Contents:
Background
Subcutaneous hydration (previously known as hypodermoclysis) is a technique used for the subcutaneous administration of large volumes of fluids and electrolytes in order to achieve fluid maintenance or replacement. It is used where administration of parenteral fluids is appropriate and where intravenous access may be difficult to obtain, sustain or is inappropriate.
Dying patients should be allowed and enabled to drink oral fluids where possible and good mouth care is key in the dying phase, whether or not a patient is receiving artificial hydration.
There is a lack of research as to the risks and benefits of artificial hydration at end of life, although trials are ongoing. For this reason, all decisions to start or stop artificial hydration should be patient specific, and involve the MDT and patients and carers where appropriate.
The decision to commence artificial hydration in palliative care is made on an individualised basis, weighing up the potential risks and benefits and ensuring that the goals of treatment have been established with the patient and family and are reviewed regularly.
There may be specific societal, cultural and ethical implications of using subcutaneous fluids. Where this involves complex decision making, the patient and family may benefit from referral to specialist palliative care teams and where necessary, discussion at MDT.
Solutions outlined in this guideline are only licensed for intravenous use therefore their use in this way is in an unlicensed procedure. However, the effective use of infusion fluids in this way has been well documented.
Dying patients should be allowed and enabled to drink oral fluids where possible and good mouth care is key in the dying phase, whether or not a patient is receiving artificial hydration.
There is a lack of research as to the risks and benefits of artificial hydration at end of life, although trials are ongoing. For this reason, all decisions to start or stop artificial hydration should be patient specific and involve the MDT and patients and carers where appropriate.
The decision to commence artificial hydration in palliative care is made on an individualised basis, weighing up the potential risks and benefits and ensuring that the goals of treatment have been established with the patient and family and are reviewed regularly.
There may be specific societal, cultural and ethical implications of using subcutaneous fluids. Where this involves complex decision making, the patient and family may benefit from referral to specialist palliative care teams and where necessary, discussion at MDT.
Solutions outlined in this guideline are only licensed for intravenous use therefore their use in this way is in an unlicensed procedure. However, the effective use of infusion fluids in this way has been well documented.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.