Deep Suctioning: Should We Do It At End of Life?

[tencat]

Hi, I've got a conundrum. A family wants the nurses to do deep suctioning on a conscious (although very confused) patient who has recurring aspiration pneumonias. We have a new nurse (new to hospice, 1.5 years experience total), and she's all for trying it. I wouldn't be comfortable doing it for several reasons: 1.) I've never done it except on a practice dummy 2.) Sending a catheter down the nose and the back of the throat into the lungs does NOT sound comfortable to me AT ALL and hospice IS about comfort. 3.) In the home setting I would worry about introducing more beasties into the lungs this way (though a home might be cleaner than an ICU :) ) This family also will not allow the patient to have any morphine because an ignorant doctor told them that it had caused him to have pneumonias in the first place. I did tell the new nurse that I didn't think it was such a great idea because of the infection issue and the comfort issue, but she had to use her nursing judgement to make the call. In all respects, this new nurse is going to be a good hospice nurse, I think, when she comes to understand what defines comfort for a patient at the end of life. I'm just kind of torn between supporting the nurse and advocating for this poor patient whose family doesn't understand hospice and doesn't care to (they keep taking the poor guy to the hospital at regular intervals when he sniffles). Any thoughts would be much appreciated!

[leslie :-D]

what is hospice there for, if you can't give her morphine or anything for comfort?

fwiw, that'd be my first priority...advocating for her comfort.

i am totally opposed to deep suction.

it is invasive, and can suck the o2 right out of you.

whatever happened to atropine, scopolamine, etc?

leslie

[ErinS, BSN, RN]

I agree with Leslie. What a mean thing to do to someone at the end of life. I think the family needs some education on lots of things. The use of morphine, the cause of aspiration pneumonia, death from pneumonia (generally easily managed in my experience). Also, suctioning can often result in rebound secretions. When a family is insisting on something that I feel is cruel I discuss how it is done, why it is done, and suggest some interventions to try first (like scopolamine). Good luck.

[tencat]

Thanks for your replies. This particular family has been educated until every nurse has been blue in the face, to no avail. Three different nurses have been in there to educate. I agree: Why is hospice even there??? Because the company I work for wants the money, and the family of the patient loves to use any and all resources they can get their paws on. I have felt that this poor patient should be discharged as we are only providing some equipment for him, but not allowed to do anything else to keep him comfortable. I wish the poor guy would just go as he is really suffering and we're not allowed to help. He's no longer my patient as I was pretty straight with the family about his condition and they got very angry with me and 'fired' me, which is a GOOD thing as I hate to sit by and watch someone suffer because the family is crazy. The guy's family physician is of no help as well, because he's got them convinced that morphine is the cause of all of the issues, and that atropine, etc. will just dehydrate the patient or cause an irregular heartbeat that will hurt the patient.

[evolvingrn, BSN, RN]

When i first started I suctioned a pt, the look of terror in his eyes was horrible. The only time i do suctioning is with Gi bleeds now. Suctioning actually exacerbates the issue at the EOL and can cause more mucus and congestion to present.

[saribeth]

never, never, never....these poor pts have been through enough already by the time they come to us. :grn: Good that you listened to your gut!!!!!

[systoly]

Thanks for your replies. This particular family has been educated until every nurse has been blue in the face, to no avail. Three different nurses have been in there to educate. I agree: Why is hospice even there??? Because the company I work for wants the money, and the family of the patient loves to use any and all resources they can get their paws on. I have felt that this poor patient should be discharged as we are only providing some equipment for him, but not allowed to do anything else to keep him comfortable. I wish the poor guy would just go as he is really suffering and we're not allowed to help. He's no longer my patient as I was pretty straight with the family about his condition and they got very angry with me and 'fired' me, which is a GOOD thing as I hate to sit by and watch someone suffer because the family is crazy. The guy's family physician is of no help as well, because he's got them convinced that morphine is the cause of all of the issues, and that atropine, etc. will just dehydrate the patient or cause an irregular heartbeat that will hurt the patient.

So now dehydration is a bad thing? What a duck.

[tewdles, RN]

so...the flippin physician is an idiot who doesn't understand end of life care...that explains much.

[leslie :-D]

so...the flippin physician is an idiot who doesn't understand end of life care...that explains much.

there's a lot of those type docs, too...

who have absolutely no business in dealing with eol.

leslie

[tencat]

there's a lot of those type docs, too...

who have absolutely no business in dealing with eol.

leslie

And they all live in the town I live in....sigh......

The patient in question finally got to die after trying to do it for months and being thwarted at every turn. I hope he finds the peace he didn't get at the end of his life.....

[SoCalRN1970]

Have you ever been deep suctioned? I have, and it hurts! I also have had this done due to having my jaws wired after surgery.

I make sure when I get the request for this I explain, I have had this done, it hurts! I also had an NG tube.. it hurt the back of my throat so much I could barely talk... so I use this as my own input on such options. Neither fit my idea of what hospice is. I can deep suction like the best of them, do I like ot do it? no, does it hurt the patient? yes, Does it make a difference? No, the patient is dying anyway.

[jrowmom]

The Dr. sound like the problem. I wonder if he will want morphine on his death bed??? I would assume they are considering this after scopalamine patch tried??? Ignorant question but would it be more comfortable to be suctioned, I mean afterwards for the patient??? I don't know. Or would it just come back worse and prolong? Kudos to you hospice nurse BTW. Asking these questions because I may one day (if I am ever ready) want to be a hospice nurse.