Sub-cut Fluid Referral Form

Author:  Sarah Alton, Head of Medicines Management, STH Community Based Services

Date Published: July 2023

Date to Review: July 2024

Description:  Request for Subcutaneous Administration of Sodium Chloride 0.9%

Complete the Authorisation and Administration Record form when requesting Infusion Set, Butterfly Needles and Tegaderm IV dressings to be supplied by the Wicker Pharmacy (along with a prescription for sodium chloride infusion fluid) for patients in a community setting in need of fluid replacement and so avoid an unnecessary hospital admission.  The District Nursing team will supply the drip stand.