Hyaluronidase for localised infusion site reaction during continuous subcutaneous infusion

Local skin site reactions may occur at continuous subcutaneous infusion (CSCI) sites. Factors that contribute these reactions include the concentration of medications, the pH of the solution, type and duration of cannula insertion and site selection. The case of a patient with advanced metastatic cholangiocarcinoma is described. Medications were delivered subcutaneously via a syringe driver and multiple infusion site reactions occurred. Hyaluronidase temporarily depolymerises hyaluronic acid in connective tissue and been has been shown to increase the dispersion and absorption of coadministered molecules. A single dose of 150 IU hyaluronidase was injected into the subcutaneous site prior to commencement of the syringe driver. Subsequent skin site erythema and tenderness was observed. Hyaluronidase may be indicated for use as an adjunct to increase the absorption and dispersion of injected drugs as well as for subcutaneous fluid rehydration. There is, however. limited evidence to indicate its use in skin site reactions and it may contribute to poor tolerance of a CSCI. To the author's knowledge, this is the first case report of the use of hyaluronidase in the management of infusion site skin reactions.