Q Should medications be given subcutaneously during targeted temperature management at 33°C?

A Michelle E. Deckard, rn, msn, acns-bc, ccrn-cmc, replies:

The neuroprotective effects of targeted temperature management (TTM) after cardiac arrest are well known, but how hypothermia affects the distribution and metabolism of medications is only beginning to be understood. Most of these studies have focused on those medications that are given intravascularly. Few studies have been reported that specifically address hypothermic patients and the subcutaneous administration route, although other studies can help guide decision making on whether to use the subcutaneous route to administer medications.

From a simple physiological view, hypothermia causes vasoconstriction, a great defense mechanism to protect the vital organs by shunting blood away from nonessential areas. The resulting decrease in blood circulation to the subcutaneous tissue hampers the ability of medications administered subcutaneously to be absorbed. But what does the evidence...

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