Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-19T16:38:45.112Z Has data issue: false hasContentIssue false
  • English
  • Français

Basic-Level Emergency Medical Technician Administration of Fluids and Glucose via Enzyme-Assisted Subcutaneous Infusion Access

Published online by Cambridge University Press:  05 July 2012

Olanrewaju A. Soremekun ,
Melissa L. Shear ,
Jay Connolly ,
Charles E. Stewart  and
Stephen H. Thomas
Olanrewaju A. Soremekun
Affiliation:
Harvard Affiliated Emergency Medicine Residency Program, Boston, Massachusetts USA Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA
Melissa L. Shear
Affiliation:
Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA
Jay Connolly
Affiliation:
Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA
Charles E. Stewart
Affiliation:
Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma USA Oklahoma Disaster Institute, Tulsa, Oklahoma USA
Stephen H. Thomas*
Affiliation:
Department of Emergency Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts USA Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma USA
*
Correspondence: Stephen H. Thomas, MD, MPH Department of Emergency Medicine University of Oklahoma, School of Community Medicine Tulsa, Oklahoma 74135 USA E-mail stephen-thomas@ouhsc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

During disasters and mass-casualty incidents (MCIs), there may be insufficient numbers of advanced life support (ALS) providers to provide intravenous (IV) access to all patients requiring parenteral fluids and/or medications. Enzyme-assisted subcutaneous infusion (EASI) access, in which human recombinant hyaluronidase (HRH) augments subcutaneous fluid dispersion and absorption, may be useful when ALS resources are insufficient to meet intravascular access needs. The utility of the use of the EASI lies, in part, in its ease of placement by ALS personnel.

Objectives

The objectives of this study were to document the feasibility, comfort, and speed/degree of infused-glucose uptake through EASI lines placed by basic-level emergency medical technicians (EMT-Bs).

Methods

Eighteen EMT-Bs instituted EASI access on each other. A total of 150 units (1 mL) of HRH were administered through the EASI line, followed by the administration of 250 mL of tracer-labeled D5W. Timed phlebotomy enabled gas chromatography/mass spectrometry characterization of glucose uptake. Enzyme-assisted subcutaneous infusion placement and comfort ratings were tracked and analyzed using non-parametric statistics and Fisher's Exact Test.

Results

In all 18 subjects, EASI access required only one attempt and was rated by the EMT-Bs as easy to accomplish. Glucose was absorbed quickly (within five minutes) in all subjects. The rate of infusion was rapid (median 393 mL/hour) and was comfortable for the recipients (median pain score 1/10).

Conclusions

The use of EASI may be viable as a fast, simple, and reliable method for the administration of fluid and glucose by EMT-Bs.

Soremekun OA, Shear ML, Connolly J, Stewart CE, Thomas SH. Basic-level emergency medical technician administration of fluids and glucose via enzyme-assisted subcutaneous infusion access. Prehosp Disaster Med. 2012;27(3):1-6.

Keywords

disaster medicineemergency medical servicesfluid resuscitationhyaluronidasemass-casualty incidentprehospitalsubcutaneous infusion
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 3 , June 2012 , pp. 220 - 225
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sever, MS, Vanholder, R, Lameire, N. Management of crush-related injuries after disasters. N Engl J Med. 2006;354(10):1052-1063.Google Scholar
2. Stafford, PW, Blinman, TA, Nance, ML. Practical points in evaluation and resuscitation of the injured child. Surg Clin North Am. 2002;82(2):273-301.CrossRefGoogle ScholarPubMed
3. American College of Surgeons. Advanced Trauma Life Support, 7th ed. Chicago, IL USA: American College of Surgeons; 2004.Google Scholar
4. Soremekun, O, Shear, M, Patel, S, et al. . Rapid vascular glucose uptake via enzyme-assisted subcutaneous infusion: EASI Access Study. Am J Emerg Med. 2009;27(9):1072-1080.CrossRefGoogle ScholarPubMed
5. Craig, A, Eikenberry, E, Parry, D. Ultrastructural organization of the skin: classification on the basis of mechanical role. Connect Tissue Res. 1987;16:213-223.Google Scholar
6. Bookbinder, L, Hofer, A, Haller, M, et al. . A recombinant human enzyme for enhanced interstitial transport of therapeutics. J Control Release. 2006;114(2):230-241.CrossRefGoogle ScholarPubMed
7. Laurent, U, Dahl, L, Reed, R. Catabolism of hyaluronan in rabbit skin takes place locally, in lymph nodes, and liver. Exp Physiol. 1991;76(5):695-703.CrossRefGoogle ScholarPubMed
8. Frost, GI. Recombinant human hyaluronidase (rHuPH20): an enabling platform for subcutaneous drug and fluid administration. Expert Opin Drug Deliv. 2007;4(4):427-440.Google Scholar
9. Baxter Healthcare Corporation. Hylenex Package Insert. Deerfield, Illinois USA; 2006.Google Scholar
10. Thomas, JR, Yocum, RC, Haller, MF, von Gunten, CF. Assessing the role of human recombinant hyaluronidase in gravity-driven subcutaneous hydration: the INFUSE-LR study. J Palliat Med. 2007;10(6):1312-1320.CrossRefGoogle ScholarPubMed
11. Pirrello, RD, Ting Chen, C, Thomas, SH. Initial experiences with subcutaneous recombinant human hyaluronidase. J Palliat Med. 2007;10(4):861-864.CrossRefGoogle ScholarPubMed
12. Thomas J, Yocum R, Haller M, von Gunten C. Hylenex recombinant hyaluronidase human injection dose-comparison study of subcutaneous hydration: the INFUSE-LR study. Abstract presented at: Cleveland Clinic Palliative Medicine 2006; March 23-25, 2006; Sarasota, Florida USA.Google Scholar
13. Yu, YM, Wagner, DA, Walesreswski, JC, Burke, JF, Young, VR. A kinetic study of leucine metabolism in severely burned patients. Comparison between a conventional and branched-chain amino acid-enriched nutritional therapy. Ann Surg. 1988;207(4):421-429.Google Scholar
14. Duro, D, Duggan, C, Valim, C, et al. . Novel intravenous (13)C-methionine breath test as a measure of liver function in children with short bowel syndrome. J Pediatr Surg. 2009;44(1):236-240; discussion 240.CrossRefGoogle ScholarPubMed
15. Alam, HB, Rhee, P. New developments in fluid resuscitation. Surg Clin North Am. 2007;87(1):55-72, vi.Google Scholar
16. Kramer, G, Hoskins, S, Copper, N, Chen, JY, Hazel, M, Mitchell, C. Emerging advances in burn resuscitation. J Trauma. 2007;62(6 Suppl):s71-s72.Google ScholarPubMed
17. Turner, T, Cassano, A. Subcutaneous dextrose for rehydration of elderly patients—an evidence-based review. BMC Geriatrics. 2004;4(2):1-6.CrossRefGoogle ScholarPubMed
18. Dalal, S, Bruera, E. Dehydration in cancer patients: to treat or not to treat. J Support Oncol. 2004;2(6):467-479,483.Google Scholar
19. Sasson, M, Shvartzman, P. Hypodermoclysis: an alternative infusion technique. Am Fam Physician. 2001;64(9):1575-1578.Google Scholar
20. Kozak, I, Kayikcioglu, OR, Cheng, L, et al. . The effect of recombinant human hyaluronidase on dexamethasone penetration into the posterior segment of the eye after sub-Tenon's injection. J Ocul Pharmacol Ther. 2006;22(5):362-369.CrossRefGoogle ScholarPubMed
21. Allen, CH, Etzwiler, LS, Miller, MK, Harb, G. Subcutaneous hydration in children using recombinant human hyaluronidase: safety and ease of use (abstract). Ann Emerg Med. 2008;52(4):s75-s76.Google Scholar
22. Schen, RJ, Singer-Edelstein, M. Hypodermoclysis. JAMA. 1983;250(13):1694-1695.Google Scholar