Ativan

[Mborn2185]

I am a new RN. I was being oriented by a nurse who had a patient that that was dying. The 79 year old patients HR was 130 and BP 160/90 SaO2 54 . She had entered the phase where secretions weren't moving and was making that death rattle. My preceptor gave her 1ml of Ativan. It appeared to me that she was choking after administrating the Ativan. She told me that because her O2 levels were down she was gasping for air. I have seen many patients die while I was a personal care tech. And personally, I have never seen this before. I've looked on line and books and seriously can't find where giving a liquid med is ok when secretions aren't moving. Is it the norm to give Ativan or any oral meds at that time, outside of roxanol that dissolves in the month.

[chillin4me]

That's a good point.. Thank you, that particular pt was under hospice and no IV line though..

[ClearBlueOctoberSky]

I really think that there are two different discussions going on. chill be is in Hospice and it sounds like the OP was in a Critical Care setting.

The setting matters on how interventions are administered. Pain and anxiety in transitioning and dying patients is handled differently in LTC and Hospice than it is in a a Hospital or inpatient setting. We usually don't have IV access, so our meds are given rectally, PO, or SL.

As a personal caveat to this, as a Paramedic doing Hospice transports, I have often asked for IV's not to be dc'd from the hospital, or have placed IV's on Hospice patients because my standing protocols for pain management were often based on that IV and with it, I would be able to aggressively manage pain. Without that access, I would have to call my online direction to give IM meds.

[ktliz]

I really think that there are two different discussions going on. chill be is in Hospice and it sounds like the OP was in a Critical Care setting.

You're right... I think chillceb's reply could be considered "hijacking" a post which leads to confusion. Chillceb, not sure if you realize it but this post is in the MICU/SICU forum.

[chillin4me]

My bad, i know it was from that setting, i was just asking one member relating to hospice. Sorry!

[ClearBlueOctoberSky]

Sorry about autocorrect butchering your name, chillceb. Didn't catch it until now.

[Do-over, ASN, RN]

You can wind up with a dying/comfort care/hospice patient in an ICU... Terminal weans, etc.

[ClearBlueOctoberSky]

You can wind up with a dying/comfort care/hospice patient in an ICU... Terminal weans etc.[/quote']

Yes, but you will still have the IV's to effectively manage them.

[Do-over, ASN, RN]

Yes, but you will still have the IV's to effectively manage them.

Not necessarily. I would not restart a bad iv on a comfort care pt, wherever they are.

[ktliz]

Not necessarily. I would not restart a bad iv on a comfort care pt, wherever they are.

True. So far haven't had this happen though. Often, when we withdraw care and the patient is too sick to go to hospice, they already have a central line/picc/port or something. If I lost IV access on my minimally conscious patient, I would be highly uncomfortable. Have gotten a some good info on this thread though... I like the atropine drops sublingually!

[Do-over, ASN, RN]

True. So far haven't had this happen though. Often, when we withdraw care and the patient is too sick to go to hospice, they already have a central line/picc/port or something. If I lost IV access on my minimally conscious patient, I would be highly uncomfortable. Have gotten a some good info on this thread though... I like the atropine drops sublingually!

Seen it several times. There is no issue with proper orders. The only times I am uncomfortable about losing IV access is when there is an intent to resuscitate/pursue curative treatment. Sublingual meds are highly effective. FWIW, I find sublingual morphine to be much better for these patients than IV anyway - even if I had a good IV I would go SL if given the choice.