Parenteral fluid administration beneath the fascia lata

Abstract

T HE importance of meeting adequate fluid and electrolyte requirements in the sick surgica1 patient cannot be stressed too strongIy. A marked decrease in morbidity and mortality has been evident in those patients whose requirements are competentIy and carefully suppIied day by day. This replacement of tIuids assumes its greatest consequence in the patient unable to take Auids by mouth. The giving of fluids and eIectroIytes by parentera means has been empIoyed for many years. OriginaIIy, they were given for the most part by proctoclysis. However, this method has faIIen into disrepute to some extent in Iate years for several reasons. Among these may be mentioned first, technical diffIcuIties in administration; second, inability of many patients to retain fluids rectaIIy; third, variations in absorption among different patients; and fourth, doubtfu1 accuracy as to the exact Auid intake. Thus, the utilization by the surgeon of more precise methods, such as intravenous and subcutaneous infusions, has Iargely supplanted rectaJ fluid administration. RecentIy, Tocantins’ has described a method of infusion into the sterna1 bone marrow and has devised a needle for administration. This shows great promise as an adjunct in regulating parentera fluid intake. Infusions by the intravenous and subcutaneous routes, however, are still the methods of choice of most surgeons at the present time. Unquestionably, hypertonic soIutions and whole bJood, where indicated, shouId be given by the intravenous route. However, there is a widespread difference of opinion as to the relative merits of hypodermoclvses and of intravenous infusions in giving isotonic or near isotonic fluids. Probably the greatest source of dispute between the adherents of the two methods rests on the safety factor of the hypodermoclysis as compared to the ease of administration and Iack of pain of the venoclysis. That there is definite harm in indiscri second, overburdening of the circulator) svstem bv rapid increase in blood volume; third, thrombosis and concomitant embolus formation at the site of injection; fourth, the danger of dehydration because of the use of hypertonic soIutions; an d fifth, the production of general edema. Hc has discontinued the use of continuous intravenous infusions because of the danger of local venous thrombosis and embolism and reports one fataIity following excessive quantity of fluid by vein to an anemic patient with damaged heart muscle. Clark” stress& the dangers of acute cardiac dilatation. Hirshfeld, Hyman and Wanger” calI attention to the possibilit)of so-caIIed “speed shock” when venocIj-sis is given too rapid1.v. Further dangers and fataJities have been reported by Orator