Why keep NG tube in for hydration only?

Klohmann330 · Jan 31, 2011

The only reason I can think of to use the NG tube for hydration instead of IV therapy is if the pt has issues with keeping their veins patent, and IV fluids are not an option due to collapsed veins etc... that's my guess!

I work in homecare and we had a patient who needed IV hydration after a hospital stay but the parents didn't want the kid to come home with a line because they were worried about infection, and were more comfortable with the NG tube for a few days

hope that helps!

merlee · Jan 31, 2011

There is no need for 'hydration' at the end-of-life scenario. Maybe to administer meds to keep the pt comfortable if they don't have a line. But NG tubes are annoying, too.

The pt is less likely to accumulate excess fluids if hydration is kept to a minimum. If the kidneys show signs of decreasing function, where do YOU (the OP) think all this fluid will go?

silentRN · Jan 31, 2011

.....

FLArn · Jan 31, 2011

In younger terminal patients (under age 60) it is more common to see myoclonus due to dehydration and also a condition (the name of which is eluding me at the moment) where the pain medications actually cause an increase in pain which is treated by hydrating the patient. This is most commonly done with IV hydration, but as long as the gut is still functioning might be achieved with an NG Tube (but I've never seen it done that way).

FLArn · Jan 31, 2011

To dhammo,

Actually in terminal patients who are actively dying it is NOT miserable to be dehydrated generally. When the body is shutting down it can not process foods or fluids and will actually shift fluids from the circulation to the spaces in the tissues and around the heart and lungs so you can effectively drown a patient trying to hydrate them at end of life--- That's miserable!.

Zookeeper3 · Jan 31, 2011

please research end of life and hospice care. The gut is one of the first organs to stop working due to decreased perfusion. So while hydration or feeds... or family fear of "starving them to death" are common worries, filling the dead gut with feeds and fluid causes distention, pain, vomiting and aspiration.

purely in an end of life scenerio, if the family requests feeds and fluids there is a basic misunderstanding that a comfortable death is now the care plan and prolonging suffering with forced food and hydration will only extend that suffering.

Education for the family is now the focus and providing that knowledge with the availability of morphine.. atropine patches... all the care for "comfort measures" will be the priority and the patient will no longer be fed or hydrated for the above reasons.

If the family agrees that it is time for a natural and comfortable death to occur... which is beautiful IMHO.. than force feeding and hydration is in violation of that and you just need to keep explaining...."we're either going to fight to prolong death with nutrition, or we'll let death occur in a natural state. When your family member is no longer able to drink or swallow, we'll keep their mouth moist with swabs and insure that their comfort is the number one priority"..

to do otherwise is ignorant (meant nicely), cruel and wrong. Death is a natural part of life and very few are given the means to pass this way.

Hospice search time.

CCL RN, RN · Jan 31, 2011

please research end of life and hospice care.
to do otherwise is ignorant (meant nicely), cruel and wrong. Death is a natural part of life and very few are given the means to pass this way.
Hospice search time.

Editing for clarity, and bolding my own...

I couldn't agree with you more. Some of the most ignorant to hospice care are MDs. In the ICU we would extubate and Withdraw care, but leave IVF and DHT? Why? Because it makes the MD and family "feel good"?

To the OP:

Let the death process happen, naturally. Or as naturally as possible. And if our patients families state they are worried about starvation or thirst, then this is called a teachable moment. It means your family is in need of your guidance to educate them on the death process. A gut full of tube feeding, and swelling organs from IVF are not the way we should treat our dying patients. Not to mention, we prevent the ability for them to feel their own endorphins that they produce when dying.

We interfere way too much.

Be a patient advocate, and do what's best for your patient.

Zookeeper3 · Jan 31, 2011

We interfere way too much.

Be a patient advocate, and do what's best for your patient.

Thank you so much, that's what I wanted to say in two sentences. I'm just too wordy these days. What you said times 10.