If a patient isn't able to swallow because of a medical problem, he or she 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.
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 everyday in 2 ways: by going to the bathroom (about 45 ounces a day) and by sweating and breathing (at least 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.
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, doctors and nurses need to watch the person very closely in a hospital. But a family member or another caregiver can do hypodermoclysis at home after a doctor or nurse shows him or her how to do it.
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 doctor will decide how fast the fluid should drip. Your doctor will show you how to control the drip and tell you when to check it at home. You can ask your doctor for help if you have questions or problems. A nurse or doctor should replace the needle every 4 to 7 days so the flesh around the needle does not become infected.
Most of the time, hypodermoclysis is safe. Sometimes though, there can be problems. Here are a few things that might happen during hypodermoclysis:
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.
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.
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.
The patient and his or her family should talk with the doctor about the patient's medical condition and risks and benefits of giving artificial hydration and nutrition. Each situation is different. Your doctor can help you make the decision that is right for the patient and family.
Withholding and Withdrawing Life-Sustaining Treatment by RJ Ackermann, M.D. (American Family Physician October 01, 2000, 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.
Written by familydoctor.org editorial staff