Congress Abstracts 2005

29

HYPODERMOCLYSIS AND INTERMITTENT SUBCUTANEOUS MEDICATION ADMINISTRATION FOR HYDRATION, ANALGESIA AND PALLIATIVE SEDATION IN THE ACUTE PALLIATIVE CARE SETTING. Teresa Smith, BSN, Emylinda Basa, BSN, and Thuc Nguyen, BSN, M.D. Anderson Cancer Center, Houston, TX.

From 1914 through the 1950s, hypodermoclysis was a primary route of medication and fluid administration in the clinical practice setting. It was replaced by intravenous therapy primarily due to faster absorption of fluids and increased efficacy of drug administration. Hypodermoclysis has regained momentum, first with the hospice movement in England and now the United States. This route has become a useful tool for nurses in symptom management. It provides an easy, safe and cost effective method of hydration, electrolyte replacement, pain management and palliative sedation.

The use of hypodermoclysis in the acute palliative care inpatient setting helps the transitino of the patient to home with hospice. It enables the patient’s family to administer medicatins easily with minimal teaching. This method of administration is especially effective for the terminal patient who is unable to tolerate the oral, nasogastric or rectal route.

Interventions included a literature review, best practice evaluation and piloting hypodermoclysis and subcutaneous medication administration on the Acute Palliative Care Unit. Education materials were developed which included a detailed poster presentation, a comprehensive resource book of medications, and on-line teaching materials accessible to all institutional nursing staff for patient teaching. Additionally a competency check-list was developed for the ACPU staff to assure annual competency.

The APCU staff is required to complete the annual competency checklist and perform site initiation. They are also required to complete a palliative sedation competency and drug administration knowledge test.

Changing the patient to a clysis site, while they are still hospitalized, affords the patient greater flexibility for medication administration and hydration. This eases the transition of the patient and family tohome with hospice. Using this method prior to dischard, ensures adequate control of symptoms and demonstrates to the caregiver they can ensure patient comfort. When the caregiver realizes that they can effectively treat symptoms, without causing more discomfort, the patient and family can focus on making the most of their last days at home.