To Suction or Not To Suction, End of Life & Hospice Patients

[NickICU-RN]

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 needs suctioning. But of recent, I have run into some nurses with a different school of thought, in which they do not believe in suctioning of the dying patient.

"NOT to Suction"

Some nurses believe suctioning of the dying patient is actually more harm than good. They believe it is uncomfortable and goes against the comfort care principles. They feel suctioning is unnecessary because it is not a curative treatment of the dying patient, but only symptom mangement. Some think it makes the family feel better but does nothing for the patient.

• Nasal suctioning can cause Pain, Trauma, and Bleeding in your fragile End-of-Life Patients.
• Many patients in the active phase of dying are not aware of their surroundings and therefore bite down on or "tongue-out" suctioning equipment.

"To Suction"

Some nurses believe they are not only dealing with the patient but also the whole entire family, therefore treating both is of most importance. They think it only seems reasonable to suction a person who is in need, even if it is only considered symptom mangement. They want to give patients a dignified death, not one where they sounded like they were drowning in secretions as the family looks on.

• The Death Rattle is common and can be a very unnerving experience for families as well as caregivers.
• Medications and patches used to dry up secretions causing the Death Rattle do not always work... Some patients still require pharyngeal or subglottic suctioning, for example: pneumonia patients.

My Conclusion "Suction with Dignity"

Although I can understand not wanting to do excessive suctioning to a dying patient, some suctioning may be necessary. I would not consider any suctioning comfortable, but there are techniques and methods of suctioning that make it much more comfortable such as No-Bite V suctioning with the use of a red rubber catheter. Red rubber suction catheters are much softer and minimize any insertion trauma. And the No-Bite V allows you to introduce a catheter orally and avoid the nose altogether. I think everybody basically considers nasal suctioning an act of torture at this point, especially repetitive nasal suctioning. But if suctioning can be done in a minimally invasive manner, it increases the patient's comfort level once suctioned properly. And I definitely think suctioning a dying patient brings a calmness to the room, as well as the family. I would never want a family to take away that their loved one suffered or went through some difficulty breathing, in that they actually heard the patient's breathing difficulties in the form of the death rattle. This is something a family would never forget. A nurse's goal is to minimize any degree of suffering, physically and mentally, to both the patient and the families.

PLEASE COMMENT and share which side of argument you are on "To Suction" or "Not To Suction" your End-of-Life Care / Hospice Patients

Hospice and Palliative Care provides humane and compassionate care for people in the last phases of an incurable disease. The focus is on patient comfort and symptom management. One symptom, the death rattle, which refers to the gurgling noise of excessive secretions, can be misinterpreted as the sound of gagging or choking to death. The death rattle occurs in up to 92 percent of people actively dying and can be an unnerving experience for the patient's family as well as the caregivers.

One way to treat the death rattle is to dry up the secretions with medication. But that does not always work and some patients still require pharyngeal suctioning.

[Leader25, ASN, BSN, RN]

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.

[Tenebrae, BSN, RN]

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.

[heron, ASN, RN]

And when all else fails, there's always atropine, scopolamine and glycopyrrolate.

[anon456, BSN, RN]

I have struggled with this as well. My company doesn't take any particular stance on it other than to do whatever is needed to make the patient and family comfortable.

I also don't want a patient to die on my watch because of poor nursing care instead of because of their underlying disease. For example I will suction a trach to keep it patent. The patient should not die from a plugged trach. They should die because their body gives out from their disease.

Here's my general personal rules:

-- If the patient is fully aware or even partially aware of the fact that they can't breathe because of secretions, I suction. No one wants to die this way.

-- I then call the MD and advocate for further medications so the patient is not aware enough anymore. Generally if a patient is close to death from respiratory issues and aware of it, such as an ALS patient, Versed will be given to make the patient more comfortable and unaware of what is happening.

-- If the patient is unresponsive because of disease and dying process but still struggling to breathe, I suction only enough to preserve the patient's dignity (no one wants to die with secretions flowing out of their nose and mouth) and I make sure they continue to be medicated for respiratory distress, just in case they are aware in some way but can't tell us.

[dodah677]

They say one of the last senses to go is hearing. I don't want to lay there and listen to myself and I know my family and friends don't either. A trach suction tube is all one needs. Furthermore, are you going to let me lie in my bodily waste because it is too much to turn me? Get a life, we are nurses. We take care of patients first, then their families.