[spoiled28]

I have been doing Hospice care for about 5 years now. I recently had a patient with CA of the gallbladder and had uncontrolled n/v. We tried topical compounds, PO meds (Phenegran, reglan and finally switched to Zofran) with still very little relief from the vomting. We also tried Scaplomine transderm scope patches. Any body with any other ideas??? She refuses anything rectally and refuses any injections or IV or line placement....
For anyone new getting started in Hospice it has been one of the toughest and yet MOST REWARDING decisions I ever made.

[RnRatchet]

We also start with Phenergan and then go from there. One combo that we commonly use for any type of cancer involving the abdomen is a BRD.. Benedryl, Reglan, Decadron.. I've also seen variations with Ativan or Haldol in them depending on patient need. We do either pills (ends up being several to swallow), a topical cream compounded by one of the pharmacies in the area, a compounded suppository, or on occasion IV is used.

[suebird3]

How about Phenobarb/Maalox/Viscous Lido ? It is worth a shot. Seemed to work when my GB acted up last year.

Suebird

[sanctuary]

Has anyone tried accupressure? There is a pressure point on the back of the wrist, between the radius and ulna. Have found it effective for morning sickness, flu, GB, terminal AIDS.

[doodlemom]

Is she vomiting because she is obstructed? Is she eating? We've used sandostatin to decrease gastric secretions in pt's that are obstructed and are not eating with good relief. I've only seen it used and work in pt's that are basically vomiting up bile. It is a sq injection and it is very expensive - but it works.The problem occurs in that even if a pt is not eating, their body still secretes gastric secretions that have to go somewhere (emesis). Another alternative for this problem would be pretty invasive (ng or g-tube to LWS.) If she is not obstructed, then I would try some of the other alternatives listed here - especially a preparation that includes decadron and haldol. Maybe Ativan, decadron, haldol, and reglan? Do you have an inpatient facility that you could send her to to try different alternatives?

[spoiled28]

Thanks guys its always good to get some new ideas. We use a topical compound of haldol, decadron, ativan and reglan, it most genreally works great for our patients, just not this time. The family is dtermined to keep her at home, she has not been able to keep any food down for over 1 week and now she's afraid to drink. But thanks for all the great ideas

[oncalllorraine]

i like haldol, sublingual, and have been very impressed with it, as well as addition of levsin, sometimes (hycosamine). i have also heard that those wrist bands work well in other hospices, but have yet to try. they are under 10$ in most drug stores. don't forget the easy things- cool face cloth,fan,rest,popsickles. hope something works-we all hate those case we can't 'fix'.

[Daye]

Our class about freaked when our NI told us use Cold Pacs on the neck for N/V? I haven't tried it though

[abnerRN]

Originally Posted by spoiled28

I have been doing Hospice care for about 5 years now. I recently had a patient with CA of the gallbladder and had uncontrolled n/v. We tried topical compounds, PO meds (Phenegran, reglan and finally switched to Zofran) with still very little relief from the vomting. We also tried Scaplomine transderm scope patches. Any body with any other ideas??? She refuses anything rectally and refuses any injections or IV or line placement....
For anyone new getting started in Hospice it has been one of the toughest and yet MOST REWARDING decisions I ever made.

Have you tried Haldol? It seems to work for some of our patients.

[jerseyRN]

Just had a ovarian CA patient with obstruction and intractable vomiting.... tried her on ABHR gels, with partial relief, then upped the concentration of the ABH with still no complete relief. Finally moved her to our inpatient unit where she was started on the same meds, plus decadron, IV.... that got her comfortable enough to hold down some fluids and even feel a little hungry.

Also they're giving her Robinul which we don't use much and I understood to be mostly for terminal secretions. But in this case was ordered for N/V

They also had sandostatin on order in case the above didn't work.