A report on preventing dehydration in cancer patients – The Hydrant drinking system

Our cancer centre cares for patients who have complications of their cancer, and one example of this is a Malignant Spinal Cord Compression (MSCC). This is where a tumour grows around the spinal cord area- either in a bone or the soft tissues and that presses against the cord causing pain, nerve disruption and paralysis. The cancers most likely to cause MSCC are breast, lung, prostate and lymphoma are myeloma (Macmillan.org)

This condition is classed as an oncological emergency, and needs to be treated as fast as possible to preserve the spinal cord, and therefor nerve function (NICE, 2014).
To do this, where a spinal cord compression is suspected our first action is to place the patient on flat bed rest, until and MRI scan can confirm or rule out the diagnosis. If confirmed, radiotherapy is prescribed to reduce the tumour, and therefore pressure on the spinal cord.

The patient remains on flat bed rest until the spine is deemed stable- usually after around three fractions of radiotherapy. By this time the patient has been on flat bed rest for about four days. Imagine trying to do everything lying flat on your back, staring at the ceiling!

Eating, drinking, talking to people stood next to you, listening to your bedside handover, out of your eye line, maybe, trying to pass urine or open your bowels…
We discovered one small thing that could help these patients to drink. The Hydrant system, winner of The Queens Award for Enterprise: Innovation – a simple, low-cost solution to the problem of dehydration. It solves the problem patients have in reaching, lifting or holding drinks.

The Hydrant System is a really simple idea, a reusable, dishwasher safe bottle, with a cap that has a flexible handle, so it can be attached to bed heads, chairs or hung on drip stands. This is the part that helps patients with hand problems, or tremors, as they can lift the bottle without having to grip. It has two tops, one for the straw to go through, or a sports cap. The straw has a bite block so fluid only travels along the tube when this is crushed, to open the outlet, which means it does not leak.

This can be a draw back, as the patient must be able to co ordinate biting and sucking to take a drink, but we have not really seen this in our area, teaching patients and nurses to explain this might explain why.
The nurses and patients do need to be informed how to use the system successfully; there are a couple of tips that make its use more successful, like priming the straw before use, and hanging the bottle high to aid drinking.

The straw even has a clip so it can be attached to clothing or pillows for easy access.

Teresa Miller, HCSW says: The Hydrant bottle is the answer to some of the problems we, as healthcare support workers, encounter on the wards. I work on a very busy Haematology and Oncology ward. Very often we have spinal cord compression patients and elderly patients who don’t drink anywhere near enough to keep hydrated.

Many times elderly patients just refuse because they can’t manage cups or they feel embarrassed drinking from beakers. The hydrant bottle is just perfect for them.
Our spinal cord compression patients cannot sit up or move so find drinking from normal cups with a straw very difficult. The hydrant allows them to drink independently without having to wait for help.

Having seen first hand what a difference the hydrant bottles make I would urge all wards in hospitals to think about using them for patients who could really benefit from using them.
The hydrant bottles come in 2 sizes – 500mls or one litre, with various attachments for easy use. The bottles are graduated, so make measuring for fluid balance easy too.

Patients with tremors with illnesses such as Parkinson’s’ disease would benefit from the smaller bottle with the larger handle for easy grip and will not spill over them. Patients with spinal problems would benefit from the larger bottle with a 1.5m straw attached for easy use.  Once we had started to use the Hydrant System, we started to see many other patients it would benefit.

Many of are patients are exhausted, and too tired to reach for drinks, and hold them. Drinks get spilled onto beds and floors because patients nod off holding a cup, which then spills. The Hydrant means they can sip, without fear of spillages. We have seen a very positive effect with this group of patients.

Theresa says “Dehydration is the single biggest issue facing healthcare. Lack of easy independent access to fluids is a major cause of dehydration and its associated problems. The hydrant is the solution to these issues. 9 out of 10 elderly patients arrive at hospital with problems caused by dehydration.

As moderate dehydration increases, mental performance deteriorates further, medical risks increase and serious symptoms may need emergency care. Simply drinking water can have an instant alerting and revitalising effect”.

An elderly, fatigued gentleman, who was using oxygen continuously, was assisted to use the Hydrant, hung from a drip stand, so the fluid fed down the straw when he opened the bite valve, without him having to suck, drank 800mls overnight, unassisted, because he could just sip as and when he wanted to.

One young man had a Para neoplastic syndrome, which paralysed him almost totally, but he could use a litre bottle for his cold drinks, and a 500 ml bottle and sports cap for his hot drinks. One of the only things he could do independently, with the aid of this system, was drink.

The benefits from using the Hydrant system are significant and varied, evidence from a pre and post hydrant trial in nursing homes has shown a huge reduction in Urinary Tract Infections and also falls. See the table below for the impact in those care homes. The objectives of the care home programme were:

• Promote independence, dignity and a persons well being.
• Reduce the use of medications especially antibiotics and laxatives. 
• Reduce the amount of infections that a person may have. 
• Reduce the amount of falls a persons may have 
• Reduce the amount of hospital admissions.

Care Homes Hydrant project: Amalgamated summary of reduction in ‘events’ from 2 care homes

The cost? Via the internet it costs £14.95 for a bottle and straw, but this is heavily discounted via NHS Procurement, as a non stock item – order code is GTB415 . Within the hospital environment straws are disposed of daily, and a fresh one supplied, and the bottles are washed up.

The Hydrant system is of great benefit to our patients, allowing them to increase their oral intake of fluids, independently, it also allows for easy fluid balance monitoring. Increased fluids lead to reduced Intravenous fluids, urinary tract infections, mental alertness and reduced falls.

Patient feed back is very positive, and use is endorsed by nurses in our wards.

References

www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects /Othersymptomssideeffects/MSCC.aspx
https://www.nice.org.uk/guidance/QS56/chapter/introduction