Comparing Subcutaneous Fluid Infusion with Intravenous Fluid Infusion in Children

摘要

Introduction: This study examined subcutaneous (SC) infusion as a parenteral alternative for children with mild to moderate illness. The purpose was to compare the difference in infusion start time of parenteral fluid between an initial SC order and an initial intravenous (IV) order. In addition, the number of needlesticks a child received for each method was evaluated. This study also sought to address the following question: If SC fluids were given and an IV attempt was made later, did the administration of SC fluids enhance the success of venous cannulation? Methods: A retrospective descriptive design was used for review of medical records for 36 children from November 2008 to May 2010 who had received SC fluids only or received SC fluids after 2 or more failed IV attempts, Results: The IV/SC group had significantly longer time to infusion (M= 97.33 minutes) than did the SC group [M= 20.95 minutes; U= .000; P< .001). The IV/SC group included the number of needlesticks for the intravenous attempts plus the needle stick needed for the subcutaneous infusion, A significant difference was found between the 2 groups (mean IV = 4.87; mean SC = 1; Z= .000; P< .001). Discussion: In a child who is not seriously ill, SC infusions appear to facilitate the initiation of parenteral rehydration. SC infusions minimized the number of needlesticks a child endured. More study is needed to determine if SC fluids enhance success of subsequent venous cannulation. Dehydration is defined as a clinical state involving the loss of fluid from the body. Oral rehydration therapy (ORT) is the first-line therapy recommended by the Centers for Disease Control and Prevention since 1992 and the American Academy of Pediatrics (AAP) since 1996 for children with mild to moderate dehydration. When ORT fails, nasogastric tube (NGT) or intravenous (IV) therapy is recommended by the AAP; however, these methods may result in increased complications, costs, skills, and time needed. In addition, NGT and IV therapy may only be performed in certain settings. Subcutaneous (SC) infusion of fluid once was a standard of care from the 1940s through the early 1960s and is now resurfacing as an alternative to IV therapy in children who are mildly to moderately ill. Whereas acute gastroenteritis (AGE) is one of the most common reasons that children present to the emergency department for fluid rehydration therapy, other conditions may include respiratory, genitourinary, and febrile illnesses. The degree of dehydration may complicate recovery. The gold standard for estimating the degree of dehydration is a documented weight loss generally from 1% to 10% or more; however, in an urgent or emergency care setting, a recent weight usually is not documented for comparison. In 1997, approximately 10 clinical dehydration findings were validated for the first time in an effort to guide clinicians in determining an estimation of a child's fluid deficit when a recent weight was not available. The most current validated clinical dehydration score has refined and revalidated those findings, but only 4 of the clinical findings (appearance, eyes, tears, and tongue) were determined as most important when evaluating the degree of dehydration.