Under the Skin - An Alternative to IV Hydration

Many questions about food and fluids arise in the care of patients at home, in both the young and the old, the sick and the relatively well. Of course the response in each case must be tailored to the patient's condition and their goals of care. Are we preventing or treating wounds? Are we grappling with constipation or delirium? Does the patient wish to extend life as long as is practical or to prioritize quality of life over longevity?

Delirium is an example of a symptom that can resolve with proper hydration. In this context, I am often asked about intravenous fluids. Although patients can receive IV fluids at home (they don't have to go to the hospital) it's not my preferred way of delivering hydration when oral intake is insufficient.

I like to use a technique that is unfortunately little used outside of veterinary medicine. It's called hypodermoclysis, and it involves the placement of a very small needle under the skin. Fluid runs very slowly (passively even, if you're not using a pump), through tubing to the needle and into the tissue where it is absorbed into the body.

The technique of hypodermoclysis is uncomplicated and requires little training. Done correctly, the risk of infection or complication is exceedingly low, much lower than the risks posed by IV’s. Many medications can be delivered this way as well. It's not for everyone of course, but I consider subcutaneous hydration an essential tool of palliative care, one that has the potential to improve both quality and length of life.