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i understand Joe but given the lower risk with clysis, less patient distress and the advantage of the fluid being absorbed vs vomited or not absorbed, i think clysis with Hylenex is a better option. if that fails then ng is the next best option.


Marty, (Dad, Brother, etc.)
Martin Herman , M.D.
1527 Columbine Dr
Tupelo Ms 38801
901 219 9202
Sent from my iPhone


On Jun 10, 2017, at 11:39 AM, Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Martin

Disagree re your concerns.

Yes all of the risks you mentioned are plausible but exceedingly rare.

Please look at the myriad of studies - especially from Australia attesting to safety and success.



Sent from my iPhone

On Jun 10, 2017, at 12:15 PM, Martin Herman <[log in to unmask]<mailto:[log in to unmask]>> wrote:

we used it in Pensacola at the Sacred Heart Children's Hospital ED.
very helpful for moderate dehydration cases, when po and IV failed. by failed I mean the team couldn't establish IV access in 2 attempts

someone mentioned NG, which has a role, but also is more risky in an uncooperative child. choking, vagal syncope, tracheal intubations and esophageal injuries are attendant risks, not seen with clysis.





Marty, (Dad, Brother, etc.)
Martin Herman , M.D.
1527 Columbine Dr
Tupelo Ms 38801
901 219 9202
Sent from my iPhone


On Jun 10, 2017, at 6:58 AM, PED-EM-L automatic digest system <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

There are 4 messages totaling 10948 lines in this issue.

Topics in this special issue:

1. Clysis (3)
2. Fwd: Clysis

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----------------------------------------------------------------------

Date:    Sat, 10 Jun 2017 01:29:27 +0000
From:    "Kilian, Karen" <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
Subject: Re: Clysis

We are doing NG fluids in the ED on occasion, not Urgent Care (we don't have the pumps needed).  Clysis would seem to be a very good idea for the UC environment when starting IV's may not be performed as often, so skills aren't as great as in the ED.  I do like the "2 strikes and you're out" idea on a previous email---given, again; one doesn't need lab work and *simply* needs fluids.   Articles I read about clysis stated the clysis fluids would help with hydration leading to a subsequent IV start being much easier.

Karen

-----Original Message-----
From: Joe Nemeth, Dr [mailto:[log in to unmask]]
Sent: Friday, June 09, 2017 5:40 PM
To: Kilian, Karen
Cc: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>
Subject: Re: Clysis

I have never seen it not heard of it being used in the ED ( have worked at 2 of the busiest PEDs in Canada).



Personally, the NG literature especially from the Aussies is quite convincing in this context and would think it be more ideal and physiologic than clysis if iv access was an issue.





Joe Nemeth MD

Toronto Hospital for Sick Children

Montréal Children's Hospital



Sent from my iPhone



On Jun 9, 2017, at 8:08 PM, Kilian, Karen <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:



I tried to get this enacted at my facility in situations in which IV access was difficult and/or the pt *simply* needed IVF (no labs beyond glucose).   However, despite me thinking it would be GREAT to use in urgent care and/or the ED.....seemed other's weren't so keen on it.    Those who have enacted this procedure---what made folks buy into it?



Karen Kilian, ARNP

Seattle Children's



-----Original Message-----

From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Brian Sanders

Sent: Friday, June 09, 2017 4:20 PM

To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>

Subject: Re: Clysis



We have similar volume in community hospital and similar protocol. Parents love it.



Brian Sanders, MD

Medical Director

Pediatric Emergency Medicine

Lowell General Hospital



On Jun 9, 2017, at 6:04 PM, Carla Laos <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:



We just started using  hylenex , context is that we are a small community Peds ED, Level 4, 16.5k kids/year. Single physician coverage, APC coverage 8-10hrs.



We utilize hylenex for moderate dehydration, explain to parents we will attempt IV x2, and if unsuccessful will move to SQ. Parents receptive and love it.



It works because we are small and can't support a PICC team ($$), are housed in an adult hospital so Peds Anesthesia not in house 24-7, and during RSV/Flu season it's not ideal to have NICU nurses help us (but in off season they do help us with difficult access cases).



Let me know if you want me to send policy.

Carla



...cml...

Sent from my iPhone



On Jun 9, 2017, at 16:18, Van der Jagt, Elise <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:



Hi, Sergey,



You might want to contact Dr. Sharon Mace at the Cleveland Clinic. She is a friend of mine in pediatric emergency medicine and first introduced me again to the concept (I was familiar with it since it had been used in the 1950s and 60s, as well as in veterinary medicine).  I believe she was involved in the clinical trials of Hylenex (hyaluronidase) which is used under the skin before the IV catheter is inserted.  She was using it at the time, probably about 10 years ago and was very impressed with it. She used to be here in Rochester, then in Syracuse and then went out to the Cleveland Clinics.  She is wonderful to work with and please give her my regards. I am also glad to contact her and give you an introduction, if that would work better.



I personally have used clysis on one of our cats once when she couldn’t drink, and it worked well, was easy and kept the cat hydrated for at least 24-36 hours.



Elise



Elise W. van der Jagt, MD, MPH, FAAP, FCP, SFHM, Professor of

Pediatrics and Critical Care Chief, Pediatric Hospital Medicine

University of Rochester Medical Center

601 Elmwood Ave., Box 667

Rochester, NY 14642



Tele:  585-275-8138/585-276-4113

Fax:   585-276-1128

Golisano Children's Hospital





-----Original Message-----

From: Pediatric Emergency Medicine Discussion List

[mailto:[log in to unmask]] On Behalf Of Sergey Kunkov

Sent: Friday, June 09, 2017 10:31 AM

To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>

Subject: Clysis



Dear colleagues,



I wanted  to ask you about clysis: I know there was a discussion a few years back about its use , but does anyone is using it on a routine basis or , better yet, incorporated it in some kind of a protocol for difficult IV access?



Thank you very much



Sergey Kunkov

Stony Brook



For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:



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For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:

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------------------------------

Date:    Sat, 10 Jun 2017 00:40:17 +0000
From:    "Joe Nemeth, Dr" <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
Subject: Re: Clysis

I have never seen it not heard of it being used in the ED ( have worked at 2 of the busiest PEDs in Canada).

Personally, the NG literature especially from the Aussies is quite convincing in this context and would think it be more ideal and physiologic than clysis if iv access was an issue.


Joe Nemeth MD
Toronto Hospital for Sick Children
Montréal Children's Hospital

Sent from my iPhone

On Jun 9, 2017, at 8:08 PM, Kilian, Karen <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

I tried to get this enacted at my facility in situations in which IV access was difficult and/or the pt *simply* needed IVF (no labs beyond glucose).   However, despite me thinking it would be GREAT to use in urgent care and/or the ED.....seemed other's weren't so keen on it.    Those who have enacted this procedure---what made folks buy into it?

Karen Kilian, ARNP
Seattle Children's

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Brian Sanders
Sent: Friday, June 09, 2017 4:20 PM
To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>
Subject: Re: Clysis

We have similar volume in community hospital and similar protocol. Parents love it.

Brian Sanders, MD
Medical Director
Pediatric Emergency Medicine
Lowell General Hospital

On Jun 9, 2017, at 6:04 PM, Carla Laos <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

We just started using  hylenex , context is that we are a small community Peds ED, Level 4, 16.5k kids/year. Single physician coverage, APC coverage 8-10hrs.

We utilize hylenex for moderate dehydration, explain to parents we will attempt IV x2, and if unsuccessful will move to SQ. Parents receptive and love it.

It works because we are small and can't support a PICC team ($$), are housed in an adult hospital so Peds Anesthesia not in house 24-7, and during RSV/Flu season it's not ideal to have NICU nurses help us (but in off season they do help us with difficult access cases).

Let me know if you want me to send policy.
Carla

...cml...
Sent from my iPhone

On Jun 9, 2017, at 16:18, Van der Jagt, Elise <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

Hi, Sergey,

You might want to contact Dr. Sharon Mace at the Cleveland Clinic. She is a friend of mine in pediatric emergency medicine and first introduced me again to the concept (I was familiar with it since it had been used in the 1950s and 60s, as well as in veterinary medicine).  I believe she was involved in the clinical trials of Hylenex (hyaluronidase) which is used under the skin before the IV catheter is inserted.  She was using it at the time, probably about 10 years ago and was very impressed with it. She used to be here in Rochester, then in Syracuse and then went out to the Cleveland Clinics.  She is wonderful to work with and please give her my regards. I am also glad to contact her and give you an introduction, if that would work better.

I personally have used clysis on one of our cats once when she couldn’t drink, and it worked well, was easy and kept the cat hydrated for at least 24-36 hours.

Elise

Elise W. van der Jagt, MD, MPH, FAAP, FCP, SFHM, Professor of
Pediatrics and Critical Care Chief, Pediatric Hospital Medicine
University of Rochester Medical Center
601 Elmwood Ave., Box 667
Rochester, NY 14642

Tele:  585-275-8138/585-276-4113
Fax:   585-276-1128
Golisano Children's Hospital


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Sergey Kunkov
Sent: Friday, June 09, 2017 10:31 AM
To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>
Subject: Clysis

Dear colleagues,

I wanted  to ask you about clysis: I know there was a discussion a few years back about its use , but does anyone is using it on a routine basis or , better yet, incorporated it in some kind of a protocol for difficult IV access?

Thank you very much

Sergey Kunkov
Stony Brook

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:

https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.ed
u_ped-2Dem-2Dl.html&d=DQIBaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLU
QRxhA&r=U8mD137vcSlcKJYPnZ2lgpiN1pKg9W8j4g606YTHprDbGeReCmYTGhJOFWn9r
qv-&m=8rqhcQ3wiNOdA5YfBNTUIAb2htW_BoRTpOsYYDfO1QI&s=3B1pR9Z5pIdAu433u
-Tj_BCSMhiKDdTrAT_7pV8h2Rg&e=

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with
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For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
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------------------------------

Date:    Sat, 10 Jun 2017 06:32:24 -0400
From:    Michael Falk <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
Subject: Re: Clysis

While I am familiar with the idea of it, I have to agree with Joe…NG/OG rehydration is easy and safe.  I am really not sure why you would do this procedure over those options?  The reviews I have seen say that OG is quicker, faster and fewer side effects than IV.
Mike Falk
NY, NY.

On Jun 9, 2017, at 8:40 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

I have never seen it not heard of it being used in the ED ( have worked at 2 of the busiest PEDs in Canada).

Personally, the NG literature especially from the Aussies is quite convincing in this context and would think it be more ideal and physiologic than clysis if iv access was an issue.


Joe Nemeth MD
Toronto Hospital for Sick Children
Montréal Children's Hospital

Sent from my iPhone

On Jun 9, 2017, at 8:08 PM, Kilian, Karen <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

I tried to get this enacted at my facility in situations in which IV access was difficult and/or the pt *simply* needed IVF (no labs beyond glucose).   However, despite me thinking it would be GREAT to use in urgent care and/or the ED.....seemed other's weren't so keen on it.    Those who have enacted this procedure---what made folks buy into it?

Karen Kilian, ARNP
Seattle Children's

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Brian Sanders
Sent: Friday, June 09, 2017 4:20 PM
To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>
Subject: Re: Clysis

We have similar volume in community hospital and similar protocol. Parents love it.

Brian Sanders, MD
Medical Director
Pediatric Emergency Medicine
Lowell General Hospital

On Jun 9, 2017, at 6:04 PM, Carla Laos <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

We just started using  hylenex , context is that we are a small community Peds ED, Level 4, 16.5k kids/year. Single physician coverage, APC coverage 8-10hrs.

We utilize hylenex for moderate dehydration, explain to parents we will attempt IV x2, and if unsuccessful will move to SQ. Parents receptive and love it.

It works because we are small and can't support a PICC team ($$), are housed in an adult hospital so Peds Anesthesia not in house 24-7, and during RSV/Flu season it's not ideal to have NICU nurses help us (but in off season they do help us with difficult access cases).

Let me know if you want me to send policy.
Carla

...cml...
Sent from my iPhone

On Jun 9, 2017, at 16:18, Van der Jagt, Elise <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:

Hi, Sergey,

You might want to contact Dr. Sharon Mace at the Cleveland Clinic. She is a friend of mine in pediatric emergency medicine and first introduced me again to the concept (I was familiar with it since it had been used in the 1950s and 60s, as well as in veterinary medicine).  I believe she was involved in the clinical trials of Hylenex (hyaluronidase) which is used under the skin before the IV catheter is inserted.  She was using it at the time, probably about 10 years ago and was very impressed with it. She used to be here in Rochester, then in Syracuse and then went out to the Cleveland Clinics.  She is wonderful to work with and please give her my regards. I am also glad to contact her and give you an introduction, if that would work better.

I personally have used clysis on one of our cats once when she couldn’t drink, and it worked well, was easy and kept the cat hydrated for at least 24-36 hours.

Elise

Elise W. van der Jagt, MD, MPH, FAAP, FCP, SFHM, Professor of
Pediatrics and Critical Care Chief, Pediatric Hospital Medicine
University of Rochester Medical Center
601 Elmwood Ave., Box 667
Rochester, NY 14642

Tele:  585-275-8138/585-276-4113
Fax:   585-276-1128
Golisano Children's Hospital


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Sergey Kunkov
Sent: Friday, June 09, 2017 10:31 AM
To: [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>
Subject: Clysis

Dear colleagues,

I wanted  to ask you about clysis: I know there was a discussion a few years back about its use , but does anyone is using it on a routine basis or , better yet, incorporated it in some kind of a protocol for difficult IV access?

Thank you very much

Sergey Kunkov
Stony Brook

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:

https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.ed
u_ped-2Dem-2Dl.html&d=DQIBaQ&c=4sF48jRmVAe_CH-k9mXYXEGfSnM3bY53YSKuLU
QRxhA&r=U8mD137vcSlcKJYPnZ2lgpiN1pKg9W8j4g606YTHprDbGeReCmYTGhJOFWn9r
qv-&m=8rqhcQ3wiNOdA5YfBNTUIAb2htW_BoRTpOsYYDfO1QI&s=3B1pR9Z5pIdAu433u
-Tj_BCSMhiKDdTrAT_7pV8h2Rg&e=

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with
the message: info PED-EM-L The URL for the PED-EM-L Web Page is:

https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.ed
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------------------------------

Date:    Sat, 10 Jun 2017 04:55:07 -0700
From:    David Nelson <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
Subject: Fwd: Clysis



This study in Peds in 2009 showed promising results…


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------------------------------

End of PED-EM-L Digest - 9 Jun 2017 to 10 Jun 2017 - Special issue (#2017-110)
******************************************************************************

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