Fluids / IV access

Dad has had another trip to hospital and looks like he might be heading the same way again even though there doesn’t ‘appear’ to be anything wrong. He was treated for a UTI after presenting with confusion & then hallucinations - his urine was dipped & he showed very small amounts of proteins & leucocytes. Then his sats dropped & he looked like he’d all but passed out but I think he’d just worn himself out. The paramedics said his sats hadn’t really dropped, it was just a a cheap monitor and their’s showed him around 90+. They said keep him at home (nursing home obvs), the nursing home we’re clearly trying to get him in hospital, I said he should stay home, the GP said fine but he might die so off we went. She suggested he needed IV antibiotics & nobody could do that except a hospital. My first question is - has anyone been able to get an IV done out of hospital?

After his 6 hour sleep he was fine but dehydrated so the hospital put a drip up and gave him oral antibiotics. He was lucid when I left Saturday night and still pretty much lucid when we saw him back at the nursing home Sunday afternoon. He’s stayed on the oral meds but got more and more confused and today was kicking off like he was in hospital with his back - I was pushing him back into his chair to stop him from standing and then quickly stepping back to avoid being punched. He was refusing to drink & often couldn’t coordinate closing his mouth and sucking on the straw, or closing it after tipping fluids in. We tried all sorts. So my second question (two parter) a) How do you get fluids into someone who doesn’t want it but gets dehydrated easily? B) Again, are IV fluids only available in a hospital setting? It seems ridiculous. We’re trying to keep him out of hospital because it makes everything worse but I can’t let him pass away just because he needs fluids. On the other hand, we can’t keep going to hospital just because he needs fluids. Or does he? This lack of capacity is so sudden that if it isn’t an infection, could it be that all of the change recently has triggered something?

A few years ago my Mum had a spell of extreme confusion that was put down to a UTI: they took her to hospital to check the diagnosis, put her on an IV as she was severely dehydrated…and she improved a bit but not much. They sent her home against my wishes two days later. She wasn’t home for more than 12 hours and she’d had another fall and was seriously confuddled.

So back to the hospital at 4 in the morning. Turned out that the UTI was clearing up nicely but she had another infection, which turned out to be on her heart. Apparently that can only be treated by IV antibiotics, and it has to be in hospital. Nobody explained why, but basically it’s a nursing function and probably requires close supervision, which is theoretically possible in a hospital but of course never really happens…whereas in a care home there’s little nursing provision.

Long way round way of saying IV meds are usually nursing only, in a hospital. Fluids…probably the same. Only difference may be end of life treatment at home, but that’s a very different story and needs nursing care anyway.

Thanks ‘s really helpful. I asked about end of life care yesterday and they said it was a different form of administration (a pump) and only for pain relief. There is always a RGN on duty where dad is because it’s a nursing home and he definitely has more supervision now because he’s right by the nurses station and he has a motion mat as of yesterday.

Can I ask how they picked up the infection in your mum’s heart please? Strangely I spoke to the heart failure team yesterday as I was going through dad’s paperwork and realised he hadn’t been seen since autumn 2019 and should in theory have been having 6 monthly check ups. When I eventually tracked the team down they said he’d been discharged in 2019 and they can’t keep people on their books forever. I get that, but dad has a very complicated heart history with a very specialist intervention. They did ask if he was currently experiencing any heart issues and I said that appears to be the least of his issues! He had an ECG on Saturday and that was okay but I don’t know what would indicate an infection.

Ok…it was endocarditis: I think first they ruled out everything else. She’d had an artificial heart valve installed a year or so earlier, and apparently they are a risk factor. The NHS has a good page on it here: Endocarditis - NHS

Thanks Charles. He has had a TAVI and a previous valve replacement so definitely in the at risk group but he doesn’t appear to be showing any symptoms that they describe.

We had another ambulance trip on Friday and since then his delirium / hallucinations have fluctuated so I never know what version of him I’m going to get when I go in. He’s had several bags of fluid, a chest x-ray, multiple blood and urine tests, but as of yesterday there was nothing remarkable in any of them. There is a big question mark over his kidney function though and I’ve spoken to the nursing home about moving forward in any case. Despite drinking a fair amount he’s getting dehydrated really easily so they’ve suggested hourly visits to prompt for a big drink but I don’t think his body is utilising the fluids properly for some reason. He’s very very weak and tired poor chap.