Why Not IV Fluids in Hospice? Navigating Fluids and Food at the End of Life

For individuals nearing the end of life in hospice care, questions about food and hydration can arise.  One common question is why intravenous (IV) fluids are not routinely administered in hospice settings.  This guide explores the rationale behind this practice, along with considerations regarding food and hydration at the end of life.

Understanding the Role of IV Fluids

IV fluids are sterile solutions administered directly into a vein, bypassing the digestive system. They primarily serve two purposes:

• Hydration: Replenishing fluids lost through sweating, urination, or other bodily functions.
• Delivery of Medications and Electrolytes: IV fluids can be used to deliver medications, electrolytes (minerals essential for bodily functions), and nutrients directly into the bloodstream.

Why IV Fluids Might Not Be Used in Hospice

While IV fluids play a crucial role in various medical situations, their use in hospice care is often limited due to several factors:

• Decreased Need for Hydration: As the body shuts down naturally towards the end of life, the need for fluids significantly decreases. The body becomes more efficient at conserving water, and thirst diminishes.
• Potential for Discomfort: IV insertion can be uncomfortable, and maintaining the IV line can require ongoing monitoring and potential discomfort, which may outweigh the benefits.
• Limited Impact on Survival: Studies haven't shown a significant impact of IV fluids on lifespan in terminally ill patients.
• Focus on Comfort: Hospice care prioritizes comfort and symptom management. If IV fluids cause discomfort or anxiety, they may not be the best approach.

Alternative Approaches to Hydration in Hospice

Even though IV fluids might not be used routinely, there are ways to ensure comfort and hydration in hospice care:

• Oral Fluids: Offering small amounts of fluids like water, ice chips, broth, or popsicles can provide comfort and alleviate thirst.
• Mouth Care: Moistening the lips and mouth with swabs dipped in water, glycerin swabs, or oral sprays can promote comfort and prevent dryness.
• Subcutaneous Fluids: In some cases, fluids may be administered under the skin (subcutaneously) to provide hydration without the discomfort of an IV.

Food and Nutrition at the End of Life

Similar to hydration, the desire to eat naturally decreases as the body prepares for death.  Here's what to consider regarding food in hospice care:

• Respecting Preferences: The patient's wishes are paramount. If they have little appetite, forcing them to eat can cause distress.
• Focus on Comfort: Offer small, easily digestible foods they may enjoy. Focus on the pleasure of eating rather than forcing a full meal.
• Nutritional Support: In some cases, nutritional supplements may be offered, but the goal is to maintain comfort, not necessarily prolong life.

Open Communication is Key

Discussions about food and hydration are essential when entering hospice care.  A hospice team, including a doctor, nurse, and social worker, can help create a personalized plan that prioritizes the patient's comfort and well-being.

Additional Considerations:

• Religious or Cultural Beliefs: Some religious or cultural practices may have specific customs around food and hydration at the end of life. It's important to be respectful of these beliefs.
• Managing Fluid Build-Up: In some cases, fluid buildup might occur even with minimal intake. The hospice team can manage this with medication to ensure comfort.
• Advanced Directives: Discussing preferences regarding food, fluids, and medical interventions in advance through an advanced directive can be helpful for both patients and families.

Remember: The goal of hospice care is to ensure a dignified and comfortable end-of-life experience.  Decisions about food, hydration, and other interventions are made on a case-by-case basis, considering the patient's comfort and individual needs.

Additional Resources:

• National Hospice and Palliative Care Organization
• Canadian Hospice Palliative Care Association
• The Conversation Project

By understanding the rationale behind fluid management practices in hospice and having open communication with the hospice team, families can make informed decisions and ensure their loved ones receive care that prioritizes comfort and dignity during this sensitive time.

At Eirene, we believe that end-of-life planning should be comforting, transparent, and dignified. Too often, families struggle with the chaos, opacity, and expense of conventional funeral arrangements. We envision a better way - one centered on the belief that the end of life deserves as much beauty, grace, and meaning as the moments that came before.