Hypodermoclysis: a review of evidence to assist the care for the critical patient

Abstract

Hypodermoclysis is an old, simple and safe technique for the infusion of large volumes subcutaneously, and may offer important benefits in critically ill patients, in whom difficult venous access is common or this may not be tolerated or desirable. This study aims to carry out a literature review on the use of medications by hypodermoclysis, allowing its safe and effective practice. For this, the pharmacotherapeutic profile of patients in an intensive care unit at a university hospital in Ceará was evidenced, with a database survey carried out from March to May 2018, selecting the 20 most used injectable drugs. For the review, articles, manuals and guidelines were searched until September 2023 in the tools Medical Literature Analysis and Retrieval System Online (Medline), Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO) and Google Scholar. Seventy
publications with information about the technique were selected, in which 45.71% (32/70) referred to case reports and series. Of the 20 drugs selected, 3 (15%) are contraindicated for administration by hypodermoclysis, 2 (10%) were not found reports about this technique and 2 drugs (10%) contained insufficient information regarding the method of preparation. Many of the drugs addressed in this study have shown, in the literature, efficacy and safety similar to the intravenous route, and some
showed superior safety, such as midazolam. Although hypodermoclysis is enshrined in the literature, studies in the area are still scarce, especially with regard to the efficacy and safety of medications commonly used in clinical practice.