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!

[tothepointeLVN, LVN]

I'm having this issue on a case I'm currently on. Pt has a trach and I think she is being over suctioned. I caught the unskilled caregiver suctioning the patient behind my back yesterday even though I have told him not too and the RN case manager has addressed this twice. She was starting to get terminal secretions last night. I go back at 4pm and I can almost guarantee she'll be sounding nice and dry again.

Poor dear has not had fluids for 3 weeks. She's trying so hard to let go but no one is letting her for their own selfish reasons like job security.

[SoCalRN1970]

I have found, that it's been actually seen rather by me.. that pcg or hired care givers will do anything within thier power to keep their patient alive.. in turn to keep their job. I have seen morphine withheld, actively dying patinet put into wheel chairs and forced fed.

The only saving grace is I will and have gotten family involved with this issue well before the patient is actively going. "they are not following the plan of care". Witholding meds.. etc. Family members or the one's footing the bill can usually figure out it's not an emotional tye that prohibits the care giver from medicating the patient but fear of losing a job.

[tothepointeLVN, LVN]

The weird thing is about this case is the caregivers didn't start until continous care nursing started (2 weeks ago) as the patient was coming home after being in the nursing home for 2 years. So I'm not sure where this caregiver is getting the sense of job security from. Even today after my shift he were asking if she might last another week.

Of course what doesn't help is every time the daughter comes to talk to the nurse on duty he jumps up and tells her she's doing good that she's strong. Does not help at all.

[SoCalRN1970]

The weird thing is about this case is the caregivers didn't start until continous care nursing started (2 weeks ago) as the patient was coming home after being in the nursing home for 2 years. So I'm not sure where this caregiver is getting the sense of job security from. Even today after my shift he were asking if she might last another week.

Of course what doesn't help is every time the daughter comes to talk to the nurse on duty he jumps up and tells her she's doing good that she's strong. Does not help at all.

I have also found.. that sometimes culturally hospice philosophy doesn't fit. Meaning certain ethnicities and cultural religious beleifs are at times full barriers to full hospice care and symptom management. Of coures this is a stereo typical comment but it's what I have witnessed with my hospice pateints with hired. pcg. I have also noted ethnic pcgs at times get "it". They are first or second generation and have other insight.