Hydration is another issue that comes up a lot in hospice. Many families want to make certain that hydration or IV fluids will be part of the treatment plan. There are two schools of thought on this issue. Many physicians believe that hydration is important at the end of life as a comfort measure. Other physicians believe that dehydration is the body’s natural process at the end stage of dying and actually helps to numb the body and function as a natural pain reliever.

I have participated in the care of patients who have been hydrated and cared for many patients who were not. I did not observe the dying process to be any more uncomfortable for those patients who were not hydrated. It was my observation, however, that some of the hydrated patients had more difficulties in certain situations.

The principle is the same for hydration as it is for tube feeding. If the organs are shutting down and the kidneys are putting out fewer fluids, then to keep putting more fluids in is going to cause problems. Many of these patients are unable to process the extra fluid and may develop edema (swelling in the arms and or legs). In patients with congestive heart failure (CHF), the heart is often overworked, and the extra fluids end up in the lungs, making it more difficult to breathe.

The same problem often occurs with patients that have lung diseases such as lung cancer and COPD. Often fluid buildup is common for these patients and difficulty breathing is an issue as well. Patients with diseases such as these do no usually tolerate additional fluids very well.

This does not mean that these interventions may not be beneficial, to a degree, for some patients in the early stages of the dying process. At the very end of life, however, new problems tend to develop as a result of administering excessive IV fluids.

For families that insist on IV hydration, one of my favorite methods was to get orders to administer the fluids subcutaneously rather than intravenously.  First of all, this is a much safer method of administration in the home setting. Secondly, when fluids are being administered subcutaneously the patient is not hooked up to a pump and the usual method is to use a device called a dial-a-flow to set the rate of administration. The body will allow the fluids to be administered to the degree they are needed. If a patient is really dehydrated then the fluids will flow with no problem. If the body is in fact not dehydrated, then the fluids will not go in. This has the effect of making the family comfortable knowing that the patient is not dehydrated while at the same time not allowing excessive fluid buildup.

I would suggest it is not wise to insist on interventions that are determined to not be necessary by medical professionals. Nurses can assess for dehydration and even if dehydration is present, it may not necessarily mean that something must be done about it if it is not causing the patient any distress.

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