Intravenous Therapy for the Terminally Ill

How is intravenous therapy used in hospice care? Can UCLAH provide intravenous (IV) antibiotics at home? Is IV hydration therapy effective for terminally ill patients?

When a patient is terminally ill, it can seem cold-hearted, even cruel, to move the patient to a hospital or doctor’s office to receive medical care. But home hospice has become more popular in recent years, allowing terminally ill patients to experience as much as possible of their last days in the comfort of their home, surrounded by family. Not long ago, intravenous therapy for the terminally ill was limited to hospital settings and nursing homes. But with the expansion of home hospice care, medical staff can come to your home and administer IVs to your loved one nearing the end of life; it is not necessary to travel to the physician when one of our concierge physicians can come to you.

There are two main IV therapies that might help hospice patients:

- Antibiotics can help patients who suffer from an infection.
- Hydration and nutrition can extend the life of those who lose the ability or desire to swallow food and drink.

These benefits must be weighed carefully against the downsides that might worsen the patient’s quality of life.

- Applying the IV will cause pain and potentially a small infection at the insertion site.
- The bulky apparatus will make movement difficult. Caring for the patient will become more challenging as well.
- The different treatments can have harmful side effects.

Caregivers and families must take care when considering putting a terminally ill patient on an IV. While such therapies can prolong life, there are some situations where they might cause more distress than relief. The attendant physical ramifications of having an IV needle in one’s arm can hurt patients and diminish their already-low mobility. Decisions to administer an IV must be made on a case-by-case basis, with ample discussion between medical staff, family, and (if possible) the patient.

Unique Care Los Angeles Hospice offers a variety of IV therapies for patients who need them. IV therapies have various pros and cons, and our staff can help you make the right choice.

Intravenous Therapy for the Terminally Ill

Intravenous Antibiotics at Home

The terminally ill often suffer from wounds in their last months of life. This has several causes: the skin becomes weak, dry, and brittle, the body’s immune system ceases to work well, and loss of motion can result in accidental wounds and bedsores. Such wounds for a patient at the end of his life often cannot heal, even when he is receiving top-quality care. With the feebleness of the aged immune systems comes a high probability of infection, not just in wounds, but in illness-affected organs, in the urinary tract, or in the respiratory tract.

Using intravenous antibiotics at home during the end of life is a polarizing topic among some medical practitioners.

- If the patient does not have an obvious infection, the antibiotics may not help her feel better.
- Additionally, antibiotics are known to affect liver and kidney function in the terminally ill.
- Patients undergoing antibiotic treatments in hospitals often develop Clostridioides difficile (C. Diff) infections.

For terminally ill patients who aren’t quite so close to death, however, there are some benefits.

- For patients with an obvious, specific infection, antibiotics can relieve pain and swelling. This is especially true for urinary tract infections.
- IVs can help patients meet end-of-life goals. They are useful to help patients move from hospital to home, or even to allow a patient to attend an event outside the home.

Administering IV antibiotics is a difficult decision that we put a lot of thought into. For certain kinds of infection, an intramuscular (IM) injection of antibiotics might be enough to provide relief, without the bulky IV apparatus. Our medical staff can help you make the right choice for your loved one.

IV Hydration Therapy

During his last days on earth, a terminally ill patient will likely lose any sensation of hunger and thirst. He might also struggle to swallow. These are expected steps in the process of death and are a sure sign that the body is malfunctioning.

Healthy people tend to associate hunger and thirst with discomfort, but hunger and dehydration in a terminally ill person may not be uncomfortable. Research shows that people in the process of death have little or no experience of dehydration; any thirst that occurs can be relieved with a little water to hydrate the lips.

However, hydration can extend the longevity of a patient. As a terminal illness takes over, the patient loses his sense of thirst and will to drink, but hydration can slow their decline. It is also used before transferring a patient between settings. If the patient wishes to live longer and can cope with the discomfort of an IV, then hydration can help him meet his end-of-life goals, such as meeting death at home or staying alive to witness a family event. Nutrients can also be delivered through IV, though starvation is much less likely to be an acute problem than dehydration.

The decision to administer IV hydration therapy is a difficult one. Dying people should not be forced to consume water, either through IV or through the mouth. If the patient wishes to extend his life through hydration, we can help you form a plan to minimize discomfort.

Potential Dangers to IV Antibiotics and Hydration

Applying an IV to a terminally ill patient is not a decision to be made lightly. The primary goal of hospice care is to increase comfort and quality of life for the terminally ill, and IVs do not necessarily align with that goal. Intravenous fluids require bulky tubing and apparatus, which can limit a seriously ill person’s already-low range of motion. The needle may cause pain, bruises, and swelling when inserted; small infections are not uncommon at the injection site.

The family and the patient, if possible, must be made aware of the risks before deciding to apply an IV. Antibiotics can relieve pain and discomfort if there is a clear case of infection, but applying antibiotics unnecessarily can increase the risk of a C. diff infection and impair liver and kidney function. Hydration can extend a patient’s life, allowing him to meet his end-of-life goals. But hydration can also cause electrolyte imbalances or fluid overload, causing nausea and swelling.

If the patient can communicate, then his will must be followed regarding end-of-life care. Should the patient wish for intravenous therapy, the nurses, doctors, and aides at UCLAH will do their best to minimize any discomfort caused by the IV. We will also help the family understand the pros and cons of intravenous therapies. To a healthy person, starvation and dehydration are dreadful, but they are a natural part of the process of death, and a terminally ill person experiences little of the discomfort we associate with hunger and thirst. Above all, we must not worsen the patient’s quality of life during his final days.