Atropine 1% Eye Drops SL

tewdles, RN · Jul 17, 2010

Lexxie said:
There is a resident who is on Hospice and actively dying. Towards the end of my shift today, he had an extreme amount of secretions that he was unable to clear by coughing. We have an order for Atropine Eye Drops, 2 drops SL q6 hrs. However the 2nd shift nurse who was taking over was adamant about NOT using it. "You have to be extremely careful when using that". Things happen, as usual, and I was unable to ask her what she meant by that. I know that Atropine affects the CNS, but the man is dying and was uncomfortable - ie: dyspnea d/t the secretions and was becoming restlessness. I know you can't read this nurse's mind, but can you help me to understand why she was being so cautios?
Thanks!

You have received some excellent responses...

Did you know that any hospice which regularly cares for patients in your facility would likely be happy to provide in-services (often with CEUs) on a variety of topics?

AtlantaRN, RN · Jul 17, 2010

She just doesn't know any better...........................educate. drying secretions is more important than a rapid heart rate.

ErinS, BSN, RN · Jul 19, 2010

Our current medical director is kind of funny about scopolamine and atropine gtts. He is fine with us using them but reminds us of the risk of psychosis. I have not ever seen this side effect myself, and we use these meds a lot and in big doses. Anyone else seen the psychosis with these meds?

leslie :-D · Jul 19, 2010

ErinS said:
Our current medical director is kind of funny about scopolamine and atropine gtts. He is fine with us using them but reminds us of the risk of psychosis. I have not ever seen this side effect myself, and we use these meds a lot and in big doses. Anyone else seen the psychosis with these meds?

this is a rare side effect, and usually happens with toxicity/overdose.

it's important to know when to initiate this particular therapy, as to ensure pt is in active dying process.

leslie

Ginapixi, BSN, RN · Jul 19, 2010

Personally I do not like to give atropine for secretions if the secretions are not bothering the patient and it is "just" mild "death rattle";often positioning on one side can relieve that- if families are bothered or the secretions are copious by all means go for it; we changed from atropine to levsin again and i still have to figure out the difference ie effectiveness; I do explain to families to give it until the symptoms are controlled, then back off, or why I hesitate to give atropine when a pt has a hr >100 to start with; why send them on a marathon?

I have also seen nurses start atropine way early and d/c it again because the pt is not actively dying; or i have seen nurses give atropine for increased secretions while the pt is still receiving iv fluids... Hello? Pump it in and try to dry it up - where is your brain???

If needed use, the pt is dying and if the secretions cause problems by all means

Then I am wondering: does it dry pts up too much? Do they experience extreme thirst during this process just before they die? Guess no one can really answer that one

tewdles, RN · Jul 20, 2010

Ginapixi said:
personally i do not like to give atropine for secretions if the secretions are not bothering the patient and it is "just" mild "death rattle";often positioning on one side can relieve that- if families are bothered or the secretions are copious by all means go for it; we changed from atropine to levsin again and i still have to figure out the difference ie effectiveness; i do explain to families to give it until the symptoms are controlled, then back off, or why i hesitate to give atropine when a pt has a HR >100 to start with; why send them on a marathon? i have also seen nurses start atropine way early and d/c it again because the pt is not actively dying; or i have seen nurses give atropine for increased secretions while the pt is still receiving IV fluids... HELLO? pump it in and try to dry it up - where is your brain???
if needed use, the pt is dying and if the secretions cause problems by all means
theni am wondering: does it dry pts up too much? do they experience extreme thirst during this process just before they die? guess no one can really answer that one

I like your balanced approach to symptom management, you could be my hospice nurse any ol' time.

I always advocate for a side lying position with the head low in those patients who are not dyspneic or orthopneic, and who have mild to moderate secretions. It seems to me that some people are afraid to try that position.

gwafuh_rn, BSN, RN · Jul 25, 2010

I have a question.It says that atropine is used prn for excessive saliva.But when I read the drug info,it says that it is used to prevent inflammation of the eyes.Im kind of confused

Ginapixi, BSN, RN · Jul 25, 2010

gwafuh_rn said:
I have a question.It says that atropine is used prn for excessive saliva.But when I read the drug info,it says that it is used to prevent inflammation of the eyes.Im kind of confused

Atropine is an Anticholinergic drug. A poisonous, crystalline alkaloid derived from certain nightshade plants, especially Egyptian henbane, atropine is used chiefly to dry up bodily secretions, to dilate the bronchi, to prevent excessive cardiac slowing during anesthesia, and in ophthalmology to dilate the pupil of the eye. It works by suppressing the parasympathetic nervous system. Atropine is also used as an antidote for nerve gas poisoning.

In hospice care we do not use it as eye drops but sublingually to make use of the drying effects

Does this help?

CQD, RN · Jun 20, 2011

Anyone aware of atropine 1% being used to control the profuse secretions of an elderly person with alzheimers, who is up and about?

My 91 yr old mother has alzheimers and is greatly distressed by the profuse secretions that leave the front of her clothing (or bib if she'll keep it on) soaking wet? She was always so meticulous about her own personal hygiene and appearance that I believe this is more of a dignity issue than a medial one.

Atropine drops have been recommended by the staff and I am not adverse to using them if the "cure" isn't worse than the condition. The scopalamine patch was tried and it was very effective on secretions, but each time it was used she became dehydrated, developed a UTI, and became bedridden and non-responsive. When the scopalamine patch was discontinued she rallied. She has now stabilized to the point that she was discharged from Hospice. She weighs 88#, walks around the memory unit much of the day and night, and has had no further UTI's.

Ginapixi, BSN, RN · Jun 21, 2011

CQD, RN said:
Anyone aware of atropine 1% being used to control the profuse secretions of an elderly person with alzheimers, who is up and about?
My 91 yr old mother has alzheimers and is greatly distressed by the profuse secretions that leave the front of her clothing (or bib if she'll keep it on) soaking wet? She was always so meticulous about her own personal hygiene and appearance that I believe this is more of a dignity issue than a medial one.
Atropine drops have been recommended by the staff and I am not adverse to using them if the "cure" isn't worse than the condition. The scopalamine patch was tried and it was very effective on secretions, but each time it was used she became dehydrated, developed a UTI, and became bedridden and non-responsive. When the scopalamine patch was discontinued she rallied. She has now stabilized to the point that she was discharged from Hospice. She weighs 88#, walks around the memory unit much of the day and night, and has had no further UTI's.

i would assume Atropine will have the same dehydrating effect as the scope patch did, also increases the heart rate

how about Robinul? we use it for our ALS patients with too much secretions

tewdles, RN · Jun 21, 2011

I recommend extreme caution with the anti-cholinergics outside of the dying process. It is not difficult for our fragile patient population to struggle with mucous plugs and atelectasis, etc when their secretions are "too" thick or tenacious.