[KatrinkaRN]

I have a question about standard nursing care on an inpatient hospice unit. I used to work on an inpatient hospice unit connected to the hospital. We often would get patients with tracheostomies...one of the nurses I worked with felt it was unneccesary to use sterile technique when suctioning and would often use the same suction catheter through out the shift. This question was posed to the hospice medical director and he felt that this wasn't a problem and was actually "okay" to do. Most of my fellow co-workers didn't see anything wrong with it either.

It bothered me immensly...I don't think the dying should have different standards of care just because they are dying.

Any feedback??

[ChicagolandRN]

Wow! That's pretty unreal. I would think that if this trach pt developed an infection they would be LESS comfortable, which kinda goes against the whole "comfort care" thing!!! GRRR

[Briar]

It is my understanding that standards of care are to be exactly the same for hospice pts as for any other pt in a health care facility. This is legally mandated, though it may differ from state to state.
-Briar

[BarbPick]

That is harmful.

[KatrinkaRN]

The patients that I was referring to were in the active phase of dying, comatose. So they felt the justification was that death was iminient so they were so point in suctioning using sterile technique. I don't think there ever is a justification.

[BarbPick]

at that stage of life/dying, is to use a scopolomaine patch behind the ear to dry up all secretions. No longer need to section or hear a death rattle.

[KatrinkaRN]

Sometimes scopolamine doesn't work on tracheal congestion. For the most part, suctioning is only done when it's occluding the airway.

[mah_h]

Originally Posted by BarbPick

That is harmful.

hello
why is that harmful?

[jmsrn]

I have used small doses of atropine also to help dry up secretions or those death rattles. I have also heard that the more you suction a dying pt the more secretions they produce. I agree that all patients should be treated with the same level of care so probably should use a new suction tube each time.

[NRSKarenRN]

Standard of care in homecare and most hospice porgrams is clean technique using one new suction kit/day. Need for suctioning individualized, only done when absoulutely necessary. Inpatient hospice should follow same standard of care if individual room; those sharing rooms may need to utilize sterile techniquw to prevent cross contamination.

Focus on: new vs old trach.

Most patients with trachs several months/years duration only need daily cleaning inner cannula. room humidification if dry. They are used to own flora germs (you'd be shocked at how some older trached patients lived/cared for trach)

Patients wwith new trachs or those with copius secretions might need occasional suctioning. If actively dying, atropine or scopalamine indicated.