(F5) Successful Implementation of a Pediatric Subcutaneous Rehydration Program to Limit Unnecessary Pokes

A subset of children presenting with dehydration may have difficulty establishing peripheral intravenous access. Subcutaneous (SQ) fluid administration can be utilized especially with recombinant hyaluronidase to increase connective tissue permeability and facilitate fluid movement. Over a period of 16 months, 23 pediatric patients received subcutaneous hydration for the main indication of dehydration. All patients had difficult vascular access documented. Median age for the cohort was 2 years (30% were infants). Half the patients were female. The service was utilized in the emergency department (ED) as well as on inpatient pediatric units including general hospitalist and subspecialty services. Of the 9 patients initiating this service in the ED, a third were successfully discharged home. More than 50% had no complications noted. Use of SQ rehydration is frequently successful and well tolerated in addressing dehydration in children with difficult IV access. This approach has the benefit of potentially limiting number of IV pokes attempted, can promote vessel preservation and limit painful procedures.