Review of References: Subcutaneous rehydration
Holly Leveille
Ferris State University

Credible sources are important sources to use when conducting research. Different types of
research can be conducted such as quantitative or qualitative research. Many times when a nurse
conducts research, they need to look at where the article is from, who wrote the article,
determine if it is a nursing journal, and try to figure out how it may impact the nursing field.
When in Nursing 324, subcutaneous fluid therapy was researched by the author. This paper
addresses the authors reflection of the sources she used to write her paper.
Keywords: subcutaneous fluid therapy, reflection paper, credible source
Review of References: Subcutaneous rehydration
Administering medications, performing interventions, and completing various other
orders (or intervention) that physicians request, must all be done for a reason. “Questions to ask
include these: Am I performing this intervention….because someone told me to or maybe even
because this is the intervention that has always been used?” (Nieswiadomy, 2012, pp. 2). Many
times the intervention that is selected is based on research. When a study is completed, the
results are then published in a journal.
Nurses typically read about previous research studies when then they access a journal.
Choosing a journal source to conduct your research or to guide your practice can be
overwhelming. First the nurse must determine if the journal comes from a credible source.
Authors can publish their articles in refereed journals or nonrefereed journals. According to
Niewsiadomy (2012), “a referred journal is one in which subjects experts, chosen by the
journal’s editorial staff, evaluate manuscripts” while a “nonrefereed journal uses editorial staff
members or consultants to review manuscripts” (pp. 265). Most often an author’s work is
reviewed by their professional colleagues who are experts at what they do. This type of review
is called a peer review and most nursing journals use this type of review.
When an author conducts a study they are often conducting either a quantitative or a
qualitative study. A quantitative study is a study that contains no controls and tests a hypothesis.
According to Niewsiadomy (2012) there are 19 steps in the quantitative study approach however
they can be condensed down into fewer steps by the researchers. Quantitative studies have a
very organized approach. The steps of a quantitative study consist of identifying the problem,
determining the purpose of the study, formulating the research question, reviewing the literature,
developing framework, identifying the study assumptions, acknowledging the limitations of the
study, formulating the hypothesis, defining the study terms, selecting the research design,
identifying the population, selecting the sample, conducting a pilot study, collecting the data,
organizing the data for analysis, analyzing the data, interpret the findings, communicating the
findings, and utilizing the findings (pp. 33). “A qualitative research study takes into
consideration a patients feelings or how the individual is doing vs. in quantitative research the
focus is on the group or population of interest” (Nieswiadomy, 2012, pp. 45). The steps in a
qualitative research study include identifying a problem, stating a purpose, selecting a research
design, reviewing literature, selecting the sample, gain entry to the research site, protecting the
rights of the participants, collecting data, analyzing data, interpreting data, communicating the
study results, and utilizing the study results (Nieswiadomy, 2012, pp. 47-52). There are times in
which both qualitative and quantitative research methods maybe used.
Article One
The authors, all licensed as medical doctors or doctors of osteopathic medicine, created a
clinical trial to test their hypothesis that using the product recombinant human hyaluronidase
would facilitate subcutaneous rehydration in children ages 2 months to 10 years of age. They
formed a study called Increased Flow Utilizing Subcutaneously-Enabled (INFUSE)-Pediatric
Rehydration Study to test the safety and efficacy of this product. The article is from a credible
source because Pediatrics is an official peer-reviewed journal of the American Academy of
Pediatrics. Pediatrics however is not a nursing journal.
The study conducted was a qualitative study because the study was conducted on
individuals and the outcomes of the patients were monitored. The patient’s rights had to be
protected and only certain patients were allowed to even participate in the study. Nurses were
trained in the technique of the subcutaneous (SC) catheter placement and fluid administration. It
was determined that it was easier for a nurse to place the SC catheter than to try and place an
intravenous (IV) catheter on a child who has mild-moderate dehydration.
The used of SC fluid administration is not widely used around Michigan yet. It is
important for nurses to be aware of the upcoming medical advances that will be coming out in
the future. This study helps show that nurses were able to efficiently place the catheter quickly
and start administering fluids without traumatizing the pediatric patient or their family member.
Using the SC fluid administration technique from this article could be considered borrow
knowledge because the nurses were assisting with the physicians in this study.
Article Two
The Journal of Emergency Nursing is a journal that is an official peer reviewed journal
by the Emergency Nurses Association (ENA). This makes the article number two a credible
source and a nursing journal.
The author of the study, Kuensting, is a Pediatric Nurse Practitioner and Clinical Nurse
Specialist at a children’s hospital. In this study her goal was to compare the start times of initial
subcutaneous (SC) and intravenous (IV) fluids in addition to evaluating the number of needle
sticks a child undergoes for each procedure. This study used a retrospective descriptive design
that looked back at data on 39 children from 2008 to 2010.
The data concluded that there was 100% success rate on first time SC needle placement
and use of hyaluronidate versus IV placement. The data also found that the SC group had a
mean time of 21 min from order to start time of the infusion whereas the mean time for the IV
start time was 97 minutes. This study also shows that SC needle placement can be done
effectively and quickly. As previously stated, Michigan is not using SC fluid replacement
Article Three
Pediatric Emergency Care is a magazine that is published by Lippincott Williams &
Wilkins but is peer-reviewed by many different doctors. Their targeted audience is pediatricians
and emergency physicians who treat children and adolescents. Pediatric Emergency Care is a
credible source however not a nursing journal.
The type of research conducted was a quantitative study that looked at previous data.
This author, Spandorfer, is a medical doctor that has decided to look at many different factors
involving the technique of subcutaneous (SC) rehydration therapy (SCRT) which was developed
back in 1913. He wrote about what needed to change, the mechanism of action, safety,
advantages, costs, limitations, and recommendations.
The conclusions to this study could provide significant benefits to the nursing profession
in the future. Spandorfer concluded that one should take into consideration the amount of time it
takes for proper placement of the catheter and the amount of people required for each procedure.
Because of this, it was determined that it costs more to place an IV then to seek SCRT in
children. Spandorfer did identify the limitations though which include not being able to
administer medications or drawing blood from the SC catheter. This knowledge was borrowed
knowledge because it was not from a nursing journal and was written by a doctor.
All the articles that were used for the Nursing 324 paper were from quality sources and
were credible. Although only one journal article was from a nurse, they were still all very
helpful in guiding practice. The other two articles were written by physicians, which also makes
them credible. When it comes to administering fluids to pediatric patients, physicians are the
ones who provide the orders for the patients. Nurses are not able to make any practice decisions
when it comes to the topic of subcutaneous fluid therapy. Michigan does not use SC fluid
rehydration technique; therefore, our small hospital in West Michigan is not willing to try it,
until our local children’s hospital starts it.
It is important for a nurse to use credible sources and nursing research because nurses
need to help their profession stand out and not rely on other professions for an identity. Nurses
need to make sure they are staying up to date on current trends in their focus of study.

Allen, C., Etzwiler, L., Miller, M., Maher, G., Mace, S., Hostetler, M., & ... Harb, G. (2009).
Recombinant human hyaluronidase-enabled subcutaneous pediatric rehydration.
Pediatrics, 124(5), e858-67. doi: 10.1542/peds.2008-3588
Kuensting, L. L. (2013). Comparing Subcutaneous Fluid Infusion with Intravenous Fluid
Infusion in Children. JEN: Journal Of Emergency Nursing, 39(1), 86-91. doi:http://0-
Nieswiadomy, R. (2012). Foundations of Nursing Research (6th ed.). Upper Saddle River, NJ:
Pearson Education, Inc.
Spandorfer, P. (2011). Subcutaneous rehydration: updating a traditional technique.
Pediatric Emergency Care, 27(3), 230-236. doi:http://0-