title: How and why are subcutaneous fluids administered in an advanced illness population: a systematic review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre of Palliative Care Research, Calvary Health Care and Australian Catholic University, Canberra, ACT, Australia.
authors.forename: Liz
authors.initials: L
authors.lastname: Forbat
authors.affiliation: Australian Catholic University, Canberra, ACT, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Kunicki
authors.affiliation: Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Chapman
authors.affiliation: Calvary Health Care, Canberra, ACT, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Lovell
mesh_terms: D000328:Adult; D003657:Decision Making; D003681:Dehydration / Q000628:therapy*; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D055104:Infusions, Subcutaneous; D010166:Palliative Care / Q000379:methods*; D015532:Rehydration Solutions / Q000008:administration & dosage*
chemical_list: D015532:Rehydration Solutions
keywords: advanced illness; hydration; hypodermocylsis; palliative care; subcutaneous; systematic review