Death Rattle

I saw a few people mention the death rattle in another thread and that got me thinking...are scopalamine patches used a lot in hospice? I know we use them a lot in "wet" near death patients on my onc unit.

[Mazzi]

In our hospice we use Levbid (tablet under the tongue) because it is cheeper. We used to use Scope patches all the time and they work well/better. and easier for the family. Meds only HELP, I always stress to the family that it will not take away the moisture completely and the moisture doesn't bother the patient near as much as it does the family listening. Turning the pt to thier side also helps. We don't like to suction-only causes more production of fluid/mucus.

[aimeee, BSN, RN]

We have "comfort kits" in the home that contain hyoscyamine (levsin) tablets that can be given SL. Atropine is another alternative.

[Mazzi]

Boy, does God has a way of keeping us humble. Yesterday at work a fellow nurse told a pt to put the wrong amount of morphine into a nebulizer. I was upset for it was my pt. Then I post the wrong med. Just goes to show....Thanks Aimee for correcting it.

[saribeth]

Our hospice uses scope patches routinely for the death rattle...sometimes we even put 2 on! They work really, really well and the cost is approx $27 for a box of 5 and they are changed q 72h...and actually by the time they develope the rattle they usually pass away within 24-48h...hope this is helpful:p

[adrienurse, LPN]

We tend to put in an SC catheter (basically an IV cath inserted into the abdomen or thigh SC tissue) and we give all out meds SC through that. It's more reliable than transderm (which I've used but doesn't seem as effective as SC) SL and Neb routes. We tend to give scopolamine for congestion at the end.

[Mazzi]

Adrienurse: I have not heard of SC Cath. What is it? Is it like a SC morphine pump but used with other type meds? Tell me more??

[adrienurse, LPN]

An IV catheter (not butterfly -- standard IV cath) is inserted into SC tissue. Is secured in the same manner as an IV, with a saline lock. This is for use when other routes are no longer viable. From what I've seen, the person doesn not seem to feel discomfort at the site. Meds such as Morphine and Scopolamine are given. Must be very concentrated B/C site cannot handle infusions more than a couple cc's at a time.

[fab4fan]

Hmmm...that's interesting!

Usually, if a pt is having trouble with po's, we give the MS Contin or OxyContin rectally. Transderm scop. has always worked quite well, as do atropine gtts (you only need a tiny amt.).

It is interesting to see how practice varies depending on location, though.

[adrienurse, LPN]

contravercial, but fluids can be given thorough this site by hypodermaclysis. Through an IV pump at a very slow rate.

[adrienurse, LPN]

My facility has a very progressive palliative care unit, so all our "death care" policies come from the practices there.

[Mazzi]

We too usually just give meds rectally. But there are times the family just cannot bring themselves to give it rectally or the patient has closed rectum/tumors. This is an alternate route. Thanks, I plan to follow up with our Medical Director and get a policy.