To Suction or Not To Suction, End of Life & Hospice Patients - page 2

I've been an ICU RN for 15yrs, so I have dealt with End of Life Care plenty. I was always taught to either oral suction or deep suction with a suction catheter if your patient sounds like he or she... Read More

  1. by   jodispamodi
    When I worked in hospice we strongly advocated against suctioning, in fact it could trigger the gag reflex and cause more distress. We advocated for/ and encouraged drying meds such as levsin and atropine but secretions at eol are usually much more distressing to the family than the patient themselves, so we'd educate family but no we never suctioned hospice patients.
  2. by   Been there,done that
    I am not a hospice nurse, but I provided hospice care to many patients ..and my best friend. If the meds didn't dry up the secretions sufficiently, I would deep oral suction. I would not NT suction as it could be painful.

    I just didn't want to see her die , BECAUSE she was drowning in her own secretions.

    Was that selfish?
  3. by   WestCoastSunRN
    Quote from MunoRN
    For those that believe suctioning a death rattle is appropriate, maybe you could share your rationale.
    I wouldn't put myself in the 'should-suction-death-rattle' camp, but I will say that I think it really depends on if you really know you are dealing with terminal secretions. I have cared for people who have not yet been deemed "comfort care", but probably should have. This happens a lot in acute care. That's why goals-of-care discussions are so important.

    Defining end goals is crucial. If a patient is truly comfort care and obtunded, anticholinergics should be ordered and any suctioning kept to a minimum (and certainly no NT). My .02 -- as an ICU nurse (not always the best at giving Hospice-type care even though we end up doing that) whose seen many patients pass -- some with comfort measures in place.
  4. by   WestCoastSunRN
    Quote from Been there,done that
    I am not a hospice nurse, but I provided hospice care to many patients ..and my best friend. If the meds didn't dry up the secretions sufficiently, I would deep oral suction. I would not NT suction as it could be painful.

    I just didn't want to see her die , BECAUSE she was drowning in her own secretions.

    Was that selfish?
    I'm sorry you found yourself in this situation. I can't imagine how difficult that must have been. Regardless of whether she "needed" the suctioning (none of us were there, you were) you most certainly were not selfish. Selfish does not describe those who care for their loved ones in the way you did for your friend.
  5. by   bb31677
    I came across this article on Facebook and registered for this site just so I could chime in! I work in an ICU where we use the no bite V and it truly is a game changing product. I highly recommend that you speak to your supervisors about getting it in your hospitals if you do not have it already.
  6. by   MunoRN
    Quote from bb31677
    I came across this article on Facebook and registered for this site just so I could chime in! I work in an ICU where we use the no bite V and it truly is a game changing product. I highly recommend that you speak to your supervisors about getting it in your hospitals if you do not have it already.
    The No-bite V does not make suctioning less uncomfortable, it only prevents the patient from being able to defend themselves by biting down on the tube.

    If any of you decide to suction me while I'm actively dying, I promise to do everything possible to haunt your remaining days with any form of torture I can muster in the afterlife.
    Last edit by MunoRN on Jan 25
  7. by   ruthieb16
    My mother passed away 13 years ago today. The reason I am researching suctioning is that I still wonder if we should have allowed it. My daughter and I sat with my mom, and as her rattles became louder it was distressing to us. She seemed at peace. Our concern was her strangling, or feeling as if she were strangling, on her secretions. We asked her nurse what she advised and she said "if it were my momI would suction". So she grabbed a catheter and suctioned deeply. My mom gagged and her entire body lunged forward from the bed. She went completely limp, palms up...I wouldn't want anyone to have my experience with a loved one being suctioned.
  8. by   NickICU-RN
    "Always and never.....the enemy of good Medicine!!!"

    From what I've gathered here the grand consensus is to do assessment based suctioning and then "Suction with Dignity", PRN.

    Although, some clinicians here are insisting that they NEVER EVER Suction, no matter what. My friend's mother was let go at a hospice facility, sounding like she was drowning on her own secretions, and when he asked to get her suctioned, the staff said they do not suction here. He said this haunts him to this day. (His exact words)

    again: "Always and never.....the enemy of good Medicine!!!"

    I get it..., nasal suctioning is considered torture at End-of-Life, but if you need to suction, at least use a No-Bite V and insert a suction catheter into the oral airway. This suctioning is the least traumatic suctioning you can do for your comfort care patients. This is the definition of "Comfort Care" and "Suctioning with Dignity", as long as it is on an assessment based, PRN basis. I don't think anybody was ever advocating for suctioning on ALL End-of-Life Care.
  9. by   MunoRN
    Quote from NickICU-RN
    "Always and never.....the enemy of good Medicine!!!"

    From what I've gathered here the grand consensus is to do assessment based suctioning and then "Suction with Dignity", PRN.

    Although, some clinicians here are insisting that they NEVER EVER Suction, no matter what. My friend's mother was let go at a hospice facility, sounding like she was drowning on her own secretions, and when he asked to get her suctioned, the staff said they do not suction here. He said this haunts him to this day. (His exact words)

    again: "Always and never.....the enemy of good Medicine!!!"

    I get it..., nasal suctioning is considered torture at End-of-Life, but if you need to suction, at least use a No-Bite V and insert a suction catheter into the oral airway. This suctioning is the least traumatic suctioning you can do for your comfort care patients. This is the definition of "Comfort Care" and "Suctioning with Dignity", as long as it is on an assessment based, PRN basis. I don't think anybody was ever advocating for suctioning on ALL End-of-Life Care.


    Again, the "no-bite" suction catheter does not in any way make suctioning less traumatic, if anything it makes it more traumatic. All the "no-bite" part of it does is prevent the patient from being able to defend themselves. It's like saying if you're going to punch your patient in the face, you should tie their hands down so they can't defend themselves, because that's less traumatic.
  10. by   CaroleRRT
    I have worked as an RT for over 30 years. I am in total agreement with your "Suction with Dignity" option. There are ways that it can be done with minimal discomfort, as you have mentioned. One must assess each situation on its own merits. I am more inclined to not NT suction as this is generally a more traumatic option. The option that provides relief & comfort to the patient should be the one chosen.
  11. by   imintrouble
    I only suction the dying patient when the family insists. I try, try, try, to convince them it's pointless and uncomfortable, but sometimes it's all about how the family feels. Not the patient.
    I've always considered suctioning a form of torture. Secretions build up, suction them out, secretions build up, suction them out. A cycle that simply prolongs the dying process. Not everybody thinks the way I do, so I keep my belief about torture under my hat.
    I feel the need to explain the torture thing. That's a personal observation. I'm not saying the nurse who suctions is evil and sadistic. Not saying that at all. I'm sure the nurse who thinks suctioning makes the patient more comfortable thinks I'm evil and sadistic. I've even had one or two tell me they thought I was wrong headed about this issue. Maybe when I'm dying, and I'm rattling enough to raise the roof, I'll know which one of is right.
    Last edit by imintrouble on Jun 6
  12. by   Leader25
    I just know how awful it feels when you are in the dentists chair all the way back and secretions are backing up in the throat,a little bit of suction goes a long way to providing comfort.
  13. by   Tenebrae
    I'm anti suctioning in end of life patients.

    I prefer the use of postural drainage, that is 2-3 nurses turning the patient onto their side with their head down and allowing the secretions to drain naturally, it can also be an opportunity for the family to be involved in the process.

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