Administration of Subcutaneous Fluids Guidelines - Halton and St ...

CLINCAL GUIDELINES
Administration of Subcutaneous Fluids Guidelines
For use in:
PCT-wide
Target Audience:
District Nursing Teams and Community
Matrons involved in the care of patients
requiring the administration of subcutaneous
fluids (including the RARS/RATS teams)
Purpose:
To ensure safe and consistent practice in the
administration of subcutaneous fluids by
registered practitioners in the Nursing teams of
Halton and St Helens PCT
Document Author:
Susan Davison Long Term Conditions Lead
Approved by:
Clinical Guidelines Group and Clinical
Executive Committee
Ratified by:
Policy Sub-Committee (PSC)
Policy Indexed:
HStHCL213
Version Number: 1.0
Effective From: December 2010
Review Date: December 2013
Statutory and legal requirements
Implementation Lead
Policy identified as a need in the community
for vulnerable patients requiring rehydration
taking account of the latest recommendations
Sue OHanlon
The trust is committed to creating an environment that promotes equalilty and embraces
diversity, both within our workforce and in service delivery. This document should be
implemented with due regard to this commitment.
This document seeks to uphold the duties and principles contained within the Human Rights
Act. All staff within the PCT should be aware of its implications.
This guideline is due for review by December 2013. After this date, this guideline and
associated process documents may become invalid. All users should ensure that they are
consulting the current version of this document.

Key individuals involved in developing the document
Name
Designation
Sue Davison
Long Term Conditions Lead
Linda Spooner
Professional Development Manager
Gill Clare
Medicines Management
Tracey Maskell
District Nurse Team Leader
Circulated to the following for comments
Committee
Committee
Members of the Policy Sub Committee
Members of the Clinical Guidelines Group
Members of the Clinical Executive Committee
Individual
Name
Sue O’Hanlon
Sharon Woods
Victoria Heilbron
Lorraine Hodson
Designation
IV lead nurse
Palliative lead
Divisional manager
Clinical Service Manager District Nursing

Table of Contents
Rationale................................................................................................................................. - 5 -
Objectives ............................................................................................................................... - 5 -
Target Group........................................................................................................................ - 6 -
Related Policies.................................................................................................................... - 6 -
Indications for Administration of Subcutaneous Fluids ......................................................... - 6 -
Indications for the Administration of Subcutaneous Fluids in Palliative Care ....................... - 7 -
Contraindications.................................................................................................................. - 8 -
Education and Training ........................................................................................................... - 8 -
Equipment Required............................................................................................................. - 8 -
Suitable sites for infusion ..................................................................................................... - 8 -
Suitable Fluids...................................................................................................................... - 9 -
Patient Monitoring ...............................................................................................................- 10 -
Complications/side effects...................................................................................................- 11 -
Calculation/rate of subcutaneous infusion...........................................................................- 11 -
Guidelines ..............................................................................................................................- 12 -
References.............................................................................................................................- 15 -
Appendix 1 .............................................................................................................................- 17 -
Symptoms of Dehydration ...................................................................................................- 17 -
Appendix 3 .............................................................................................................................- 18 -
Diagrams.............................................................................................................................- 18 -
Appendix 4 .............................................................................................................................- 19 -
Subcutaneous Insertion Sites Diagram ...............................................................................- 19 -
Appendix 5 .............................................................................................................................- 20 -
Subcutaneous Fluids Monitoring Chart ...............................................................................- 20 -
Appendix 6 .............................................................................................................................- 21 -
Equality Impact Assessment Tool .......................................................................................- 21 -

Appendix 7 .............................................................................................................................- 22 -
Dissemination and Training Plan.........................................................................................- 22 -

RATIONALE
This guidance has been developed to highlight the need for a collaborative approach for district
nurses and community matrons considering the administration of subcutaneous fluids. Also to
explore the complexity for the medical and ethical issues in the decision making process with
the aim of improving nursing practice and patient outcomes. Due to the relative ease of setting
up and administering subcutaneous fluids, the procedure can be carried out in the home by
district nurses and community matrons (Marsden 2004) or anyone who possesses the
necessary knowledge and skills for safe practice. However it should be noted that good
practice suggests that decisions regarding artificial hydration should involve a multiprofessional
team, the patient, relatives and carers, but the senior doctor responsible for the care has
ultimate responsibility for the decision.
Hypodermoclysis (subcutaneous infusion) is a relatively safe, simple and cost effective
technique for use in the community with a range of client groups, for example older people.
However its use in palliative care raises problems in terms of clinical evidence and ethical
issues which need to be addressed i.e. products not being licensed for this specific use, staff
requests for clinical guidance and the anticipated increasing use of hypodermoclysis for
rehydration (Moriarty 2001).
Hypodermoclysis is a way of maintaining hydration. Over the past years, this method has been
used increasingly for rehydration in care of the elderly settings where dehydration can be a
common problem. The low technological nature of this method means that it is well suited to
less acute care settings. This method also has great potential for use in people who have
problems swallowing or other problems which make them prone to dehydration but do not
necessarily mean that they need to be care for in the hospital setting. Patients recovering from
a recent cerebra-vascular accident or those experiencing milder nausea and vomiting following
chemotherapy and palliative care intervention(s). Subcutaneous hydration is not adequate or
appropriate to correct severe dehydration or electrolyte imbalance and as such, these patients
will continue to need inpatient services for thorough assessment and treatment.
These guidelines have been written to act as a guide in the decision making process. They are
intended to support the nurses undertaking the procedure of commencing and maintaining
subcutaneous infusions once the decision has been made to commence treatment.
OBJECTIVES
These guidelines aim to make nurses aware of the following:
The evidence base for practice, life long learning and professional self-regulation (Zeh
2002)
Indication for the administration of subcutaneous fluids for patients
Ethical and medical considerations in the assessment of patients in which subcutaneous
fluids may be considered an appropriate treatment.
The method of administration of subcutaneous fluids. Ensure they are administered in a
safe manner by appropriately, qualified competent staff.

Practitioners must always adhere to the NMC Code of Professional Conduct (NMC 2008)
when considering matters of clinical judgement and professional accountability.
Target Group
District Nurses and Community Matrons (including the RARS/RATS teams) involved in the care
of patients requiring the administration of subcutaneous fluids.
Related Policies
PCT Record Keeping Policy
PCT Infection Control Policy
SOP for the Disposal of Sharps
PCT Consent Policy
PCT Medicines Management Policy
PCT Health and Safety Policies
PCT Procedure for the Treatment of Anaphylaxis
Indications for Administration of Subcutaneous Fluids
Evidence to support the procedure in older people is not extensive although there are great
numbers of cases describing its successful application in the community setting. In the single
systematic review of this intervention (17 studies) it was concluded that hypodermoclysis could
be safely used with an elderly client group to provide electrolyte-containing fluid, however the
scope of the review was limited and the authors further pointed out that the majority of available
studies were of poor quality and went on to comment that of these studies only two were
randomised control trials (Rochon, Sudeep et al 1997).
The review itself has also been criticised by reviewers from the NHS Centre of Reviews and
Dissemination for failing to include some key features of the systematic review process which
includes an observation on the lack of information relating to the criteria used to assess the
validity of the primary studies and the method of data extraction. There is a need for further
research in this area of practice.
Dehydration can be a common problem in older people, both at home and long term care
settings. Acute problems and conditions such as mild infections, vomiting and diarrhoea and
temporary confusion could all precipitate dehydration because an adequate fluid intake cannot
be maintained. Subcutaneous hydration is not adequate to correct severe dehydration or
electrolyte imbalance. If rehydration is considered essential, alternative methods should be
considered.
Relatively small amounts of fluid are administered using this method e.g. one or two litres of
fluid in a 24 hour period and these can be infused continuously either overnight or by short one
or two hour infusions for more mobile patients. Up to three litres can be administered via this
route, but not glucose.

Subcutaneous infusions should be used with extreme caution where there is history of
cardiac/renal failure or in bleeding disorders in patients who have existing fluid overload and
must be subjected to increase diagnostic monitoring.
Generally the following criteria should be met:
The patient is experiencing symptoms, e.g. thirst, malaise, delirium, confusion for which
dehydration seems the likely cause
Increased oral intake is not feasible or manageable
Anticipation that parental hydration will relieve the symptoms e.g. in patients with severe
dysphasia, vomiting and diarrhoea.
Laboratory investigation supports the diagnosis
The patient’s underlying physical condition is relatively good
The patient is willing to have parental hydration
The patient and relatives understand fully understand that the purpose of the procedure
is to relieve symptoms and reduce distress but not to cure.
It is advisable initially to set a provisional time limit for parental hydration (Hypodermaclysis)
after which further assessment and discussion should be made by the multiprofessional team.
Indications for the Administration of Subcutaneous Fluids in Palliative Care
There is little evidence that artificial hydration in dying patients influences neither survival nor
symptom control. Dehydration is a common problem with patients in the terminal phase of an
illness and is associated with many possible causes. One of the most difficult and
uncomfortable symptom is that of thirst. Drug therapy and medication can also lead to an
altered thirst sensation. Appendix 1 outlines the symptoms associated with dehydration in
palliative care.
In palliative care, indications for the need for parental hydration should be symptom led and
following discussion with the palliative care team, McMillan’s as well as the senior doctor caring
for the patient. Some cancer patients experience reversible conditions such as hypercalcaemia
which may cause dehydration. Dehydration can increase the risk of pressure ulcer formation.
Hypercalceamia can develop in cancer patients, particularly if there is disease in the bone. It is
easily treatable and its effects if untreated include renal failure and cardiac arrhythmias and
hypercalceamia is a contraindication for administration of subcutaneous fluids. To confirm the
presence of hypercalceamia a simple blood test is all that is needed along side visible common
symptoms which include, nausea, vomiting, increased thirst, increased pain (especially in the
bone), urinary frequency, tiredness, confusion, poor appetite, constipation, personality changes,
visual disturbances, twitching, co ordination problems and anxiety. This should be ruled out in
appropriate patients, prior to using subcutantious fluids. Many authors urge caution in terminally
ill patients. They suggest should only be used if the patient is in someway distressed and lack of
fluid and other measures cannot correct symptoms, for example, drug alteration,
hypercalceamia correction and effective oral hygiene. The primary goal of any treatment in
terminal care should be the comfort of the patient and the ethical basis of most clinical decision
making is the assessment of the benefit.

Contraindications
Clotting disorders
Shock
Severe dehydration
Cardiac failure
Pre-renal or renal failure
Low platelet or coagulation disorders
Existing fluid overload
Marked/pitting oedema
The patient requests not to have an invasive procedure
The sum of the burden of parental hydration outweighs the likely benefits
The patient is moribund for reasons other than dehydration.
If it is not in the patient’s best interest, subcutaneous hydration should not be introduced simply
to satisfy relatives/carers who insist that something must be done. (Twycross 1997).
EDUCATION AND TRAINING
The PCT will provide training to all district nurses and community matrons (including RARS and
RATS) who will be involved in the administration of subcutaneous fluids using a competency
framework. It is the individual nurse’s responsibility to constantly review competence and keep
their knowledge and skills updated.
Equipment Required
Sterile dressing pack with gloves
Apron
Prescribed fluid and signed prescription sheet
Standard intravenous giving set
21-25g butterfly needle infusion set or sof – set infusion set, (see appendix 3)
Infusion line
Semi-permeable film dressing
Sharps bin
Portable drip stand
Fluid Balance chart
Cloraprep
Suitable sites for infusion
Abdomen

Chest (avoiding sort breast tissue)
Lateral aspect of upper arm or thigh
Back, usually below shoulder blades. (May be useful in confused patients) (see appendix
4)
Do not use on:
Lymphoedematous tissue
Skin which has been irradiated
Where there is evidence of existing rash
Peripheral limbs e.g. below knee or elbow
Bony prominences
Lack of sub cut tissue
Lateral aspect of upper arm or thigh
Mastectomy sites
Oedematous tissue
Close to stoma or PEG site
Rotation of sites is recommended to minimise tissue damage.
Suitable Fluids
(Should be isotonic)
Sodium Chloride 0.9% or 4.5%
Sodium Chloride 0.18% & Dextrose 4%
If solutions of glucose 5% used, no more than 2 litres in 24 hours (using a single site)
CAUTION the pH of glucose 5% (3.5 – 6.5) can cause irritation to the site. The rate
should not exceed 2mls per hour/ a litre in 8 hours. CAUTION rapid infusion of
electrolyte – free solutions can lead to hypertension and shock.
CAUTION Potassium solutions can cause ulceration and damage to tissues.
Other fluids may be prescribed however Sodium Chloride would be the fluid of choice in the
administration of subcutaneous fluids.
NOTE
The manufacturers of fluids for infusion are granted product licensing for the purpose of
intravenous infusion only. Therefore the use of these sterile liquids for the purpose of
subcutaneous infusion must be considered as an unlicensed procedure. This should be
communicated to patients / relatives when gaining consent for the procedure. The medical
prescriber must take full responsibility in relation to any adverse effects resulting from its use.
The prescriber should complete a request for whom they are prescribing the supply of the
specific infusion fluid and the name of the patient for whom they are prescribing the fluid as an
unlicensed procedure. Also the prescriber needs to complete the drug administration sheet,

giving details of date the fluid to be administered, the route and frequency and length of
treatment.
Patient Monitoring
Patients under the care of the district nursing teams and/or community matrons will have their
needle site and infusion rate checked at each visit (and one hour after 1 st visit commencing
treatment). The infusion site should be checked for:
Pain/tenderness
Redness
Inflammation/oedema
Leakage
Bleeding/bruising
Abscess formation
Fluid overload
Refer to appendix 5 as a prompt and record for a subcutaneous monitoring chart,
guidance score and advice for subcutaneous site.
Patient’s families/carers will be instructed by the nursing teams on how to monitor the needle
site and what to do in the event on the needle becoming displaced.
The butterfly needle and site should be changed every 48 hours and the change recorded in the
patient notes. The giving set should be changed every day but should be changed each time
the fluids are administered if the infusion is not continuous.
The patient should be checked at each visit for signs of pulmonary oedema e.g. dyspnoea and
peripheral oedema. Signs often associated with pulmonary oedema could include:
Extreme shortness of breath and difficulty breathing
A bubbly, wheezing, or gasping sound when trying to breath.
Anxiety, restlessness or a sense of apprehension
A cough that produces frothy sputum that may be tinged with blood
Excessive sweating
A blue, grey or pale colouration to skin
A rapid irregular heartbeat or palpitations
Rapid weight gain and fluid retention
Loss of appetite
Fatigue
Headache
A severe drop in blood pressure

Ankle, leg and abdominal swelling
The patient should be monitored within one hour of the infusion commencing and then six to
eight hourly for the next forty eight hours. Subsequent visits are dependent on the infusion rate
and infusion quantity.
Complications/side effects
Complication can occur at any time from hours following commencement to over 3 years,
dependent on the condition of the patient and the fluids infused. (Twycross et al 1998).
The needle should be removed and resisted if any of the above conditions occurs.
Possible side effects of subcutaneous fluid infusion include generalised oedema, local oedema
or local skin reaction.
Calculation/rate of subcutaneous infusion
As the fluid is infused by gravity, an electronic pump to regulate the flow/rate of administration is
not required.
To set up a manually controlled drip accurately by eye, the number of drops per minute need to
be counted, then applied to the formula below:
RATE = VOLUME (IN DROPS)
TIME (IN MINUTES)
To calculate the volume in drops, it is necessary to know how many drops are contained within
one millilitre (ml). This information should be available on the packaging of the administration
set.
The volume in mls is then multiplied by the number of drops per ml to give the volume in drops.
Similarly to find the rate in minutes, change the hours into minutes by multiplying by 60 (Hutton
1990)
Two common sizes are 20 drops per ml and 15 drops per ml.
Examples of calculations:
1000mls (volume of infusion) x 20 drops = 20,000 = 27.7 drops
12 (hours) x 60 (minutes) 720
1000mls (volume of infusion) x 15 drops = 15,000 = 20.8 drops
12 (hours) x 60 (minutes) 720

These calculations should be rounded up to the whole number and recorded in the patient’s
records.
Usual rates of infusions can vary from 500mls of fluid over 8 hours to a maximum of 2 to 3 litres
of fluid in 24 hours.
Most low volumes of suitable fluids can be administered subcutaneously without any problems.
If however localised oedema becomes a problem with fluid volumes of 2 litres over 24 hours or
1 litre over 8 hours. A drug called Hyaluronidase (Hyalase) can be given to try and eliminate or
prevent localised oedema at the site.
The usual dose is 1500iu per site per 24 hours. It is dissolved in saline 0.9% (enough to prime
the line, approximately 17.3mls, plus 0.5mls). This is through a Baxters Solution giving set.
It MUST NOT be added to the fluid bag but is injected as a sub-cut bolus injection.
GUIDELINES FOR SETTING UP INFUSION
ACTION
This procedure should only be carried out as
part of a planned programme of care, following
discussion with the patient’s medical
practitioner, the patient and their
families/carers.
All medications and fluids required for this
procedure must be prescribed by the medical
practitioner responsible for the patients care.
Prepare the patient and explain the procedure,
including the risks and benefits. Evidence that
this has been done must be documented in the
patients record. If possible, the patients
should sign the care plan.
Check the fluid to be administered with the
signed prescription sheet. The prescription
sheet must be signed together with the dose,
infusion rate and route of administration.
NB: If hydrating a dying patient, the
infusion should be limited to 500mls – 1
litre per day.
Ensure all equipment is assembled
Prime the giving set and the butterfly needle
with the fluid to be infused.
Assess the patient for a suitable area, either
abdomen, chest or lateral aspects of upper
RATIONALE
To ensure that all other options have been
explored and the patient is suitable for this
procedure to be carried out in the home.
To conform with NMC standards for the
administration of medicines and to fulfil the
legal requirement.
To obtain informed consent and co-operation
of the patient
To ensure correct type of fluid and quantity
administered at correct rate.
To reduce undue anxiety to the patient and for
ease of carrying out the procedure.
To prevent air bubble formation in the cannula
(Nobel-Adams 1995)
To provide a comfortable and safe area for
fluid absorption.

arm or thigh. (Noel-Adams 1995, Watt 1991)
Wash and dry hands thoroughly or use alcohol
based hand wash. This is a clean procedure
Ensure that the site is clean.
Pinch the skin into a fold. Clean site with
Choraprep then air dry
Insert the butterfly needle into the chosen site
at an angle of 45 degrees with the bevelled
edge facing uppermost. (Abdulla, Keast 1997,
Nobel-Adams 1995)
NB: If blood appears in the line on insertion
of the butterfly needle, withdraw
immediately and repeat the process.
(Berger 1984)
Coil the butterfly line and place a semipermeable
film dressing over the butterfly site
(Nobel-Adams 1995)
Ensure that the patient is comfortable.
Inform the patient/carer what actions to take
should any problems arise with either the
infusion or the site.
Ensure that the patient/carer has contact
details for day, evening and night community
nursing services.
Set the infusion at the prescribed rate using
the infusion table (page 9)
Record the date and time commenced in the
patient records together with the batch number
and expiry date of the fluid(s) used.
Commence a fluid balance chart.
Check the infusion site one hour after
commencing and then 6-8 hourly for the next
24 hours.
At each visit, check the site for:
Local irritation
Redness
Tenderness
Swelling
Inflammation
Fluid monitoring chart to be used.
Resite as necessary (following the above
actions)
The site should be changed at least every 48
To comply with universal infection control
precautions;
To reduce the risk of site contamination.
To promote patient comfort.
To ensure that a blood vessel has not been
compromised.
To ensure the flow of fluids and security of the
line. Also to protect the site from infection.
To maintain patients dignity and safety.
To ensure fluid is administered in accordance
with policy and prescription.
To ensure patient safety.
To ensure that any problems are identified
quickly and dealt with promptly.
To maintain patient comfort and dignity.
Ensure the adequate and safe absorption of
the fluid(s)
To minimise the risk of infection and to ensure

hours and/or when complications occur,
The site change and reason for re-siting must
be recorded in the patients record
Giving sets must be changed at least every
(48 hourly) hours and the change recorded in
the patients record (Mallett & Bailey 1996)
the safe administration of fluid(s)
To minimise the risk of infection,
IF HYALURONIDASE IS BEING USED
Draw up prescribed amount of hyaluronidase
in subcutaneous syringe in prescribed amount
of 0.9% saline
Prime the butterfly needle and the giving set
with the prepared syringe and leave the
syringe attached to it.
Hyalase Follow steps 1, 2 and 3 of above
procedure for subcutaneous infusions.
Pinch up a fold of skin from the chosen site
introduce the needle at a 45 degree angle.
Flush through the 0.5 hyaluronidase through
the line into the site
Disconnect the syringe and attach the
prescribed fluid for administration to the giving
set. Start the infusion at the appropriate rate.
Monitor site as per policy
To ensure the correct drug and preparation is
ready to be administered
Preparing to administer medication with only
one injection for the patient for both medication
and subcutaneous fluid administration
Ensuring site identified for administration is
identified and cleansed appropriately prior to
insertion of needle.
To ensure prior to sub cutanious fluid
administration the hyaluronidase is
administered to have desired effect.
Ant remaining hyaluronidase will go through
prior to the reaming fluid. This minimises any
discomfort to the patient and maximises the
efficiency of the drug
To monitor effectiveness of the drug. Ensure
patient comfort is provided.

REFERENCES
Reference
Abdulla A., Keast J., (1997) “Hypodermaclysis as a
means of rehydration”., Nursing Times July
16/Vol3/No29
ATM Applied Medical Technology, Disposable
Infusion Sets
Birmingham East and North NHS Primary Care
Trust, ( 2006), Policy for the administration of
subcutaneous fluids.
eMC, The electric Medicines Compendium,
(2008)Hyalase 1500I>U> Powder for Solution for
Injection/Infusion.
http://www.baxterhealthcare.co.uk/products/iv_syst
ems/sets/sub/basic_sets.html. Iv administration
sets.
http:/www.chloraprep.co.uk/chloraPrepproductLine.html
http:/www.chemocare.com., (2009), Side effects –
symptoms and solutions, Hypocalcaemia (high
calcium)
htt://www.healthcarea2z.org/ditem.aspx/284/Hypod
ermoclysis. , (2009), subcutaneous fluid
administration (hypodermoclysis)
http://palliative.info. Procedure for subcutaneous
Over-the-needle Cannula Insertion, Removal,
Medication Administration, and Fluid Administration
for the Individual in the Home.
Hutton M., (1998) “Numeracy Skills for Intravenous
calculations”, Nursing Standard July 15/Vol 12/ No
43.
Mallet J., Bailey C., (1996) The Royal Marsden
NHS Trust Manual of Clinical Nursing Procedures
4 th Edition, Oxford Blackwell Science, London.
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(whole
document
or section,
please
state)
2
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whole
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E
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MayoClinic.com. Pulmonary edema. Pages 1 to 5 E
Moriarty D and Hudson (2001), “Hyperdermoclysis
for rehydration in the community”, Journal of
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Community Nursing Vol 6 No 9.
Nobel-Adam R (1995) “Dehydration.
Subcutaneous Fluid Administration, British Journal
of Nursing 4 pp488-494
Nursing and Midwifery Council (2008), Standards
of Conduct, Performance and Ethics
Patchett M., (1998) “Providing hydration for the
terminally ill patient” International Journal of
Palliative Nursing Vol 4 No 3
Pranoy Barua, Bimal K, Bhowmick, (2005),
Hypodermoclysis – a victim of historical prejudice.
Robin Fainsinger, MD, (2006), Nonoral hydration in
palliative care#133, Journal of Palliative Medicine-9
(1):206
Rochon P., Sudeep et al,: A systematic review of
the evidence for hypodermoclysis to treat
dehydration in older people. Journal of
Gerontology, Medical Sciences 1997, Vol 52a No
3, pp 169-176
RCN, Standards for infusion therapy
Steiner N (1998) “Methods of Hydration in Palliative
Care patients” Journal of Palliative Care 14:2 6-13
Tee’s Esk and Wear Valleys NHS Foundation
Trust, (2009), Procedure for the administration of
subcutaneous fluids (hypodermoclysis)
The Royal Marsden NHS Foundation Trust (2006),
The Royal Marsden Hospital Manual of Clinical
Procedures. 6 th Edition. Blackwell Publishing,
Oxon pp 194-195
Twycross R., Wilcock A, Thorp S (1998) “Syringe
Drivers” in Palliative Care Formulary, Radcliffe
Medical Press, Oxford pp 182-202.
University hospitals of Leicester NHS Trust, (2003)
Policy for the administration of subcutaneous fluids
for the hydration of adult patients.
Zeh, P., (2002) Clinical Governance and the
District Nurse, Journal of Community Nursing April
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217
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1
2
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Pages 22 to
44
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APPENDIX 1
Symptoms of Dehydration
Symptoms which may be associated with
dehydration (Patchett 1998)
Thirst
Dry mouth
Dysphasia
Nausea and Vomiting
Muscle Cramps
Headache
Apathy
Depression
Vivid nightmares
Disorientation – (delirium, confusion and
unexpected coma state)
Physical Signs (Steiner & Breura 1998)
Thirst
Reduced skin turgor
Reduced sweating
Postural hypotension
Tachycardia
Oliguria
However some of these signs are less reliable
in advanced cancer patients and can be found
without volume depletion.
NB: There should be a review of patient’s
medication to determine if they are causing
any of the above symptoms.
NB: There should be a review of patient’s
medication to determine f they are causing
any of the above symptoms.

APPENDIX 3
Diagrams
Needled infusion set
Sof- set infusion set

APPENDIX 4
Subcutaneous Insertion Sites Diagram

APPENDIX 5
Subcutaneous Fluids Monitoring Chart
Subcutaneous Fluids Monitoring Chart
Name: ………………………….... DOB: ….……..….. NHS No: ………………………
Date:
Time:
Infusate:
Site / Position:
Appearance:
Signature:
When Considering appearance please use the following guidelines:
A
Site appears intact with no pain on palpation, redness,
swelling or oozing.
Continue infusion.
B
Slight pain on palpation and/or redness, swelling or
oozing to a diameter of less than o.5cm.
Continue infusion. Check site more frequently.
C
Pain on palpation and/or redness, swelling or oozing to a
diameter of between o.5cm and 2cm.
Discontinue infusion. Resite if appropriate or
consider IV hydration. Complete incident form and
monitor frequently until symptoms diminish.
D
Pain on palpation and/or redness, swelling or oozing to a
diameter of greater than 2cm.
Discontinue infusion. Resite if appropriate or
consider IV hydration. Complete incident form and
monitor frequently until symptoms diminish and
apply (appropriate dressing)
In acknowledgement of University Hospitals of Leicester

APPENDIX 6
Equality Impact Assessment Tool
To be completed with the policy document when submitted to the appropriate committee for
consideration, approval and ratification.
1. Does the policy/guidance affect one group less or
more favourably than another on the basis of:
Yes/No
Race No
Ethnic origins (including gypsies and travellers) No
Nationality No
Gender No
Culture No
Religion or belief No
Sexual orientation including lesbian, gay and
bisexual people
Age Yes –
Adults
Only
Disability - learning disabilities, physical disability,
sensory impairment and mental health problems
2. Is there any evidence that some groups are
affected differently
3. If you have identified potential discrimination, are
there any exceptions valid, legal and/or
justifiable
4. Is the impact of the policy/guidance likely to be
negative
5. If so can the impact be avoided No
6. What alternative are there to achieving the
policy/guidance without the impact
7. Can we reduce the impact by taking different
action
No
No
No
No
No
No
No
Comments
If you have identified a potential discriminatory impact of this policy document, please refer it to
[insert name of appropriate person], together with any suggestions as to the action required to
avoid/reduce this impact. For advice in respect of answering the above questions, please
contact [insert name of appropriate person and contact details].

APPENDIX 7
Dissemination and Training Plan
To be completed with the policy document when submitted to the appropriate committee for
consideration, approval and ratification.
The status column must be given a Red, Amber or Green rating with evidence to demonstrate
an action has been completed.
DISSEMINATION PLAN
Title of document: Administration of Sub
Cut Fluids
Dissemination Lead: (Print name and
contact details) Sue OHanlon
Irwin Road Clinic
Date finalised: December 2010
Previous document already being used
appropriate)
If yes, in what format and where
No (Please delete as
Proposed action to retrieve out-of-date
copies of the document:
To be disseminated to:
District Nurses/Community Matrons/
RARs/RATs
TRAINING PLAN
Withdraw from the internet/intranet/portal
Disseminated
by whom
Community
Service
Managers
Event (Please provide details of available training venues/dates to
educate staff about this policy document)
Timescale
(Date)
December
2010
Status
R A G
Paper
or
Electronic
Electronic
Comments
Timescale Owner Status
R A G
To be incorporated into the ongoing IV training programme January 2011 Sue
OHanlon
Training Plan Lead (Please provide details of staff who will be
responsible for overseeing this training)
Sue OHanlon
Additional information (Please provide details of any processes in place
to support implementation)
To be
incorporated
into IV
Introduction
study days
throughout
the coming
year
Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided.
Denotes: Action partially implemented.
Denotes: Action complete.