Indicazioni all’uso della via sottocutanea per la somministrazione di liquidi e farmaci: una revisione della letteratura

Introduction. Hypodermoclysis is a practice valued in recent years for its safety. However, it continues to be underutilized. Objective. To analyze the most recent evidences on the use of hypodermoclysis for fluids and drugs administration, evaluating its efficacy, safety and mode of use on the elderly population and palliative care patients. Methods. Pubmed, Cochrane Central Register of Controlled Trials and CHINAL databases were searched with the keywords "hypodermoclysis, subcutaneous fluid, subcutaneous infusion"; studies published from 2020 onwards were included. Results. No relevant new findings emerged compared to the knowledge already available but the number of evidences increased. The amount per infusion site should not exceed 1000 ml with a suggested hourly rate of 50 ml/hour in the elderly population. In the palliative, setting hypodermoclysis has emerged as a promising option to provide controlled rehydration, reducing the need for invasive interventions. Studies suggest that subcutaneous hydration carries a lower risk of agitation than intravenous hydration, a reduced rate of serious adverse events (1 per 270 infusions), and comparable results in terms of plasma osmolarity after 48 hours. Conclusions. The technique is safe for administration of fluids and some drugs with fewer adverse effects than parenteral administration. Many aspects still need further studies but recommendations for safe use of this technique are already available.

Introduzione. L’ipodermoclisi è una pratica valorizzata negli ultimi anni per la sua sicurezza. Continua, tuttavia, a essere poco utilizzata. Obiettivo. Analizzare le evidenze più recenti sull’utilizzo dell’ipodermoclisi per la somministrazione di fluidi e farmaci, valutandone efficacia, sicurezza e modalità di applicazione sulla popolazione anziana e i pazienti in cure palliative. Metodi. Sono state consultate le banche dati PubMed, Cochrane Central Register of Controlled Trials e CHINAL con le parole chiave hypodermoclysis, subcutaneous fluid, subcutaneous infusion, includendo gli studi pubblicati dal 2020 in poi. Risultati. Non sono emerse novità rilevanti rispetto alle conoscenze già disponibili, ma sono aumentate le prove di efficacia a sostegno. La quantità per sito di infusione non deve superare i 1.000 ml, con una velocità oraria suggerita di 50 ml/h nella popolazione anziana. In ambito palliativo, l’ipodermoclisi si è rivelata un’opzione promettente per garantire una reidratazione controllata, riducendo la necessità di interventi invasivi. Gli studi suggeriscono che l’idratazione sottocutanea comporta un minor rischio di agitazione rispetto a quella endovenosa, un tasso ridotto di eventi avversi gravi (1 ogni 270 infusioni) e risultati comparabili in termini di osmolarità plasmatica dopo 48 ore. Conclusioni. L’ipodermoclisi rappresenta una tecnica sicura per la somministrazione di liquidi e di alcuni farmaci, con un rischio di effetti avversi generalmente inferiore rispetto alla somministrazione per via parenterale. Sebbene restino ancora aspetti da approfondire, sono già disponibili raccomandazioni per un utilizzo sicuro e appropriato della metodica.

Indications to the use of subcutaneous route for fluids and drugs administration: a literature review. Introduction. Hypodermoclysis is a practice valued in recent years for its safety. However, it continues to be underutilized. Objective. To analyze the most recent evidences on the use of hypodermoclysis for fluids and drugs administration, evaluating its efficacy, safety and mode of use on the elderly population and palliative care patients. Methods. Pubmed, Cochrane Central Register of Controlled Trials and CHINAL databases were searched with the keywords “hypodermoclysis, subcutaneous fluid, subcutaneous infusion”; studies published from 2020 onwards were included. Results. No relevant new findings emerged compared to the knowledge already available but the number of evidences increased. The amount per infusion site should not exceed 1000 ml with a suggested hourly rate of 50 ml/hour in the elderly population. In the palliative, setting hypodermoclysis has emerged as a promising option to provide controlled rehydration, reducing the need for invasive interventions. Studies suggest that subcutaneous hydration carries a lower risk of agitation than intravenous hydration, a reduced rate of serious adverse events (1 per 270 infusions), and comparable results in terms of plasma osmolarity after 48 hours. Conclusions. The technique is safe for administration of fluids and some drugs with fewer adverse effects than parenteral administration. Many aspects still need further studies but recommendations for safe use of this technique are already available.