Utility of clysis for hydration in nursing home residents

Abstract

Objectives: To determine the utility of hypodermoclysis in the management of dehydration in nursing home residents and to review the recent literature on the use of clysis in older adults.

Design: A retrospective chart review.

Setting: Two continuing care retirement community nursing home units in Cincinnati.

Participants: Thirty-six nursing home residents with a mean age of 85 years.

Measurements: A standard chart auditing form was used to collect demographic and clinical data from the patients' nursing home charts. Clinical outcomes were assessed at 1 week following the cessation of clysis.

Results: The study subjects were functionally impaired, with 86% having significant cognitive impairment and 81% totally dependent with transfer. The most common indication for clysis was in association with an infection. Clysis was frequently initiated upon nursing observation of inadequate oral intake before obtaining laboratory results and discontinued upon resumption of adequate oral intake. The use of clysis was associated with the return to clinical/functional baseline in 71% of the cases. In the subset of subjects with pre- and post-clysis measurements of serum sodium and BUN/creatinine ratios, improvement in laboratory values was not significant. The use of clysis was not associated with significant complications, but in nine cases minor local skin reactions were documented.

Conclusions: Hypodermoclysis is a relatively safe and effective procedure in a nursing home. The use of clysis in the nursing home is an alternative to intravenous hydration. The use of clysis for short-term hydration has the potential to reduce cost and transfers to the hospital.