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Hygiene care for dying people is a symptom management issue
  1. Vicky Robinson, Consultant Nurse
  1. St Christopher’s Hospice, London

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One Saturday I visited a dying patient at home. I was accompanied by a medical colleague. The patient had been discharged from hospital a week previously following an abdominal paracentesis (removal of excess fluid from the peritoneal cavity (ascites) by inserting a surgical drain through the abdominal wall). The patient had expressed a wish to die at home.

Unfortunately, the abdominal swelling had recurred and the patient was very uncomfortable. He had been seen by his GP, who had concluded that the ascites required draining again and requested a home visit from the palliative care team to perform another abdominal paracentesis. We had arranged to meet the district nurse at the patient’s house.

The patient was cachectic, jaundiced and very weak. My colleague examined him. There was no ascites, but he had an enlarged liver and was constipated. He …

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