United States patients receive subcutaneous fluids less frequently than intravenous fluids when compared to Canadian patients

1. Canadian patients receive subcutaneous administration of medications and/or fluids more frequently than patients from the United States.

2. Length of stay in the acute palliative care unit was reduced in the US site, compared to the Canadian site.

Evidence Rating Level: 2 (Good)

Study Rundown: Though there are many benefits to using subcutaneous (SC) fluid administration, it is an underused option in the United States (US). This study compared the frequency of SC fluid and medication administration utilization in two different sites (one Canadian, one US). The primary outcome of this study was the frequency of SC use in these locations. Secondary outcomes included any associations between identified patient characteristics and the use of SC fluids. This study found that for the 200 patients from Canada, the majority received SC only (106 patients). 9 received IV only, and 76 received both SC and IV. For the 197 patients in the US, the majority received IV-only medications and fluids, and 1 received both. Limitations to this study include that two locations were used which may affect the generalizability of the results. Overall, the results from this study confirm that for at least these two locations, Canadian patients receive SC fluids at a higher frequency than patients from the US and that there is a requirement for further investigation into the use and role of SC fluids and medications in the US.

Click to read the study in JAMA Oncology

Relevant Reading: Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews.

In-Depth [retrospective cohort]: This retrospective, cross-sectional study based in Canada and the US enrolled 398 patients. Of the 200 patients from Canada, 55.5% received SC only, 4.7% received IV only, and 39.8% received both options. In the USA, no patients received SC only, 99.5% of patients received IV only, and only 0.5% received both options. Length of stay in the acute palliative care unit (APCU), one of the characteristics examined as part of the secondary outcomes, was reduced in the US site as compared to the Canadian site. The reasons for such are unclear and would require further exploration in future studies to fully explain.

Image: PD

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