How and why are subcutaneous fluids administered in an advanced illness population: a systematic review.

Forbat, L; Kunicki, N; Chapman, M; Lovell, C

How and why are subcutaneous fluids administered in an advanced illness population: a systematic review.

Forbat, L Kunicki, N Chapman, M

Lovell, C

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Journal of Clinical Nursing, 2017, 26, (9-10), pp. 1204-1216
Issue Date:: 2017-05

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Field	Value	Language
dc.contributor.author	Forbat, L
dc.contributor.author	Kunicki, N
dc.contributor.author	Chapman, M https://orcid.org/0000-0003-1333-3448
dc.contributor.author	Lovell, C
dc.date.accessioned	2022-09-09T05:43:04Z
dc.date.available	2016-12-03
dc.date.available	2022-09-09T05:43:04Z
dc.date.issued	2017-05
dc.identifier.citation	Journal of Clinical Nursing, 2017, 26, (9-10), pp. 1204-1216
dc.identifier.issn	0962-1067
dc.identifier.issn	1365-2702
dc.identifier.uri	http://hdl.handle.net/10453/161587
dc.description.abstract	AIMS AND OBJECTIVES: To identify the mechanisms of subcutaneous fluid administration in advanced illness. BACKGROUND: Hydration at end of life is a fundamental issue in quality care internationally. Decision-making regarding the provision of artificial hydration in advanced illness is complicated by a paucity of evidence-based guidance. Despite considerable attention given to the topic including two recent Cochrane reviews, there has been no focus in systematically identifying papers that report the mechanisms for delivering hydration subcutaneously. Consequently, there is a need to produce guidance on the site, mode, volume and rate of infusion, based on empirical evidence. DESIGN: Systematic review of papers reporting empirical research data. METHODS: Key databases (CENTRAL, Medline, EMBASE, Web of Science, CINAHL) were searched in September 2015, with no date limitations. Inclusion criteria focused on hypodermoclysis in adults within an advanced illness population. Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. RESULTS: Fourteen papers were included in the analysis; most (n = 8) were conducted in hospices with others (n = 6) in long-stay units with a population affected by chronic conditions associated with ageing. Studies were of moderate or high quality. The site and mode of infusion were not well described in these papers, and rates of infusion varied widely allowing for little clear consensus to guide clinical practice in the administration of subcutaneous fluids. CONCLUSIONS: Studies under-report the mechanisms by which artificial hydration is provided, creating a paucity of evidence-based guidance by which to practice. There is a need for evidence generated from nonmalignant populations to ensure applicability to the large number of people with other advanced illness. RELEVANCE TO CLINICAL PRACTICE: In the absence of sufficiently powered robust evidence, the mode of delivery of artificial hydration at end of life remains in the gloaming between evidence and unfounded habit.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Journal of Clinical Nursing
dc.relation.isbasedon	10.1111/jocn.13683
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1110 Nursing, 1117 Public Health and Health Services, 1701 Psychology
dc.subject.classification	Nursing
dc.subject.mesh	Adult
dc.subject.mesh	Decision Making
dc.subject.mesh	Dehydration
dc.subject.mesh	Evidence-Based Medicine
dc.subject.mesh	Fluid Therapy
dc.subject.mesh	Humans
dc.subject.mesh	Infusions, Subcutaneous
dc.subject.mesh	Palliative Care
dc.subject.mesh	Rehydration Solutions
dc.subject.mesh	Adult
dc.subject.mesh	Decision Making
dc.subject.mesh	Dehydration
dc.subject.mesh	Evidence-Based Medicine
dc.subject.mesh	Fluid Therapy
dc.subject.mesh	Humans
dc.subject.mesh	Infusions, Subcutaneous
dc.subject.mesh	Palliative Care
dc.subject.mesh	Rehydration Solutions
dc.subject.mesh	Humans
dc.subject.mesh	Dehydration
dc.subject.mesh	Rehydration Solutions
dc.subject.mesh	Fluid Therapy
dc.subject.mesh	Palliative Care
dc.subject.mesh	Decision Making
dc.subject.mesh	Evidence-Based Medicine
dc.subject.mesh	Adult
dc.subject.mesh	Infusions, Subcutaneous
dc.title	How and why are subcutaneous fluids administered in an advanced illness population: a systematic review.
dc.type	Journal Article
utslib.citation.volume	26
utslib.location.activity	England
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
utslib.for	1701 Psychology
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-09-09T05:43:02Z
pubs.issue	9-10
pubs.publication-status	Published
pubs.volume	26
utslib.citation.issue	9-10

Abstract:

AIMS AND OBJECTIVES: To identify the mechanisms of subcutaneous fluid administration in advanced illness. BACKGROUND: Hydration at end of life is a fundamental issue in quality care internationally. Decision-making regarding the provision of artificial hydration in advanced illness is complicated by a paucity of evidence-based guidance. Despite considerable attention given to the topic including two recent Cochrane reviews, there has been no focus in systematically identifying papers that report the mechanisms for delivering hydration subcutaneously. Consequently, there is a need to produce guidance on the site, mode, volume and rate of infusion, based on empirical evidence. DESIGN: Systematic review of papers reporting empirical research data. METHODS: Key databases (CENTRAL, Medline, EMBASE, Web of Science, CINAHL) were searched in September 2015, with no date limitations. Inclusion criteria focused on hypodermoclysis in adults within an advanced illness population. Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. RESULTS: Fourteen papers were included in the analysis; most (n = 8) were conducted in hospices with others (n = 6) in long-stay units with a population affected by chronic conditions associated with ageing. Studies were of moderate or high quality. The site and mode of infusion were not well described in these papers, and rates of infusion varied widely allowing for little clear consensus to guide clinical practice in the administration of subcutaneous fluids. CONCLUSIONS: Studies under-report the mechanisms by which artificial hydration is provided, creating a paucity of evidence-based guidance by which to practice. There is a need for evidence generated from nonmalignant populations to ensure applicability to the large number of people with other advanced illness. RELEVANCE TO CLINICAL PRACTICE: In the absence of sufficiently powered robust evidence, the mode of delivery of artificial hydration at end of life remains in the gloaming between evidence and unfounded habit.

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http://hdl.handle.net/10453/161587