IV Hydration

IV (intravenous) Hydration for Hospice Patients

IV hydration in hospice patients is much debated. And because End of Life decision making is an emotional roller coaster, this is a dangerous combination. Caught up in this stressful time, we can forget to weigh the risks and benefits when asked to make decisions about advanced directives.

Because our bodies naturally become dehydrated at End of Life, using IVs to hydrate a hospice patient is unusual.

Things to consider:
1. It is painful to have an IV started. Though some patients have a portacath (a surgically implanted device for vein access) most patients do not. As IVs are harder to start in dehydrated patients, often more than one “stick” is needed. These repeated “sticks” mean more discomfort.
2. In the elderly, the skin and blood vessels are fragile. IVs often fail and leak into the surrounding tissue leaving bruised and swollen areas behind.
3. Another concern is fluid overload. Remember that the body’s natural dying process is to become dehydrated. Adding fluid interrupts this and can give the body more fluid than it can handle, extending general discomfort. Once fluid overload has occurred, it’s almost impossible to get the fluid out of a dying patient.
4. It’s important to understand that when a patient no longer eats or drinks, the body’s metabolism changes and a sense of euphoria follows as a result of this change.
5. You can choose “No IVs” as an Advanced Directives in some nursing homes.

Families and patients (if able) should be included in the decision making process around IV Hydration and End of Life Care

Please note that the above information is general in nature.
Each patient’s decision needs to be considered based on their stage of illness.