Losing a loved one to a terminal illness is a challenging experience. As a hospice nurse with years of experience, I understand the challenges families face during this time. One aspect that often arises is intravenous (IV) fluids in the final stages of life. Families need to be aware that IV fluids may not always be the best choice for their loved one’s comfort and well-being.
The Hospice Approach
Hospice care focuses on providing comfort and support during the final stages of life. Our goal is to enhance the quality of life for patients and ensure that their end-of-life experience is as peaceful and comfortable as possible. Hospice care addresses physical, emotional, and spiritual needs, ensuring that patients and their families receive the care and attention they deserve during this challenging time.
The Purpose of IV Fluids
IV fluids are commonly used in medical settings to hydrate patients who cannot take fluids orally. However, as the end-of-life approaches, the benefits of IV fluids can diminish significantly. In fact, in the last month of life, IV fluids can sometimes cause more harm than good, leading to unnecessary suffering for the patient.
The Risks and Discomfort
When a person nears the end of life, their body naturally begins to shut down. As a result, their appetite and ability to drink fluids may decrease. This decrease in oral intake is a normal part of the dying process and is not necessarily a sign of distress or dehydration. Administering IV fluids to a patient who is naturally experiencing reduced oral intake can lead to several discomforting and distressing effects, including:
Increased Delirium:Delirium, a common symptom in the final stages of life, can be worsened by excessive fluid intake. This can negatively impact the patient’s comfort and quality of life.
Fluid Overload: IV fluids can cause fluid to accumulate in the lungs and other organs, leading to difficulty breathing and discomfort.
Swelling: Fluid retention caused by IV fluids can lead to swelling in the extremities, making the patient uncomfortable.
Increased Urination: IV fluids can result in increased urine output, leading to frequent trips to the bathroom and potential discomfort for bedridden patients.
Promoting Comfort and Quality of Life
Families must understand that the primary goal of hospice and palliative care is to promote comfort and quality of life for their loved one in the final stages of life. This often involves focusing on symptom management and providing compassionate support. IV fluids may not align with these goals in the last month of life.
Alternative Approaches
Instead of relying solely on IV fluids, there are alternative approaches that can be considered to ensure comfort and well-being for the terminally ill patient. These include:
Mouth Care: Regular mouth care, including moistening the mouth with a damp sponge, ice chips, or small sips of water, can help relieve discomfort associated with dryness.
Medications: Symptom management medications, such as pain relievers and anti-anxiety medications, can be administered orally or through other routes (e.g., sublingual or transdermal) to alleviate discomfort and promote calmness.
Emotional and Spiritual Support: Providing emotional and spiritual support to the patient and their family can greatly enhance their overall well-being and comfort during this grim time.
Communication and Decision-Making
Families need to communicate openly and honestly with the healthcare team, including hospice professionals, to discuss the potential risks and benefits of IV fluids in the last month of life. Understanding the unique needs and wishes of the patient, as well as considering their comfort and quality of life, can guide decision-making.
Conclusion
The use of intravenous (IV) fluids in the final stages of life is a complex and sensitive issue. While IV fluids are commonly used to hydrate patients, their benefits can diminish significantly as the end-of-life approaches. Administering IV fluids to a patient who is naturally experiencing reduced oral intake can lead to discomfort and distress. Therefore, families must understand that the primary goal of hospice and palliative care is to promote comfort and quality of life for their loved one in the final stages of life. Instead of relying solely on IV fluids, alternative approaches such as mouth care, medications for symptom management, and emotional and spiritual support can be considered to ensure the comfort and well-being of the terminally ill patient. Open and honest communication with the healthcare team, including hospice professionals, is essential to discuss the potential risks and benefits of IV fluids in the last month of life, considering the unique needs and wishes of the patient. Ultimately, the focus should be on enhancing the quality of life for patients and ensuring that their end-of-life experience is as peaceful and comfortable as possible.
