Janice Gabriel

Subcutaneous fluid administration and the hydration of older people

Hypodermoclysis, or the subcutaneous administration of fluids, is a method of rehydration that is not routinely used in the UK. Yet it is a simple and effective method of fluid administration for individuals with mild-to-moderate dehydration, especially for the frail and elderly ( Sasson and Shvartzman, 2001 ). Subcutaneous infusion is an alternative route of parenteral administration. It provides a number of advantages over the intravenous route for those individuals unable to tolerate enteral fluids, as it is associated with fewer complications, as well as a wider range of infusion sites. This makes it particularly advantageous for frail and/or older patients requiring low-volume hydration in the community setting. This article discusses indications and contraindications for subcutaneous infusions, as well as patient assessment, placement, securement and potential complications.

Current thinking on catheter securement and infection prevention

Janice Gabriel, Clinical Network Manager, NHS England (Wessex), Southampton, janice.gabriel@nhs.net , explains the importance of catheter securement in preventing complications of infusion therapy.

Understanding the challenges to vascular access in an ageing population

At the beginning of the 21st century, one in five of UK residents can expect to see their 100th birthday and one in four people are aged 60 years or older. The UK has an ageing population. With older age comes an increasing variety of comorbidities that have an impact not only on an individuals quality of life but also on healthcare resources. Older people account for a rapidly rising cohort of individuals admitted to hospital, often with complex needs, and this can require achieving venous access. Venepuncture and cannulation are the most commonly performed invasive procedures in health care today. This article aims to increase awareness of vascular access challenges in older patients so the potential for complications relating to venepuncture, cannulation and infusion therapy can be minimised, thereby improving their overall quality of care. The article will look at the healthcare challenges facing the older population, and the importance of a holistic approach to assess their vascular access needs to deliver optimum care.