Innovations in subcutaneous infusions

International Consensus Recommendation Guidelines for Subcutaneous Infusions of Hydration and Medication in Adults: An e-Delphi Consensus Study

Infusion of fluids and medications is traditionally performed intravenously. However, venous depletion in patients has led to the quest for vessel health preservation. A safe, effective, acceptable, and efficient alternative is the subcutaneous route. A lack of organizational policies may contribute to the slow uptake of this practice. This modified e-Delphi (electronic) study aimed to derive international consensus on practice recommendations for subcutaneous infusions of fluids and medications. A panel of 11 international clinicians, with expertise in subcutaneous infusion research and/or clinical practice, rated and edited subcutaneous infusion practice recommendations from evidence, clinical practice guidelines, and clinical expertise within an Assessment, Best Practice, and Competency (ABC) domain guideline model. The ABC Model for Subcutaneous Infusion Therapy provides a systematic guideline of 42 practice recommendations for the safe delivery of subcutaneous infusions of fluids and medications in the adult population in all care settings. These consensus recommendations provide a guideline for health care providers, organizations, and policy makers to optimize use of the subcutaneous access route.

A Novel Use of Long-Term Subcutaneous Hydration Therapy for a Pediatric Patient With Intestinal Failure and Chronic Dehydration: A Case Report

Long-term subcutaneous hydration has not been described in pediatrics. A case of a 4-year-old born prematurely with subsequent intestinal failure, large vessel thrombi, and repeated central line-associated bloodstream infections prompting catheter removal is discussed. Chronic dehydration ensued and was managed with long-term subcutaneous fluid infusions with no serious complications.

Successful Infusion Therapy in Older Adults

Older adults are a special patient population who require attention to a variety of issues and considerations related to infusion therapy. The need to alter practice approaches includes vascular access techniques and the administration of intravenous medications, fluids, and blood components. In addition, older adults will manifest very different signs and symptoms related to development of an infection in the body. This article reviews the normal physical changes that occur in their major body systems and discusses recommendations to accomplish successful venous access and correct administration of infusates.