Fluid retention in palliative care

Causes and origins

Conditions causing fluid retention in the tissues beneath the skin, or oedema, include lymphatic disorders; reduced function of the heart, kidneys, or liver; and reduced circulation in the leg veins.

Treatment

Treatment for lymphatic disorders, or lymphoedema, aims to relieve interfering symptoms and maintain the patient’s functional capacity. The oedema can be relieved with compression treatment (using compression sleeves, gloves, socks, or bandages), lymphatic drainage massage, or exercise.

Other types of oedema are treated by either treating the underlying illness or relieving any interfering symptoms with assistive products. An example of treating the underlying illness includes prescribing diuretics for heart failure.

Self-management

If compression treatment is used to address oedema, the compression garment in question should be used regularly. Maintaining the results of lymphatic drainage massage also requires the use of compression garments.

Keeping the affected limb elevated and participating in the kind of physical activity that you feel comfortable with may reduce swelling and relieve the feeling of pressure. To prevent infections and skin breakage, the affected limb should be kept clean and moisturised regularly.

Causes and origins

Fluid retention around the lungs may be caused by malignancies in the pleura surrounding the lungs. These often occur in lung cancer, but may be associated with other forms of cancer as well. Another common cause of fluid in the pleural space is heart failure. As the fluid builds up in the space between the lung and the chest wall, the lung is left with less space, which leads to shortness of breath.

Treatment

Shortness of breath can be relieved by performing a pleural tap, which involves placing a needle in the pleural space to get the excess fluid out. A pleural tap is usually preceded by an ultrasound to determine the amount of pleural fluid as well as a suitable location for performing the tap. Next, the surface of the skin is disinfected and the area is numbed using an anaesthetic. The fluid is then removed using a larger needle. The procedure is usually performed from the back, with the patient either seated leaning slightly forward or lying on one side. The procedure usually takes around 30 minutes, followed by a short monitoring period.

If the build-up of fluid recurs frequently, a more permanent drainage catheter may be inserted, allowing the patient to drain the fluid at home. Another option is to insert medical talc in the pleural cavity, which “glues” the layers of the pleura together and prevents the fluid from getting between them.

If the build-up of fluid around the lungs is caused by heart failure, diuretics are often used to reduce it, but in some cases a pleural tap may be applicable as well. A build-up of fluid caused by cancer usually doesn’t respond to diuretics.

Self-management

Unfortunately, if the build-up of fluid around the lungs is caused by cancer, there’s no way to either control the speed at which the fluid accumulates or to remove the fluid using self-management techniques.

If the build-up of fluid is caused by other illnesses, the doctor may recommend fluid or sodium restrictions for the patient to follow.

Causes and origins

The abdominal cavity is lined by the peritoneum. Common causes of a build-up of fluid in the abdominal cavity include diseases affecting the liver, such as cirrhosis of the liver. In such cases, the flow of blood from the abdominal area and back to the heart via the liver is reduced. The increase in pressure causes fluid to “seep” from the veins and into the abdominal cavity. Even heart failure may cause fluid to build up in the abdominal cavity – the principle is the same. In addition, fluid in the abdominal cavity is often the result of malignancies in the peritoneum. This is fairly common in gynaecologic cancers and cancers affecting the gastrointestinal tract, for example.

Treatment

Fluid can be removed from the abdominal cavity by performing an ascitic tap. Draining the fluid from the abdominal cavity often takes a while, in which case a drainage catheter can be inserted and kept in place for a few hours or for up to 2 days. Alternatively, an indwelling catheter can be inserted under the skin, which makes it possible to remove the ascitic fluid while the patient is at home.

If the build-up of fluid in the abdominal cavity is caused by liver or heart failure, the amount of fluid can often be reduced with diuretics; an ascitic tap may be used as well. If cancer is causing the build-up of fluid, diuretics are usually unhelpful.

Self-management

Unfortunately, if the build-up of fluid in the abdominal cavity is caused by cancer, there’s no way to either control the speed at which the fluid accumulates or to remove the fluid using self-management techniques.

If the build-up of fluid is caused by other illnesses, the doctor may recommend fluid or sodium restrictions for the patient to follow.