Subcutaneous fluids

There is a lack of any strong evidence, therefore decisions to initiate subcutaneous (SC) hydration rests with the multidisciplinary team in discussion with the patient and family, and will vary from patient to patient depending on the estimated burden to benefit balance. 

The patient should be assessed for the potential benefits and burdens on an individual basis (see figure below) and this should be discussed with the patient and family as below (see practice points).

Potential benefits

• Improved hydration.
• May improve thirst (may be unrelated to fluid status).
• May improve renal function.
• May reduce opioid toxicity.
• May reduce sedation.

Potential complications

• Line discomfort/infection.
• Oedema/ascites/effusions.
• Worsening secretions.
• Increased symptom burden as a result of above.
• Family/patient distress.
• Systemic fluid overload.

• If SC fluids are to be used, an SC infusion line should be sited with aseptic technique.
• Isotonic or hypotonic solutions only should be used (for example 0.9% Sodium Chloride).
• Generally prescribed at a rate of 500ml/8 to 12 hours, but rate of infusion will vary by patient. (Subcutaneous infusions may be administered under gravity feed after calculation of the drip rate, usually on giving set packet - refer to local policy).
• Infusion site should be under daily review for signs of infection, fluid accumulation or discomfort.
• Patient should be under daily review for fluid accumulation or overload.
• Patient should be under daily review for benefit and review of future prescribing.

• Nutrition and hydration are often emotional topics for families and patients towards the last days of a person's life. There is a necessity for ongoing sensitive discussions about goals of care and realistic expectations of treatment.
• Assess the dying person's hydration status as part of standard practice, and review the possible need for starting clinically assisted hydration, respecting the person's previously expressed wishes and preferences, as well as any cultural, spiritual or religious beliefs that may be important to them.
• The views of the patient and any advanced care planning should be considered throughout. Support for the carers when these decisions are being made is essential.
• Discuss the risks and benefits of clinically assisted hydration with the patient and those close to them.
• Consider a time-limited trial of clinically assisted hydration if the person has distressing symptoms or signs that could be associated with dehydration, monitoring closely for benefits or burdens of this.
• Treatment should always be in conjunction with other quality care, including good mouth care.