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Questions and Answers: Artificial Nutrition and Hydration and End of Life Decision Making

Are there side effects from artificial nutrition and hydration?

Yes. A number of side effects may occur, especially with the long-term use of artificial nutrition and hydration. Tubes can damage and erode the lining of the nasal passage, esophagus, stomach, or intestine. If tube placement requires surgery, complications such as infection or bleeding may arise. Intravenous lines can become uncomfortable if the insertion site becomes infected or if fluid leaks into the skin causing inflammation or infection. Intravenous fluids must be given with extra care to frail patients in order to avoid fluid overload and serious breathing difficulties. TPN requires particular skill and care to ensure that dangerous infections do not enter the blood stream.

Many patients receiving artificial nutrition and hydration by NG or G-tube have brain disease and are unable to report that they feel full or unwell, so abdominal bloating, cramps, or diarrhea may occur. Regurgitation is common, and the feed (the nutritional substance inserted through the tube) may be inhaled into the lungs causing pneumonia.

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With careful attention by healthcare providers, many side effects can be avoided or managed fairly well. However, confused patients also can become anxious over a tube's presence and try to pull it out. This often leads to the use of restraints - tying the patient's arms down - or to sedation, which can have a serious effect on patients' mental state and their ability to interact or to perform any small activities they might be capable of such as changing position in bed.

Is artificial nutrition and hydration different from ordinary eating and drinking?

Yes, an obvious difference is that providing artificial nutrition and hydration requires technical skill. Professional skill and training are necessary to insert the tube and to make decisions about how much and what type of feed to give. Skilled management is also required to limit bad side effects.

Other important differences exist. Artificial nutrition and hydration does not offer the sensory rewards and comforts that come from the taste and texture of food and liquids. Doctors and nurses, rather than patients themselves, control when and how much will be "eaten." Finally, the social interaction that often accompanies eating and drinking is not present.

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