Agree with previous posts, Hylenex is a godsend in certain difficult IV
cases. We've used the animal recombinant in a few cases since Hylenex
went off the market but are excited to get Hylenex back, as we
participated in the study Baxter and got used to having it as a back up.
Marty, if you try IV fluids without a Hyaluronidase of some kind the pump
will keep blinking occluded. As I understand it, even back in the day
when they did clysis in NICUs pretty routinely, they still used the animal
derived hyaluronidase. RE your cat experience, animals have a plane that
can easily accomodate fluids and allow them to be picked up by the scruff
of the neck, but humans not so much.
My knowledge is by no means extensive but here are some tips:
1) By all means, use EMLA/LMX
2) It takes about 30 -45 min for the hump to go away. During that time
the pressure may cause the pump to keep beeping occluded. Per the
company, if you use a butterfly rather than an angiocath you won't have
the pump issue.
3) LR stings less than NS. I tried NS myself, and when it was infusing
there was some moderately uncomfortable itching and stinging. I had a
Buzzy on me (natch) and the vibration took care of the irritation, but we
did have kids crying with the infusions for 30 min. or so until the fluid
was flowing better. If you can, use LR.
4) I think they have studied morphine and rocephin formally, but am not
100% sure. Maybe Pip Spandorfer will weigh in, he knows more about the
5) In the Baxter-sponsored study, the success of IV placement was 100%.
This makes sense: you simply prep the skin and then poke the kid between
the upper shoulder blades, put in the hylenex through the angiocath or
butterlfly, remove the syringe, attach fluids, then put a tegaderm over
it. Hard to miss.
Amy Baxter MD FAAP FACEP
Director of Emergency Research, Scottish Rite
Pediatric Emergency Medicine Associates
Marty Herman <[log in to unmask]> writes:
>SO how do you do it? do you use EMLA/LMX to anesthetise the entry site?
>How big a needle is used for the subcut infusion? How much volume is
>placed at one time?
>DOes anyone know if Meds can be given this way also?? DOn't know why
>not, since we give meds sc at times. WOuld keep from having to stick
>another time to give meds IM..I generally prefer to go to either NG
>fluids in cases of dehydration associated with diarrhea/vomiting..or IO
>if we can't get an IV. Everywhere I have worked the nurses just take it
>as a personal challenge to get the IV and will stick 6-8 even 10 times,
>in spite of policies to the contrary.. I don't get notified of failures
>until the parents either go balistic or they ( nurses) finally quit.
>maybe I need to be more vigilant..Or better still maybe we just need a
>policy to limit the number of sticks before moving to a differnet method.
>SO using Hylenex...I know my predecessors used clysis back in the " day".
>SO what is the advantage of using Hylenex? Why not just regular IV
>fluids? As an aside, when my cat was in renal failure the vets had us do
>clysis at home. just instilled NS sc between the animals shoulder blades.
> After it was done you could see these fluid collections along his leg
>and flanks, sure looked funny. It definitely helped. We stopped after a
>while because the cat was old and seemed to hate getting stuck..we
>eventually put him down..On the plus side, I got convinced clysis would
>Martin Herman, M.D.
>Pediatric Emergency Medicine
>Sacred Heart Children's Hospital
>FSU @ Sacred Heart, Division of Pediatrics
>5153 N. 9th Ave, 6th Floor Nemours Bldg
>Pensacola, FL 32504
>Ph: 850 416 7658(office)
>Ph: 901 219 9202 ( cell)
>Fx: 850 416 7677
>Email: [log in to unmask]
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>> Date: Sun, 12 Feb 2012 13:57:59 -0500
>> From: [log in to unmask]
>> Subject: Re: Hylenex
>> To: [log in to unmask]
>> I have had excellent results with hylenex. More than a few cases where
>an IV could not be started and we were able to use the subcutaneous
>hydration alternative. I can't express how happy those parents were!
>They just wished we had started with it instead.
>> I am by no means an expert as compared to many other institutions but
>from my point of view, it's a nice back up for those tough sticks.
>> Christopher S. Amato,MD FACEP, FAAP
>> Sent from my iPhone
>> On Feb 12, 2012, at 12:39 PM, Dominic Lucia <[log in to unmask]>
>> > Hello all,
>> > I have been informed Hylenex is back on the market with FDA approval
>for use and my institution will be carrying it. Does anyone have
>experience using this with children in the ED for rehydration (and
>presumably difficult IV access) ?
>> > It is something that I am not familiar with and wanted some front
>line feedback on your experiences with it in children. Thanks in advance.
>> > Dominic Lucia M.D.
>> > Medical Director Emergency Medicine
>> > Children's Hospital at Scott and White
>> > office: 254 724-1068
>> > [log in to unmask]
>> > For more information, send mail to [log in to unmask] with
>the message: info PED-EM-L
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>> > http://listserv.brown.edu/ped-em-l.html
>> For more information, send mail to [log in to unmask] with the
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