From the Guidelines
The recommended rate for administering subcutaneous fluids is typically 1-15 ml per kg of body weight per hour, with most patients receiving between 40-60 ml per hour. For maintenance therapy, a common target is 70-100 ml per kg per day, divided into multiple administrations. The specific rate should be adjusted based on the patient's size, condition, and fluid requirements. When administering subcutaneous fluids, use an appropriate gauge needle (typically 18-25 gauge) inserted into areas with loose skin such as the scruff of the neck, the area between the shoulder blades, or the flank region. The fluid should flow freely without causing significant discomfort or excessive swelling. The administration site should be rotated regularly to prevent tissue irritation. Subcutaneous fluid therapy is preferred for mild to moderate dehydration when intravenous access is difficult or unnecessary, as the subcutaneous route allows for slower absorption compared to intravenous administration, reducing the risk of fluid overload while still effectively rehydrating the patient 1.
Some key considerations when administering subcutaneous fluids include:
- Using isotonic electrolyte solutions
- Not exceeding 3000 mL per day (max. 1.500 mL per infusion site) 2
- Avoiding coagulation disorders, dermatological problems on the infusion site, and lack of subcutaneous tissue in severely malnourished patients
- Regularly rotating the administration site to prevent tissue irritation
- Monitoring the patient's condition and adjusting the fluid rate as needed to prevent fluid overload or underhydration.
It's also important to note that subcutaneous fluid therapy may not be suitable for patients needing larger volumes, hypertonic or electrolyte-free solutions 2. In such cases, intravenous fluid administration may be necessary. However, for mild to moderate dehydration, subcutaneous fluid therapy can be an effective and safe alternative, with reduced risk of complications compared to intravenous administration 1.
From the Research
Administration of Subcutaneous Fluids
The recommended rate for administering subcutaneous fluids is not explicitly stated in terms of a specific rate, but rather in terms of total volume over a period of time.
- Approximately 3 L can be given in a 24-hour period at two separate sites 3.
Suitable Solutions and Administration
Subcutaneous infusion can be administered using various solutions, including:
- Normal saline 3
- Half-normal saline 3
- Glucose with saline 3
- 5 percent glucose 3 Potassium chloride can be added to the solution bag if needed, and hyaluronidase can also be added to enhance fluid absorption 3.
Indications and Advantages
Subcutaneous infusion is suitable for:
- Mildly to moderately dehydrated adult patients, especially the elderly 3
- Patients with mild to moderate dehydration or malnutrition when oral/enteral intake is insufficient 4 The advantages of subcutaneous infusion include:
- Ease of application 4
- Low cost 4
- Lack of potential serious complications, particularly infections 4
Considerations for Subcutaneous Infusion
Subcutaneous infusion may be particularly suited for patients:
- At risk of dehydration when oral intake is not tolerated 4
- As a bridging technique in case of difficult intravenous access or catheter-related bloodstream infection while infection control treatment is being attempted 4
- In multiple settings, including emergency department, hospital, outpatient clinic, nursing home, long-term care, hospice, and home 4