Gomes, Nathália Silva; Silva, Andrea Mara Bernardes da; Zago, Luana Barbosa; Silva, Érica Carneiro de Lima e; Barichello, Elizabeth

doi:10.1590/0034-7167-2016-0424

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REVIEW • Rev. Bras. Enferm. 70 (5) • Sep-Oct 2017 • https://doi.org/10.1590/0034-7167-2016-0424 copiar

Conocimientos y prácticas de enfermería en la administración de fluidos por vía subcutánea

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Describir las evidencias, en la literatura, acerca de los conocimientos y prácticas del equipo de enfermería sobre administración de medicamentos y fluidos por vía subcutánea en adultos.

Método:

Revisión integrativa de la literatura, utilizando los descriptores: enfermería, hipodermoclisis, vías de administración de medicamentos, salud del adulto y conocimiento; en idiomas inglés, español y portugués, sin fecha límite de publicación. Fueron encontrados 569 artículos, de los cuales 8 integraron la muestra.

Resultados:

Predominio de revistas internacionales (75%), y con más de cinco años de publicación (62,5%). Al analizarse las características metodológicas, predominaron: revisiones de literatura (25%), estudios cuantitativos (62,5%), estudios transversales (50%) y no experimentales (50%).

Conclusión:

A pesar de tratarse de una técnica antigua de comprobada eficacia, la hipodermoclisis es aún poco utilizada, hecho inexplicable, dadas sus ventajas e indicaciones para cualquier edad.

Descriptores:
Enfermería; Hipodermoclisis; Vías de Administración de Medicamentos; Conocimiento; Enfermería Práctica

Database (total)	Crossing - keywords	Articles found
CINAHL (20)	Knowledge and hypodermoclysis	1
	Nursing and hypodermoclysis	15
	Adult health and hypodermoclysis
	Drug administration routes and hypodermoclysis	4
Lilacs (6)	Knowledge and hypodermoclysis	1
	Nursing and hypodermoclysis	3
	Adult health and hypodermoclysis	1
	Drug administration routes and hypodermoclysis	1
MEDLINE (4)	Knowledge and hypodermoclysis	1
	Nursing and hypodermoclysis	3
	Adult health and hypodermoclysis
	Drug administration routes and hypodermoclysis
Science Direct (524)	Knowledge and hypodermoclysis	146
	Nursing and hypodermoclysis	199
	Adult health and hypodermoclysis	87
	Drug administration routes and hypodermoclysis	92
Web of Science (15)	Knowledge and hypodermoclysis	2
	Nursing and hypodermoclysis	9
	Adult health and hypodermoclysis	2
	Drug administration routes and hypodermoclysis	2
Total		569

N^o	Title	Level of evidence	Main author's education	Language	Journal
1	A prospective comparison study between a butterfly needle and a teflon cannula for subcutaneous narcotic administration⁽¹³13 Macnillan K, Bruera E, Kuehn N, Selmser P, Macnillan A. A prospective comparison study between a butterfly needle and a teflon cannula for subcutaneous narcotic administration. J Pain and Symptom Manage [Internet]. 1994 [cited 2016 Mar 09];9(2):82-4. Available from: http://www.sciencedirect.com/science/article/pii/0885392494901600 http://www.sciencedirect.com/science/art... ⁾	II	-	English	Journal of Pain and Symptom Management
2	Emergency nursing resource: difficult intravenous access⁽¹⁴14 Crowley M, Proehl J, Barnason S, Leviner S, Lindauer C, Naccarato M et al. Emergency nursing resoure: difficult intravenous access. J Emerg Nurs[Internet]. 2012 [cited 2015 Nov 30];38(4):335-43. Available from: http://www.jenonline.org/article/S0099-1767(12)00226-7/pdf http://www.jenonline.org/article/S0099-1... ⁾		-	English	Journal of Emergency Nursing
3	Hipodermóclise em pacientes oncológicos sob cuidados paliativos⁽³3 Justino ET, Tuoto FS, Kalinke LP, Mantovani MF. Hipodermóclise em pacientes oncológicos sob cuidados paliativos. Cogitare Enfermagem[Internet]. 2013 [cited 2016 Mar 09];18(1):84-9. Available from: http://revistas.ufpr.br/cogitare/article/view/31307/20018 http://revistas.ufpr.br/cogitare/article... ⁾	VI	Nurse	Portuguese	Cogitare Enfermagem
4	Hipodermóclise: o conhecimento do enfermeiro em unidade de internação⁽¹⁵15 Takaki CYI, Klein GFS. Hipodermóclise: o conhecimento do enfermeiro em unidade de internação. ConScientiae Saúde[Internet]. 2010 [cited 2016 Mar 09];9(3):486-96. Available from: http://www.redalyc.org/pdf/929/92915180020.pdf http://www.redalyc.org/pdf/929/929151800... ⁾	VI	-	Portuguese	ConScientiae Saúde
5	Hypodermoclysis in the care of older adults: an old solution for new problems?⁽¹⁶16 Molloy DW, Cunje A. Hypodermoclysis in the care of older adults: an old solution for new problems? Can Fam Physician[Internet]. 1992 [cited 2015 Nov 30];38:2038-43. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2145510/pdf/canfamphys00127-0088.pdf http://www.ncbi.nlm.nih.gov/pmc/articles... ⁾	VI	Physician	English	Canadian Family Physician
6	Hypodermoclysis to treat dehydration: a review of the evidence⁽¹⁷17 Remington R, Hultman T. Hypodermoclysis to treat dehydration: a review of the evidence. J Am Geriat Soc[Internet]. 2007 [cited 2016 Mar 09];55(12):2051-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17971137 https://www.ncbi.nlm.nih.gov/pubmed/1797... ⁾	-	-	English	Journal compilation
7	Subcutaneous administration of drugs in the elderly: survey of practice and systematic literature review⁽¹⁸18 Fonzo-Christe C, Vukasovic C, Wasilewski-Rasca Af, Bonnarbry P. Subcutaneous administration of drugs in the elderly: survey of practice and systematic literature review. Palliat Med[Internet]. 2005 [cited 2016 Mar 09];19(3):208-19. Available from: http://pmj.sagepub.com/content/19/3/208.short http://pmj.sagepub.com/content/19/3/208.... ⁾	VI	Pharmacist	English	Palliative Medicine
8	Subcutaneous fluid administration and the hydration o folder people⁽¹⁹19 Gabriel J. Subcutaneos fluid administration and the hydration of older people. Br J Nurs. 2014 [cited 2015 Nov 30];23(suppl 14):S10-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25062366 http://www.ncbi.nlm.nih.gov/pubmed/25062... ⁾		-	English	British Journal of Nursing

Title	Year/country	Outline/N	Interventions	Results found
Hypodermoclysis: nurse's knowledge in an inpatient unit⁽¹⁵15 Takaki CYI, Klein GFS. Hipodermóclise: o conhecimento do enfermeiro em unidade de internação. ConScientiae Saúde[Internet]. 2010 [cited 2016 Mar 09];9(3):486-96. Available from: http://www.redalyc.org/pdf/929/92915180020.pdf http://www.redalyc.org/pdf/929/929151800... ⁾	2010/ Brazil	Quantitative, non-experimental, cross-sectional/n=7	Questionnaire application	29% of the nurses interviewed had heard of the technique.One cited the Internet as a source of knowledge, and another an undergraduate course.71% were unaware of the technique.100% reported not receiving guidance from the institution, ignoring nursing care.
Subcutaneous fluid administration and the hydration o folder people⁽¹⁹19 Gabriel J. Subcutaneos fluid administration and the hydration of older people. Br J Nurs. 2014 [cited 2015 Nov 30];23(suppl 14):S10-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25062366 http://www.ncbi.nlm.nih.gov/pubmed/25062... ⁾	2014/ England	Literature review/n=13		Advantages: puncture site options; simple insertion; comfort to the patient; easily usable in home care; reduces net overload.Disadvantages: limit of 1,500 ml every 24 hours per puncture site; local edema; administration of some fluids.Complications: edema; inflammation/cellulitis; local pain; hematoma; and occlusion of the device (rare).Contraindications: rapid fluid replacement; material for access fixation has to be transparent; sterile technique.

Title	Year/country	Outline/N	Interventions	Results found
A prospective comparison study between a butterfly needle and a teflon cannula for subcutaneous narcotic administration⁽¹³13 Macnillan K, Bruera E, Kuehn N, Selmser P, Macnillan A. A prospective comparison study between a butterfly needle and a teflon cannula for subcutaneous narcotic administration. J Pain and Symptom Manage [Internet]. 1994 [cited 2016 Mar 09];9(2):82-4. Available from: http://www.sciencedirect.com/science/article/pii/0885392494901600 http://www.sciencedirect.com/science/art... ⁾	1994/ Canada	Quantitative, near-experimental/n=20	Comparison between the use of the scalp no. 25 with the combination of a 26-gauge introducer needle and an abocath no. 24	Abocath dwell time was longer than scalp dwell time. Local reactions: redness; edema; pain; leakage; manipulation; infection; and cellulitis. Patients reported no difference in comfort related to the needle. Abocath insertion was more difficult.
Emergency nursing resource: difficult intravenous access⁽¹⁴14 Crowley M, Proehl J, Barnason S, Leviner S, Lindauer C, Naccarato M et al. Emergency nursing resoure: difficult intravenous access. J Emerg Nurs[Internet]. 2012 [cited 2015 Nov 30];38(4):335-43. Available from: http://www.jenonline.org/article/S0099-1767(12)00226-7/pdf http://www.jenonline.org/article/S0099-1... ⁾	2012/ United States	Literature Review/n=not informed		96% of nurses considered the procedure easy. Viability of subcutaneous therapy comparable to that of the intravenous route. Time to start hypodermoclysis of 3.4 minutes and intravenous route 6.1 minutes.
Hipodermóclise em pacientes oncológicos sob cuidados paliativos⁽³3 Justino ET, Tuoto FS, Kalinke LP, Mantovani MF. Hipodermóclise em pacientes oncológicos sob cuidados paliativos. Cogitare Enfermagem[Internet]. 2013 [cited 2016 Mar 09];18(1):84-9. Available from: http://revistas.ufpr.br/cogitare/article/view/31307/20018 http://revistas.ufpr.br/cogitare/article... ⁾	2013/ Brazil	Quantitative, non-experimental, longitudinal/n=16	Application of instrument	Of the 16 patients, 14 were oncological and two were under follow-up for pain management. 50% of the patients underwent the procedure more than once. 14 punctures in outpatient care, 11 at home, and five in the hospital. Main site of puncture: infraclavicular region (93.34%) Main device: scalp no. 21 (40%) Main drug: morphine (93.75%) Exchanges every seven days Complications: local irritation and hematoma Main reason for interruption: 13 (81.25%) deaths
Hipodermóclise: o conhecimento do enfermeiro em unidade de internação⁽¹⁵15 Takaki CYI, Klein GFS. Hipodermóclise: o conhecimento do enfermeiro em unidade de internação. ConScientiae Saúde[Internet]. 2010 [cited 2016 Mar 09];9(3):486-96. Available from: http://www.redalyc.org/pdf/929/92915180020.pdf http://www.redalyc.org/pdf/929/929151800... ⁾	2010/ Brazil	Quantitative, non-experimental, cross-sectional/n=7	Questionnaire application	Technique is not used. Physicians do not prescribe fluids and drug infusion subcutaneously. Resistance in the use of hypodermoclysis in contexts that do not include palliative care.
Hypodermoclysis in the care of older adults: an old solution for new problems?⁽¹⁶16 Molloy DW, Cunje A. Hypodermoclysis in the care of older adults: an old solution for new problems? Can Fam Physician[Internet]. 1992 [cited 2015 Nov 30];38:2038-43. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2145510/pdf/canfamphys00127-0088.pdf http://www.ncbi.nlm.nih.gov/pmc/articles... ⁾	1992/ Canada	Case Study/n=1	Case report of hypodermoclysis use in the elderly with Alzheimer's disease	Hypodermoclysis recommended after difficulty in maintaining intravenous route. Change of puncture site every two days. Indication: hydration Physician: responsible for prescribing and initiating hypodermoclysis.
Hypodermoclysis to treat dehydration: a review of the evidence⁽¹⁷17 Remington R, Hultman T. Hypodermoclysis to treat dehydration: a review of the evidence. J Am Geriat Soc[Internet]. 2007 [cited 2016 Mar 09];55(12):2051-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17971137 https://www.ncbi.nlm.nih.gov/pubmed/1797... ⁾	2007/ United Stated	Literature review/n=8		Hypodermoclysis: safe alternative for fluid administration in adults. There was no significant difference between efficacy, duration of puncture site, and discomfort (comparing subcutaneous and intravenous routes). Physicians and nurses prefer hypodermoclysis. Complications: local inflammation; pain; edema; ecchymosis; and extravasation. Costs for keeping intravenous route were four times higher.
Subcutaneous administration of drugs in the elderly: survey of practice and systematic literature review⁽¹⁸18 Fonzo-Christe C, Vukasovic C, Wasilewski-Rasca Af, Bonnarbry P. Subcutaneous administration of drugs in the elderly: survey of practice and systematic literature review. Palliat Med[Internet]. 2005 [cited 2016 Mar 09];19(3):208-19. Available from: http://pmj.sagepub.com/content/19/3/208.short http://pmj.sagepub.com/content/19/3/208.... ⁾	2005/ Switzerland	Quantitative, non-experimental, cross-sectional/n=79 (27 nurses and 52 physicians)	Application of a questionnaire to check drugs used subcutaneously in the geriatrics department and evaluate the practices	Main drugs: morphine; haloperidol; furosemide; hydromorphone; glycopyrrolate; ceftriaxone. Nurses reported administering the medications several times a day, and physicians thought they were several times a week. Puncture change every three days, except five days for morphine or hydromorphine. One of the nurses cited mixing the medications in the syringe (morphine and haloperidol). 11% of physicians reported never having checked which medications were licensed for subcutaneous administration.Of the 34 drugs used, 13 (38%) are licensed for subcutaneous use.

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[1] CORRESPONDING AUTHOR: Elizabeth Barichello. E-mail: lizabarichello@hotmail.com