chillin4me 526 Posts Specializes in Hospice. Has 3 years experience. Mar 12, 2014 That's a good point.. Thank you, that particular pt was under hospice and no IV line though..
ClearBlueOctoberSky 370 Posts Mar 12, 2014 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 379 Posts Specializes in critical care. Mar 13, 2014 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 526 Posts Specializes in Hospice. Has 3 years experience. Mar 14, 2014 My bad, i know it was from that setting, i was just asking one member relating to hospice. Sorry!
ClearBlueOctoberSky 370 Posts Mar 14, 2014 Sorry about autocorrect butchering your name, chillceb. Didn't catch it until now.
Do-over, ASN, RN 1,085 Posts Specializes in CICU. Mar 14, 2014 You can wind up with a dying/comfort care/hospice patient in an ICU... Terminal weans, etc.
ClearBlueOctoberSky 370 Posts Mar 15, 2014 You can wind up with a dying/comfort care/hospice patient in an ICU... Terminal weans' date=' etc.[/quote']Yes, but you will still have the IV's to effectively manage them.
Do-over, ASN, RN 1,085 Posts Specializes in CICU. Mar 15, 2014 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 379 Posts Specializes in critical care. Mar 17, 2014 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 1,085 Posts Specializes in CICU. Mar 17, 2014 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.
