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

What is artificial nutrition and hydration?

Artificial nutrition and hydration is a form of life-sustaining treatment. It is a chemically balanced mix of nutrients and fluids, provided by placing a tube directly into the stomach, the intestine or a vein.

When is it used?

Artificial nutrition and hydration is given to a person who for some reason cannot eat or drink enough to sustain life or health. Without nutrition and fluids a person will eventually die. Artificial nutrition and hydration is a medical treatment that allows healthcare providers to bypass whatever may be preventing a person from eating or drinking. It may be used for a variety of conditions.

Short-term artificial nutrition and hydration often is given to patients recovering from surgery, greatly improving the healing process. It may also be given to people with increased nutritional requirements, such as burn victims, or to someone who cannot swallow because of an obstructing tumor.

A highly sophisticated form of artificial nutrition and hydration (total parenteral nutrition, or TPN) can be given indefinitely. For example, TPN can be given to patients with serious intestinal disorders that impair their ability to digest food, enabling them to live fairly normal lives. However, long-term artificial nutrition and hydration also is commonly given to people with irreversible neurological disorders, such as advanced Alzheimer's disease or severe stroke, although it cannot reverse the condition or change the course of the disease itself.

How is it given?

Artificial nutrition and hydration may be given in several ways. Usually it is provided through a flexible tube inserted through the nasal passage into the stomach (nasogastric or NG tube), through the wall of the abdomen into the stomach (gastrostomy, G tube or PEG) or into the intestine (jejunostomy). Insertion through the wall of the abdomen requires a minor surgical procedure. TPN requires the surgical insertion of a special catheter or port, usually into a vein below the collar bone. Fluid with limited amounts of nutrients (or fluids alone) can be supplied directly into a vein in the arm through an intravenous (IV) line. Nutrition and hydration may be supplied temporarily, until the person recovers the ability to eat and drink, or indefinitely. If artificial nutrition is likely to be given for a long time or permanently, a surgically implanted tube is generally more comfortable for the patient and has fewer side effects.