[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medications and dose calculation](https://durgical.com/en/nursing/areas/medication/) › Continuous subcutaneous infusion and hypodermoclysis

# Continuous subcutaneous infusion and hypodermoclysis

- Procedure

Fluids or some medicines run slowly into the tissue under the skin through a small cannula when the mouth and the veins are not an option.

Updated Nov 12, 2026

## Key points

- For mild to moderate dehydration or symptom control when oral intake fails and veins are hard to access.
- Not for shock, severe dehydration or any situation that needs fast replacement: absorption is slow.
- Use isotonic fluids and only the medicines the protocol accepts for this route.
- Choose intact skin with good subcutaneous tissue, away from joints, oedema, radiation fields and tumours.
- Inspect the site at every round; change it as the protocol says or at the first sign of redness, hardness or leaking.

## What it is

Hypodermoclysis is the infusion of isotonic fluids, medicines or both into the subcutaneous tissue. It is simple, safe and quick to start, and it is useful in palliative care, in older adults and at home, when the patient cannot take fluids or medicines by mouth and venous access is difficult. Absorption is slower than through a vein, so it is not used when fluids are needed fast. Only solutions and medicines that the protocol accepts for this route are given, ideally one medicine per site.

## Indications

- Unable to take fluids or medicines by mouth: nausea, vomiting, swallowing problems, bowel obstruction or reduced consciousness.
- Difficult venous access, phlebitis or venous thrombosis.
- Symptom control at the end of life, in hospital or at home.
- Mild to moderate dehydration, especially in older adults, when a venous line is not justified.

## Contraindications and precautions

- Absolute contraindications: the patient refuses, anasarca, severe thrombocytopenia, or a need for rapid fluid replacement (shock, severe dehydration).
- Relative contraindications: bleeding disorders, oedema, heart failure or risk of fluid in the lungs, infection near the site.
- Avoid limbs with lymphoedema, the side of a mastectomy, irradiated skin, stomas, tumours, scars and bruised skin.
- Avoid the abdomen when there is ascites, and the spaces between the ribs in very thin patients.
- Check compatibility: irritant medicines or those with extreme pH are not given by this route.

## Equipment

- Small winged cannula or short flexible cannula, gauge 23 to 27, as the protocol says.
- Transparent dressing and a label for the date.
- Infusion set and pump, or a gravity set, as ordered; the prescribed isotonic solution.
- Antiseptic, clean gloves and a sharps container.
- Site-check and fluid balance records.

## Step by step (and why)

- Check order, solution, rate and route; identify and explain — the rate is prescribed and consent matters.
- Pick intact skin: below the collarbone, abdomen, front or side of thigh, upper arm or back — good tissue, away from joints.
- Perform hand hygiene, put on gloves, clean the skin with antiseptic and let it dry — reduces infection.
- Pinch the skin and insert the cannula into the fat as the protocol shows; check for blood — blood means another site.
- Cover with a transparent dressing and write the date — the site stays visible without lifting the dressing.
- Connect and start at the prescribed rate, one medicine per site when possible — mixtures can precipitate and irritate.
- At every round check the site for redness, swelling, hardness, pain or leaks — local reactions are the main problem.
- Watch fluid balance and breathing — too much fluid can overload the heart and lungs of frail patients.
- Change the site as the protocol says or at the first problem, and record — a new site absorbs better.

## Complications

- Swelling, redness, hardness or pain at the site.
- Fluid leaking at the site, bruising or bleeding, more often with low platelets or anticoagulants.
- Infection or cellulitis at the site (rare).
- Fluid overload in patients with heart failure or who are frail.
- Tissue irritation from incompatible or irritant medicines.

## Next step: when to call for help

- Stop the infusion, change the site and tell the nurse in charge if the site is red, hard, painful or leaking.
- Call if there is fever, spreading redness or pus at the site.
- Call if the patient becomes breathless, has new oedema or passes much less urine.
- Call if symptoms are not controlled, or if the patient or family want to stop the infusion.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is hypodermoclysis not used in shock?

Because absorption from the subcutaneous tissue is slow. Shock and severe dehydration need fast replacement through a vein.

## Which areas should be avoided when choosing a subcutaneous site?

Oedematous or lymphoedematous limbs, the mastectomy side, irradiated skin, stomas, tumours, scars, bruises and, with ascites, the abdomen.

## What are the most common complications of a subcutaneous infusion?

Local reactions: redness, swelling, hardness, pain or leaking at the site. They are managed by stopping and changing the site.

## Why is one medicine per site preferred?

Because mixing medicines in one site raises the risk of precipitation and tissue irritation.

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## Connections

## Related 4

- [Subcutaneous injection](https://durgical.com/en/nursing/subcutaneous-injection/)
- [Symptoms at the end of life: pain, breathlessness, secretions, delirium and mouth care](https://durgical.com/en/nursing/symptoms-at-the-end-of-life-pain-breathlessness-secretions-delirium-and-mouth-ca/)
- [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/)
- [Nursing care of the dying patient](https://durgical.com/en/nursing/nursing-care-of-the-dying-patient/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Nursing knowledge and practices regarding subcutaneous fluid administration (Gomes NS et al.)](https://scielo.br/j/reben/a/HVSWf4bxZMZHmpqY5T9LPVd/?lang=en) (Revista Brasileira de Enfermagem (SciELO), 2017); [Nursing Skills, 18.5: Administering Subcutaneous Medications](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/18%3A_Administration_of_Parenteral_Medications/18.05%3A_Administering_Subcutaneous_Medications) (Open RN (Chippewa Valley Technical College), LibreTexts, 2021).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/continuous-subcutaneous-infusion-and-hypodermoclysis/