Hyaluronidase Allows Subcutaneous Infusion of Fluids for Pediatric Patients

[southerndoc]

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I swear I'm not being paid by Hylenex. We just got this in our ED's and was curious if anyone has been using it. I wasn't told how expensive it is, but obviously if you can get an IV, then you don't use it. This is for kids that are really dehydrated but you don't want to do an IO for whatever reason (going home afterwards, parents' apprehension, etc.).

Here's the video:

http://hylenex.com/video_infuse.html

 

[WilcoWorld]

We do occasionally use subQ rehydration in our Peds ED (furthering the argument for calling peds "Veterinary Medicine") but I don't know of anyone using hyaluronidase. I have read that hyaluronidase increases the invasiveness of bacteria (because it acts on hyaluronic acid in the extracellular matrix) and that the presence of hyaluronidase on the pneumococcus is part of why it causes so much meningitis. Have you read anything about the relative risk of invasive infection in patients treated with hyaluronidase?

 

[BKN]

I swear I'm not being paid by Hylenex. We just got this in our ED's and was curious if anyone has been using it. I wasn't told how expensive it is, but obviously if you can get an IV, then you don't use it. This is for kids that are really dehydrated but you don't want to do an IO for whatever reason (going home afterwards, parents' apprehension, etc.).

Here's the video:

http://hylenex.com/video_infuse.html

Clysis is not new, it's just been out of fashion for about 50 years. Yes, the veterinarians use it, including my wife. I suggest you think of it as not as fast as an IV. IO is probably faster.

 

[southerndoc]

Clysis is not new, it's just been out of fashion for about 50 years. Yes, the veterinarians use it, including my wife. I suggest you think of it as not as fast as an IV. IO is probably faster.

Not a replacement for the IV, but with some rehydration you might can actually get an IV afterwards. Parents often are apprehensive about an IO.

I was told the cost of this is $50. Much cheaper than the IO device we are using. I'm sure much less painful too.

Haven't used it yet, and doubtful that I will anytime soon since I rarely see kids (we have our own pedi ER).

 

[Stitch]

I've never used it nor have I seen it used. It honestly looks rather painful. I'll ask my partners tomorrow if they have, but in general we don't have that many problems getting IVs in kids. Plus we've been pushing adequate and abundant oral rehydration lately. 5mL of pedialyte from a 5cc syringe every 5 minutes can do wonders. Add zofran at the start if you're worried about vomiting. Labor intensive, but it works.

Honestly, I never trust any practitioner who wears a fuzzy stuffed animal on their stethoscope (like the NP in the video). Vector anyone? 😛

 

[mlw47]

I'm confused. How does this work? The fluid is being immediately third-spaced. Does this really increase intravascular volume?

-MS3

 

[southerndoc]

I'm confused. How does this work? The fluid is being immediately third-spaced. Does this really increase intravascular volume?

-MS3

Yes, it causes the fluid to be absorbed into the intravascular space. This is also used for several extravasations of medicine.

 

[KidDr]

I've never used it nor have I seen it used. It honestly looks rather painful. I'll ask my partners tomorrow if they have, but in general we don't have that many problems getting IVs in kids. Plus we've been pushing adequate and abundant oral rehydration lately. 5mL of pedialyte from a 5cc syringe every 5 minutes can do wonders. Add zofran at the start if you're worried about vomiting. Labor intensive, but it works.

Honestly, I never trust any practitioner who wears a fuzzy stuffed animal on their stethoscope (like the NP in the video). Vector anyone? 😛

One of their reps came to our staff meeting about 6 months ago but most of our peds ED staff seemed pretty skeptical that it would be all that useful, for 3 main reasons:
1) It's really rare that our ED staff can't get a PIV or, at last resort, an EJ, in a dehydrated kid
2) NG rehydration is an appropriate second option (though NG placement is more painful than subcutaneous needle placement)
3) Any kid in true hypotensive shock needs immediate circulating intravascular volume--so if PIV or EJ placement isn't successful, they get an IO

Like anything else that is new, I'm guessing it would take awhile for people to actually start using it and become comfortable with its use. I don't know if we even stock it--I've never seen anyone use it before. I could see it being more useful in smaller EDs that don't see many kids and might have a harder time getting IV access in infants and kids.

 

[Stitch]

One of their reps came to our staff meeting about 6 months ago but most of our peds ED staff seemed pretty skeptical that it would be all that useful, for 3 main reasons:
1) It's really rare that our ED staff can't get a PIV or, at last resort, an EJ, in a dehydrated kid
2) NG rehydration is an appropriate second option (though NG placement is more painful than subcutaneous needle placement)
3) Any kid in true hypotensive shock needs immediate circulating intravascular volume--so if PIV or EJ placement isn't successful, they get an IO

Like anything else that is new, I'm guessing it would take awhile for people to actually start using it and become comfortable with its use. I don't know if we even stock it--I've never seen anyone use it before. I could see it being more useful in smaller EDs that don't see many kids and might have a harder time getting IV access in infants and kids.

👍 Totally agree