi:10.1136/pgmj.70.821.195

Cited by 61 publications

(65 citation statements)

References 7 publications

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“…Sehen and SingerEdelstein [1] reviewed 1,850 s.c. infusions given to 270 patients in acute and long-stay geriatric beds and concluded that the s.c. route was the method of choice for adminis tering fluid to elderly patients in nonurgent situations. Other writers have reported simi lar findings [2][3][4], Lipschitz et al [7] demon strated using radioisotope tracers that normal saline (with hyaluronidase) given subcuta neously was rapidly and fully absorbed into the bloodstream.…”

Section: Discussionmentioning

confidence: 93%

“…For the purpose of this study, we used a continuous infusion over 24 h. Overnight infusions leave the pa tient free from restrictions by day and are par ticularly useful in patients requiring rehabili tation [4], Hyaluronidase, which breaks down s.c. tissue, increases the speed of absorption of s.c. fluids [2,7], but is not necessary in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…Subcutaneous fluids are particularly useful in elderly pa tients in whom veins may be fragile or oc cluded. In stroke patients, rehabilitation is facilitated by s.c. infusions because the limbs are spared, and Challiner et al [4] have re cently shown that s.c. therapy is as effective as i.v. therapy in restoring hydration in elderly patients with stroke.…”

Section: Introductionmentioning

confidence: 99%

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Subcutaneous Fluids in Elderly Hospital Patients with Cognitive Impairment

O'Keeffe

Lavan

1996

Gerontology

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Sixty patients (mean age 80 years) with cognitive impairment who required parenteral fluids for at least 48 h were randomized to receive either intravenous (i.v.) or subcutaneous (s.c.) fluids. There was no significant difference in the mean volume of fluid prescribed over 48 h in the two groups (s.c. 3.3 litres vs. i.v. 3.6 litres) or in the proportion of prescribed fluids actually administered (s.c. 0.82 vs. i.v. 0.76). After adjusting for baseline differences, there was no difference between serum urea or creatinine levels in the two groups at 48 h. Agitation related to the infusion was reported in 11 (37%) patients receiving s.c. fluids and 24 (80%) patients receiving i.v. fluids (p < 0.005). The cost of the cannulae used during the study was E6.80 for the s.c. group and E28.70 for the i.v. group. Local oedema was noted in 2 patients in the s.c. group and led to re-siting of the infusion in 1 patient. No other complication was noted. These results suggest that s.c. fluid therapy is the treatment of choice in nonurgent situations for confused patients who require parenteral fluids.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subcutaneous Fluids in Elderly Hospital Patients with Cognitive Impairment

O'Keeffe

Lavan

1996

Gerontology

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“…Finally, improved communication with young patients and their parents/caregivers is a critical factor in establishing realistic expectations and in achieving patient/parent satisfaction with the quality of medical care in the hospital and the ED. As effective as IV for fluid administration in nonemergency situations 46 Rates of fluid administration and drug absorption can be accelerated with hyaluronidase [47][48][49][50][51][52][53] Vein-sparing; fewer complications than with IV 46 Easy setup and maintenance 46,54 Cost-effective 46,54 Similar serum drug levels achieved with IO and IV 55 Access and drug delivery may be faster than with IV Risk of catheter dysfunction (eg, phlebitis, inadvertent dislodgement) 57 Risk of thrombosis 57 May take longer than other routes of venous access 56 Risk of thrombosis 56 Requires special skills that are difficult to maintain if the procedure is not done frequently Abbreviations: IV, intravenous; SC, subcutaneous; IO, intraosseous; CVC, central venous catheter.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Difficult Venous Access in Children

Rauch

Dowd

Eldridge

et al. 2009

Clin Pediatr (Phila)

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discuss management strategies. This article summarizes the recommendations of the consensus panel for physicians. The recommendations for nurses will be published separately. Definition and Scope of the ProblemEarly identification of DVA is the first step in optimizing patient care. The consensus panel described DVA as a clinical condition in which multiple attempts and/or special interventions are anticipated or required to achieve and maintain peripheral venous access. Special interventions are defined as the use of any technique or hospital resource with the potential to improve peripheral IV insertion success rates. These include traditional methods of enhancing the visibility and palpability of peripheral veins (eg, warming the catheter site to induce vasodilation) [10][11][12] ; advanced visualization technologies such as ultrasound, transillumination, and nearinfrared lighting 2,[13][14][15] ; and enlisting designated IV specialists and/or hospital staff with extensive experience in starting pediatric IVs.16 Some children may need more invasive interventions such as intraosseous (IO) infusion, a peripherally inserted central catheter, or a central venous catheter (CVC) to achieve parenteral access.There is a dearth of clinical evidence on the incidence of DVA in pediatric patients. Studies of IV insertion success rates indicate that 5% to 33% of children require more than 2 needle sticks to achieve IV access. [1][2][3][4] Even when interventions such as transillumination and ultrasound are used, up to 15% of children still require more than 2 attempts to establish venous access.2 A recent prospective analysis of 593 insertion attempts in centers with pediatric hospitalist services showed that successful placement E stablishing peripheral intravenous (IV) access in pediatric patients can be challenging. Clinical studies show that only 53% to 76% of children are successfully cannulated on the first attempt.1-4 Multiple failed attempts are painful and upsetting for the child and distressing for family members and caregivers, 5-9 yet there are no guidelines or consensus statements on the recognition and management of this problem.In January 2008, a panel of physicians and nurses specializing in emergency medicine, anesthesia, critical care, and hospital medicine convened to discuss peripheral difficult venous access (DVA) in children. Daniel Rauch, MD, FAAP, and Laura L. Kuensting, MSN(R), RN, CPNP, cochaired the roundtable discussion, which was made possible by a grant from Baxter Healthcare, Inc. The main objectives of the meeting were to estimate the frequency of DVA in pediatric patients; describe its clinical and emotional impact on the patient, the patient's family, and clinicians; develop terminology that accurately describes the condition; review the factors that help identify children with DVA; and

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“…Advantages of the SC route include the possibility of selfadministration, greater mobility for patients, it provides an alternative for patients with poor venous access and can be administered at home, away from the hospital setting [2]. Cost is another element to take into account, and several studies have shown the cost effectiveness of SC delivery over the IV drug route [3][4][5][6]. In addition, out of pocket costs for patients and their families having to take time off work and travel to hospital for IV treatment could be underestimated.…”

Section: Introductionmentioning

confidence: 99%