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What is artificial hydration and nutrition?

If a patient isn’t able to swallow because of a medical problem, they can be given fluids and nutrition in ways other than by mouth. This is referred to as artificial hydration and nutrition. This is sometimes done when someone is recovering from a temporary problem, such as when fluids have been lost through vomiting, sweating, or diarrhea. It may also be done when someone has an advanced, life-threatening illness and is dying.

Why do our bodies need fluid and nutrition?

Our bodies are made mostly of water. Almost 60% of our body weight comes from water. In order to be healthy, the body needs water just as it needs food. We lose water every day in 2 ways: by going to the bathroom (about 1350 ml (45 ounces a day) and by sweating and breathing (at least 630 ml (21 ounces) a day).

Our bodies get nutrients from the food we eat. These nutrients give us energy and help our bodies work properly.

We have to eat food and drink fluids every day to get the amount of water and nutrients our bodies need.

What are the different ways to provide artificial hydration and nutrition?

There are 2 ways to replace fluids in someone who needs them. The first way is to put the fluid right into a vein. This is called intravenous (IV) fluid replacement. The other way is to put the fluid under the skin. This is called hypodermoclysis, or subcutaneous fluid replacement.

Another method of artificial nutrition and hydration is through a plastic tube called a nasogastric tube (also called an NG tube). This tube is put through the nose, down the throat and into the stomach. It can only be left in for a short time, usually 1 to 4 weeks. If the tube has to be in for longer than 4 weeks, a different kind of feeding tube may be used. It’s placed into the wall of the stomach (also called a PEG tube or g-tube).

With IV fluid replacement and feeding tubes, healthcare providers need to watch the person very closely in a hospital. But a family member or another caregiver can do hypodermoclysis at home after a healthcare provider shows them how to do it.

How does hypodermoclysis work?

A bag of fluid is connected to a long needle by a plastic tube. The needle is put under the skin and taped in place, usually on the chest, abdomen or thighs. The fluid drips from the bag, through the tube and needle, and into the skin. The skin then absorbs the fluid into the body.

A “drip chamber,” or small window, in the tube shows how fast the fluid is dripping. A roller clamp controls the speed of the drip. Your healthcare provider will decide how fast the fluid should drip. Your healthcare provider will show you how to control the drip and tell you when to check it at home. You can ask your healthcare provider for help if you have questions or problems. A healthcare provider should replace the needle every 4 to 7 days so the flesh around the needle does not become infected.

What are the common problems with hypodermoclysis and what should I do?

Most of the time, hypodermoclysis is safe. Sometimes though, there can be problems. Here are a few things that might happen during hypodermoclysis:

• The speed of the drip changes or the drip stops. Your healthcare provider will show you how to control the flow rate by rolling the roller clamp.
• The site where the needle is inserted will swell. If you gently rub the skin there, the fluid will soak in better. Your healthcare provider will show you how. Contact your healthcare provider for help if the swelling continues or does not get better.
• The site where the needle is inserted becomes painful. Check the skin for redness. Contact your healthcare provider if the skin is red. It may be time to find a different place to insert the needle.
• Blood collects in the tube. This means the needle has gone into a vein. Contact your healthcare provider if this happens.
• The person has trouble breathing or is feeling much worse. If this is the case, contact your healthcare provider.

What are the benefits of artificial hydration and nutrition?

A person who has a temporary illness and can’t swallow needs nutrients and water. Artificial hydration and nutrition can help prevent dehydration and help the patient recover from his or her illness.

For a patient who has an advanced life-threatening illness and who is dying, artificial hydration and nutrition may not provide many benefits. Artificial hydration and nutrition in these patients may make the patient live a little longer, but not always.

What are the risks of artificial hydration and nutrition?

IV fluid replacement and hypodermoclysis can cause infection at the site of the IV or hypodermoclysis needle. Blood clots can form in the vein and cause pain and swelling. Fluid overload and electrolyte imbalances are also possible side effects.

There is always a risk when someone is fed through a tube. Liquid might enter the lungs. This can cause coughing and pneumonia. Feeding tubes may feel uncomfortable. They can become plugged up, causing pain, nausea and vomiting.

Feeding tubes may also cause infections. Sometimes, patients may need to be physically restrained or sedated to keep them from pulling out the feeding tube.

What happens if artificial hydration or nutrition are not given?

Persons who don’t receive any food or fluids will eventually fall into a deep sleep (coma) and usually die in 1 to 3 weeks.

How do we decide whether to use artificial hydration and nutrition?

The patient and their family should talk with the healthcare provider about the patient’s medical condition and risks and benefits of giving artificial hydration and nutrition. Each situation is different. Your healthcare provider can help you make the decision that is right for the patient and family.

Sources

Withholding and Withdrawing Life-Sustaining Treatment by RJ Ackermann, M.D. (10/01/00, http://www.aafp.org/afp/20001001/1555.html )

Some information in this article comes from Education for Physicians on End-of-Life Care Trainer’s Guide, Module 11, withholding, withdrawing therapy. In: Emanuel LL, von Gunten CJ, Ferris FD. Education for physicians on end-of-life care/Institute for Ethics at the American Medical Association. Chicago, IL: EPEC Project, The Robert Wood Johnson Foundation, 1999.