Sunday, July 12, 2015

Down a Quart? Hypodermoclysis to the Rescue

Poor skin turgor? Coated tongue? Urinary output down? No need for blood and/or urine osmols and you can forget about getting ADH levels, diagnosis of dehydration was based on well known physical signs.  You know it when you see it.

Usually there was some issue compromising oral fluid intake. A quick, easy way to get a liter of fluid on board was hypodermoclysis which was seen as a bridge to adequate oral fluid intake. Very few patients had an IV line in place.  The equipment included a 1000cc bottle of 0.9% saline and tubing which diverged into 2 tubes via a Y shaped bifurcation about 18 inches below the bottle. The two tubes were about 36 inches long and were connected to a 2 inch 20ga. needle.

The liter of fluid was hung from an IV pole or even attached to the traction frame of an ortho bed. The 2 inch needles were inserted very shallow and parallel to the skin of the anterior thigh with one needle per thigh. As a young whippersnapperrn, I asked an experienced nurse, "Why do we have to use such long needles for this?" The answer was "The fluid leaks out with short needles." Being the free spirit that I am, I once tried 1 1/2 inch  needles and it worked just fine. Somehow, those 2 inch needles looked inhumane to me. Similar to those EKG needle electrodes that used to creep me out when sticking a patient with them.

After the needles were in place, the fluid was allowed to flow in without any clamps or regulation. This usually took about 3-4 hours. Old hospital rooms really did not have room for equipment like IV pumps or controllers which is a moot point as they were not yet invented.

One criticism I've heard of clysis is that it dumps liquid into an inappropriate fluid compartment (interstitial)  and this renders it ineffective. When patients were badly dehydrated, they seemed to absorb subcutaneous fluids well.  It did seem to work on a short term basis. Often a clysis would perk a patient up enough to begin taking oral fluids. Another advantage was since the needle insertion site was further from the patients hands, it was less likely to be pulled out.  Since a hypodermoclysis site did not need observed closely like an IV site it could be covered with a dressing to prevent patient tampering.

Clysis was a rather crude way of replacing fluids that certainly had limitations, but, amazingly usually worked fairly well.

5 comments:

  1. I remember usually doing clysis on kids and I think we put the needle in the upper back. I'm glad you mentioned the EKG needles! I was beginning to doubt my memories about this, the old brain is getting dimmer I'm afraid.

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  2. I've also heard of using the subscapular area for a clysis. It sounds like it might be a good idea with kids because it would be more difficult to tamper with. I guess I've always felt nervous about using any type of needle in the chest area. We always used the legs in adults. I always wondered what the rationale was for needle electrodes. Maybe the old monitors were not as sensitive to the signal. It always seemed inhumane to be sticking needles in someone's chest that was already stressed with cardiac issues. Thank you so much for commenting.

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  3. Heard of this in nursing school, but never saw it in practice. Did use it with supervision of DVM, as part of home nursing of a cat with liver issues who was severely anorexic. A couple of months of syringe feeding of homemade soft food (therapeutic diet and supplements) and clysis to keep up fluid balance kept her alive until the liver healed enough for her to eat and drink enough on her own. The site for clysis on felines is the area on the 'scruff' of the neck, where Mama Cat picks up her kittens. Sure gave our cat some funny looking humps!

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  4. When our little Shih Tzu developed renal failure the Vet said we could try clysis at home. I gave him fluids this way about twice a week. He had a fairly decent quality of life for another year. He had been slightly obese and had a convenient fold of skin above his back for the clysis. He really did not seem to mind it and I used to hang the IV bag from a ceiling hook that held a planter. When he saw the IV bag hanging from the planter he would hop up to my lap for his clysis. I'm glad to hear it worked so well for your cat friend. Thanks for your comment!

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  5. I never did this, but once watched a nurse initiate it. Ye gods!

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