Hipodermóclise: uma revisão de evidências para auxiliar no cuidado ao paciente crítico

Abstract

Hypodermoclysis is an old technique that consists of using the subcutaneous route (SC) for the infusion of solutions in large volumes. In the case of critically ill patients, the most common indications for this route are: patients with difficult venous access or with bloodstream infection associated with the catheter, in addition to patients whose venous access is not tolerated or desirable (such as hyperactive delirium and care predominant or exclusive palliatives). Because it is a simple and safe practice, but still not widespread and standardized in health services, this study aims to carry out a literature review on the use of medications for hypodermoclysis, allowing its safe and effective practice. The pharmacotherapeutic profile of patients assisted in the clinical ICU was evidenced through a technical review of pharmacotherapy, whose information was provided by a database based on a survey carried out from March to May 2018. Searches for articles, manuals and guidelines were carried out until October 2022 in the data indexing tools Medline (Medical Literature Analysis and Retrieval System Online), BVS (Virtual Health Library), Scientific Electronic Library Online (SciELO) and Google Scholar. Sixty-one publications were selected with information related to hypodermoclysis administration techniques, in which 42.62% (26/61) referred to case reports and series. Of the 20 drugs selected, 3 (15%) are contraindicated for administration by hypodermoclysis, 2 (10%) did not find reports in the literature about this technique and 2 drugs (10%), although with reports in the literature, have insufficient information regarding the method of preparation. Many of the drugs discussed for hypodermoclysis have shown, in the literature, efficacy and safety similar to the intravenous route, such as solutions with potassium chloride, and, in some cases, have shown superior safety than this route, as in the case of midazolam. Although hypodermoclysis is enshrined in the literature as a simple and safe technique for administering various medications and solutions commonly used in clinical practice, studies in the area are still scarce, especially with regard to the efficacy and safety of drugs.