Does hospice give iv fluids at home?

Can hospice give IV fluids at home? Does hospice give IV fluids at home? How do patients benefit? What are the pros and cons of intravenous treatments?

Can Hospice Give IV Fluids at Home? 

As a person approaches the end of her life, she may exhibit little interest in food and drink. Swallowing might become impossible, and the patient may not be able to digest anything at all. Many people ask us, “can hospice give IV fluids at home?” The short answer is yes. But does hospice give IV fluids at home—that is a more complicated question. They have some uses in hospice, but they are intrusive and uncomfortable, and lessening a patient’s comfort is not what hospice is about.

Despite many scientific studies of intravenous hydration in hospice care and the experiences and expertise of many thousands of medical professionals, there are no clear guidelines for when to administer IVs to dying patients. Each case is unique and must be considered by the hospice team, the family, and the patient herself, if possible, as it comes up. Thousands of families have agonized over the decision to apply IV therapies to their ailing loved ones.

Many are confused about the benefits and drawbacks of IV therapy. It is not as beneficial as many think, but there are some circumstances in which giving fluids intravenously can be helpful. Read on to learn more about the use of artificial hydration in hospice, and learn a bit about why it is a complicated issue.

Pros of IV Fluids

Does hospice give IV fluids at home? Not to every patient, no, but for certain specific conditions, intravenous hydration can help reduce a person’s discomfort.

• Severe vomiting and diarrhea often cause serious, potentially deadly dehydration. Fluids can sustain the patient through those difficult symptoms.
• Severe dysphagia—swallowing difficulties—when the patient is otherwise expected to live for some time can be addressed with an IV.
• Hypercalcemia, an excess of calcium in the blood, can prematurely end the patient’s life. Saline is a part of treating this deadly condition.
• Involuntarily twitching muscles can typically be calmed with fluids.
• For patients with severe dementia, an IV provides a means of quickly administering sedation.
• Some studies suggest that rates of nighttime delirium are less in patients who receive intravenous fluids.
• With a line set up, it becomes easy to administer IV antibiotics to treat infection. This is particularly useful if the patient struggles with swallowing medications.
• Electrolyte imbalances, causing cramps, confusion, and a variety of other unpleasant symptoms, can be addressed with fluids. But great care must be taken, as improper administration can actually worsen the imbalance.

For these specific conditions, an IV can help relieve great discomfort, and many patients over the years have benefited from artificial hydration. But now we must turn to the cons, and family and the hospice team must carefully consider these for every patient, even those who suffer from one of the problems listed above.

Cons of IV Fluids

It is common for a dying person to completely lose interest in food and drink. This can be greatly distressing for the family caregivers: we all have deeply embedded instincts to care for our ill loved ones, and the commonest way to show this care is to provide food and drink.

For this reason, many family members struggle to accept that providing fluid and nutrition through an IV may not be good for a dying patient. They want to care for the patient, but giving intravenous therapy to a dying person is not like giving chicken soup to someone with a cold: it is painful and uncomfortable and will not alleviate any sensations of hunger or thirst.

But most dying people experience absolutely no sense of hunger or dehydration. This is a natural consequence of the dying process. Naturally, some families want to provide IV hydration therapy anyway, thinking this will extend the patient’s life. Unfortunately, this is not the case. By the time the patient has lost her sense of thirst and hunger, artificial hydration will not extend her life or improve her remaining time. Indeed, it will likely damage her quality of life unless she is suffering from one of the problems mentioned above, where intravenous therapy can help.

Here are just a few of the concerns that medical staff will consider before administering an IV:

• Installing it involves poking the patient with a large needle, causing discomfort and pain at the injection site. Small infections and cellulitis are not uncommon.
• Once it is installed, it will almost certainly not be removed until death. Saddling the patient with bulky apparatus will inhibit her already limited range of motion. A delirious patient might unwittingly cause harm to herself by tugging at the line.
• Even if the patient has some experience of thirst, IV fluids won’t alleviate those symptoms. Nor will it provide nutrition. Mouth dryness must be treated by other means.
• The excess of fluids will cause frequent urination, necessitating difficult trips to the bathroom or frequent bedding changes for incontinent patients.
• Fluid overload can occur, causing high blood pressure, edema (swelling), and shortness of breath.
• If not monitored very carefully, electrolyte imbalances can occur, causing cramps, confusion, and other symptoms.

Remember, the goal of hospice care is to maximize the patient’s comfort. Administering an IV does not necessarily align with that goal, and they can be downright unpleasant, so we recommend avoiding them unless it’s for a specific treatment.

Reasons to Not Give an IV

Family members naturally worry that their dying loved one is suffering from thirst or hunger, but people at the end of life rarely experience hunger and thirst. Dehydration can even reduce uncomfortable symptoms:

• Less mucus production and fewer lung secretions means a reduction in congestion and cough. These symptoms are especially a concern for patients with lung cancer and other respiratory conditions.
• Edemas will gradually lose their swelling, reducing pain and discomfort.
• The digestive tract will be more settled, diminishing feelings of nausea.
• The patient will need to urinate less, reducing difficult trips to the bathroom and lessening the need to place an uncomfortable Foley catheter in the person.

Family members who worry about the patient’s dehydration should consider other, less invasive means of relieving symptoms. Certain medications, and even advanced age alone, can cause dry mouth, and this will not be relieved through artificial hydration. Instead, family members should look for other ways to help.

If the patient can still swallow, provide her with as much food and drink as she wants. Ice chips are good at relieving dry mouth. (A hospice speech therapist can find the best way for the patient to eat and drink.) Lip balms and petroleum jelly can keep the lips moist, and if the patient can no longer swallow, a soft toothbrush with a small amount of water on it can keep the gums and tongue moist. And as always, offer the patient every other form of support and care: rub sore muscles, perform skin care, and provide ample social interaction and emotional care.

Summary

Can hospice give IV fluids at home? Yes, but it should be deployed only when it can help with specific problems that are painful to the patient. It is not a standard part of hospice care, and intravenous therapies will only cause more issues for most patients rather than provide relief.

Each patient is different, and it takes dedicated and knowledgeable hospice staff to know when someone might benefit from intravenous therapy. UCLAH’s physicians and nurses have often provided IVs at home hospices, and we have developed considerable expertise in knowing when it’ll be best for the patient, and when to avoid it. With us, families are assured that their ailing loved ones can spend their final days in peace and comfort.