Comfort measures??? (RE:Convalescing Home)

[mandykal, ADN, RN]

I have a question.....If a resident is on comfort measures, and has congestion to the point where he/she is having respiratory distress should a nurse suction the resident?

[Marty1]

Comfort measures to me are just that

to keep ones last moments here as comfortable as possib

[aimeee, BSN, RN]

I'll copy an opinion from another page:

As was mentioned by several members of the group, many patient surveys of post-intensive care unit (ICU) care identify suctioning as one of the most anxiety-provoking and painful ICU procedures.9 Critical care clinicians tend to underestimate the distress caused by suctioning. The question is, do we need to suction patients, especially when they are imminently terminal? Are we suctioning patients for their comfort or because of the caregivers' discomfort with the gurgling sound (death rattle)? Perhaps this is an example of the need for ongoing education of patients, families, and staff about the process of dying and what to expect when people die. So rather than suctioning patients constantly because the staff and family appear to be uncomfortable and thus subjecting terminal patients to unnecessary suctioning procedures, we might all be prepared for the types of sounds made by patients during the dying process, which may not necessarily reflect discomfort."

taken from: Palliative Care in Respiratory Care: Conference Summary

Mitchell M Levy MD

http://www.rcjournal.com/contents/12.00/12.00.1534.asp

That pretty much sums up my perspective. Positioning and something like scopalamine, hyoscyamine, or atropine to dry up those secretions to minimize the rattling is preferable to adding to the distress with suctioning. In addition to the reasons mentioned above, I have read in numerous places that suctioning actually stimulates more secretions.

[Denise Ashley]

I have a question.....If a resident is on comfort measures, and has congestion to the point where he/she is having respiratory distress should a nurse suction the resident? The company policy according to a nurse, "They don't suction a resident if he/she's dying." I know that lots of complications associates when a person is dying, swallowing is definitely one, but to have a person die like that, that isn't right. I think that any stage, especially when the person is like gargling should be suctioned. Than when we know the person is "Comfortable" We did our share, the rest is up to he/she to let go. Your oppinion is appreciated.

Our hospice frowns on suctioning because of the trauma it can cause to the mouth. Also, that interupts the patient as he/she may be trying to connect to Heaven. Have you tried scopalamine patches?

[chris_at_lucas_RN, RN]

I was ready to post my "yes suction" opinion, and then read yours--all of yours.

I had seen patients struggle when suctioning, but primarily when nurses were perfunctory and pushy about it. When the patient could help with their own suctioning, when the nurse was gentle and slow about going in, opting for more "going in" than duration, and when there was explaining PLUS the patient's right to say no (sometimes just having the option seemed to help them permit some suctioning, at least), they seemed to benefit more and have fewer (if any) complaints.

But I really like the meds idea. Really, really, a lot. Thanks for the new perspective. Too bad they don't think about this more with other patients in similar situations.