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Hypodermoclysis or other suggestions for patient with worn out veins?


 I have a chronic medical condition, and have been receiving IV treatments for 10 years, mostly at home for the past few years.

Recently, my veins have scarred and deteriorated to the point where its almost impossible to start peripheral IV's (recently on one occassion two nurses failed after combined 2+ hours effort and 20+ attempts).  In addition, due to the condition of my immune system, prior attempts to place central line have each resulted in severe life threatening bloodstream infections requiring prolonged hospitalization.
Therefore, my doctor and I have been looking for alternatives, and I came across this site.  We are interested in subcutaneous administration (e.g hypodermoclysis) since the meds I require (echinocandin antifungals) have been proven to work by subcutaneous injection in animals but not in humans.
I was wondering if perhaps anyone you knew of any home infusion companies in Southern Calif that were experienced with the technique of hypodermoclysis, and would administer the drugs this way if my doctor ordered it.
Or if anyone has any other suggestions.
Also, I have heard that one of my meds, IVIG is especially "hard on the veins" not just where it is injected but systemically.  Is this correct, and would veins be expected to improve after a while of taking the gamma globulin subcutaneously rather than IV? (there is already FDA approved Vivaglobulin for subcutaneous use)
Another med I was on recently, anidulafungin, needs to be reconstituted in 30 cc's of 20% ethanol before being diluted in 250 cc's saline (so solution to be infused was just over 2% ethanol).  I am not sure about this - but I think the ethanol in the preparation seemed to cause irritation of my veins and tissue (especially noticeable when it leaked out) so this may have made my veins worse?  The other meds in the same class caspofungin and micafungin have almost the same coverage and do not require the ethanol, just normal saline - so we would use one of the latter if we did the hypodermoclysis.
Chris Cavanaugh
It is very difficult to

It is very difficult to comment on specific cases and cover all possibities in a forum such as this, so I would encourage you to look to your infusion provider, MD or local hosptial for an infusion specialist RN, one with the certification CRNI who can help guide you through your treatments and make appropriate suggestions for your care.

Regarding hypodermoclysis, it can be very successful with certain medicaions, such as insulin, hydration fluids, IVIG and others.  There are companies who make formulations of medications to be given subcutaneously as well as intravenously and devices specific for this type of infusion.  Not all medications can be given this way successfully, however.

As far as your access goes, a tunnelled central line placed under maximum barrier precautions and sterile technique has the least risk of infection, especially when properly maintained using sterile technique.  You may want to consider this option. 


Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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