Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 24;15(8):e0237572.
doi: 10.1371/journal.pone.0237572. eCollection 2020.

Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews

Daphne Broadhurst  1   2 , Marie Cooke  1   3 , Deepa Sriram  1 , Brenda Gray  4
Affiliations

Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews

Daphne Broadhurst et al. PLoS One. .

Abstract

Objective: To synthesize the current evidence for subcutaneous hydration and medication infusions from systematic reviews and to assess their methodological quality.

Introduction: Peripheral intravascular cannula/catheter insertion is a common invasive procedure for administering fluids and medications. Venous depletion is a growing concern for several patient populations. Subcutaneous access for the administration of isotonic solutions and medications is an alternative; however, vascular access assessment and planning guidelines rarely consider this route.

Methods: Systematic review of systematic reviews (PROSPERO CRD42018046504). We searched 6 databases published in English language from 1990 to June 2020, identifying subcutaneous infusions an alternate route for fluids or medication. Methodological quality was evaluated using AMSTAR 2 criteria and data for mechanisms of infusion and outcomes related to effectiveness, safety, efficiency and acceptability extracted. The Johanna Briggs Institute's grades of recommendation informed the strength of recommendation.

Results: The search yielded 1042 potential systematic reviews; 922 were excluded through abstract and duplicate screen. Of the remaining articles, 94 were excluded, and 26 were included. Overall, evidence is strong for recommending subcutaneous hydration infusions for older adults, weak for pediatric patients and inconclusive for palliative patients. There is strong evidence for 10 medications; weak evidence supporting 28 medications; however, there are eight medications with inconclusive evidence to make a recommendation and four medications not appropriate for subcutaneous delivery.

Conclusion: Subcutaneous access should be considered alongside intravenous therapy for hydration in older adults, and several medications. There are additional benefits in terms of ease of use and cost-effectiveness of this mode. Inclusion of subcutaneous access in clinical guidelines may promote uptake of this route to help preserve vessel health of vulnerable patients. Further high-quality research is needed to inform subcutaneous infusion therapy in a variety of populations (including pediatrics and palliative care) and medications and clarifying the mechanism of delivery.

PubMed Disclaimer

Conflict of interest statement

DB reports personal and consulting fees (i.e., travel and honoraria) and non-financial support from 3M (including research grant in unrelated field), Angiodynamics, CardioMed Medical Supplies, Covalon, Fresenius, and Excelsior Medical; DB’s former employer, Medical Pharmacies, provides infusion services; however, DB affirms research was conducted independent of her employer’s services/products and of her current consulting business; MC reports Griffith University has received unrestricted investigator initiated research or educational grants on MC’s behalf from product manufacturers: Baxter; Becton, Dickinson and Company; Centurion Medical Products and Entrotech Lifesciences, unrelated to this research. DS reports no conflicts. BG reports personal and consulting fees (i.e., consultancy travel and honoraria) from Nutrishare and Covalon. BG affirms no relationships presenting competing interests or influences. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. PRISMA flow chart.
The diagram details our literature search and screening process for selection of systematic reviews included in the systematic review. Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed.1000097.
See this image and copyright information in PMC

References

    1. Dychter SS, Gold DA, Carson D, Haller M. Intravenous Therapy: A Review of Complications and Economic Considerations of Peripheral Access. Journal of Infusion Nursing. 2012;35(2):84–91. 10.1097/NAN.0b013e31824237ce - DOI - PubMed
    1. Anderson SL, Shreve ST. Continuous subcutaneous infusion of opiates at end-of-life. Annals of Pharmacotherapy. 2004;38(6):1015–23. 10.1345/aph.1D395 - DOI - PubMed
    1. Hawes ML. A proactive approach to combating venous depletion in the hospital setting. Journal of Infusion Nursing. 2007;30(1):33–44. 10.1097/00129804-200701000-00006 - DOI - PubMed
    1. Alexandrou E. The One Million Global Catheters PIVC worldwide prevalence study. British Journal of Nursing. 2014;23(Sup8):S16–S7. - PubMed
    1. McGowan D, Wood S. Developing a venous assessment tool in IV chemotherapy administration. British Journal of Nursing. 2008;17(3):158–64. 10.12968/bjon.2008.17.3.28404 - DOI - PubMed

Publication types