Use of subcutaneous fluids in palliative care with children: a case study.

Quality of life is a major consideration in children's palliative care, particularly at the end of life. Optimal symptom management is crucial in maintaining quality of life, with the aim being to ensure the child is as comfortable as possible. Ensuring adequate hydration will often be part of symptom management but may be associated with several practical and ethical challenges. Subcutaneous fluid administration in children's palliative care is relatively uncommon, so there is a lack of evidence on the topic. This article demonstrates that it is feasible to use subcutaneous fluid therapy in the children's hospice setting to address patients' hydration needs and manage their symptoms. It presents a case study of a child who received subcutaneous fluids in a children's hospice for dehydration and myoclonus. It uses the case study to discuss subcutaneous fluid therapy in the children's palliative care setting, including its indications and contraindications, administration, complications and important factors to consider.

Manejo de la vía subcutánea en cuidados paliativos / Management of the subcutaneous way of administration in paliative care

El envejecimiento de la población, el aumento de enfermedades crónico-degenerativas, junto con una mayor esperanza de vida hacen que cada día el número de pacientes que requieren cuidados paliativos sea mayor. La vía de elección para tratar los síntomas en estos pacientes es la oral, pero ciertas circunstancias pueden imposibilitar su uso, siendo necesario recurrir a otras vías. La vía subcutánea supone una alternativa en estas situaciones al tratarse de una técnica sencilla, segura y de fácil manejo. El propósito de este trabajo es contribuir al buen uso de esta técnica y, por lo tanto, a un mejor control de los síntomas, describiendo la técnica, las ventajas y desventajas de su uso en cuidados paliativos, indicaciones y contraindicaciones, las posibles complicaciones, lugares y técnica de inserción, los cuidados posteriores, así como los tipos de administración y fármacos más empleados

The population ageing, the increase of chronic-degenerative diseases, together with a higher life expectancy, have led to an increasing number of patients who require palliative care. The administration way of choice to treat symptoms in these patients will be oral, but certain circumstances may render this impossible, making it necessary to resort to other ways. The subcutaneous way represents an alternative option in these situations, as it is a simple, safe, and easy to use technique. The objective of this paper is to contribute towards the good use of this technique and, therefore, to a better control of symptoms, describing the techniques, the advantages and disadvantages of its use in Palliative Care, indications and contraindications, potential complications, insertion sites and technique, subsequent care, as well as the most widely used types of administration and drugs

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.

Compliance with a pediatric clinical practice guideline for intravenous fluid and electrolyte administration.

The occurrence of acute hyponatremia associated with cerebral edema in hospitalized children has been increasingly recognized, with over 50 cases of neurological morbidity and mortality reported in the past decade. This condition most commonly occurs in previously healthy children where maintenance intravenous (IV) fluids have been prescribed in the form of hypotonic saline (e.g., 0.2 or 0.3 NaCl). In response to similar problems at The Hospital for Sick Children (six identified through hospital morbidity and mortality reviews and safety reports prior to fall 2007), an interdisciplinary clinician group from our institution developed a clinical practice guideline (CPG) to guide fluid and electrolyte administration for pediatric patients. This article reviews the evaluation of one patient safety improvement to change the prescribing practice for IV fluids in an acute care pediatric hospital, including the removal of the ability to prescribe hypotonic IV solutions with a sodium concentration of < 75 mmol/L. The evaluation of key components of the CPG included measuring practice and process changes pre- and post-implementation. The evaluation showed that the use of restricted IV fluids was significantly reduced across the organization. Success factors of this safety initiative included the CPG development, forcing functions, reminders, team engagement and support from the hospital leadership. A key learning was that a project leader with considerable dedicated time is required during the implementation to develop change concepts, organize and liaise with stakeholders and measure changes in practice. This project highlights the importance of active implementation for policy and guideline documents.