Giving pain meds thru a colostomy?

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The patient's wife said he can swallow his MS Contin by mouth. He is in hospice now and is having difficulty swallowing his meds. I can't give MS Contin crushed in applesauce by mouth as that would cause an instant overdose right? I was thinking I could put the MS Contin into a gelatin capsule and then insert it into his colostomy. Would this be the correct way to do it? Any advice would be greatly welcomed. Thanks:)

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I Can't See How Pt Would Get The Effect Of The Med That Way. How About Liquid Roxinol In Pudding/applesauce.lidacaine Patch Good For Pt's Without Sub Q Fat.

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Specializes in Utilization Management.

A PR med through a colostomy wouldn't even occur to me, to be honest. I'm very interested in finding out if this is a viable route for this type of patient, however, so I'll be looking with interest at your responses, Blackcat.

I'd go straight to talking to Hospice and the doc about changing this patient over to Duragesic and Roxanol, or maybe even a PCA (if you can do them at your facility).

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Thanks steelcityrn and AngieO'Plasty:) . I will be going back to work on Monday night. Yes it should be interesting to find out how they are giving this man his MS Contin. At hospice, we usually give meds rectally if they can't swallow but this colostomy thing has me stumped.

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Or they could give morphine SQ.

A PR med through a colostomy wouldn't even occur to me, to be honest. I'm very interested in finding out if this is a viable route for this type of patient, however, so I'll be looking with interest at your responses, Blackcat.

I'd go straight to talking to Hospice and the doc about changing this patient over to Duragesic and Roxanol, or maybe even a PCA (if you can do them at your facility).

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When I worked in hospice, we did sometimes give MS contin in a gel cap in the stoma of colostomy pts. This is an accepted method, but switching him to a Duragesic patch or q2hr sc injections through a sc port (which can be just an IV jelco inserted sc, with an opsite on it) might be more convenient for the pt and the staff.

Also, he can still get rectal meds if his rectum is intact. Doesn't matter that the colon is rerouted: the med would be absorbed through the mucous membrane of the rectal vault.

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Thanks GLORIAmunchkin72 and Hellllllo Nurse.:p That's very interesting. I didn't realize that one could still give meds rectally to someone with a colostomy. I'm glad to hear that giving meds thru a colostomy is possible. I wonder if he will even be on MS Contin when I get back to work on Monday night. He had been a new evening shift admit and hadn't been evaluated yet by our hospice doctor.

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Specializes in Transplant, homecare, hospice.
Or they could give morphine SQ.

Morphine SQ? Huh? Really? I've never heard of that. IM maybe, SQ? Wow...I learn something new every day. Interesting.

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Morphine SQ? Huh? Really? I've never heard of that. IM maybe, SQ? Wow...I learn something new every day. Interesting.

IM route is not recommended for MS administration. It is the most painful route, andMS is poorly absorbed IM.

A method of giving MS in NS with an IV bag and tubing, but with the Jelco inserted SC is called CLYSYS adminstration.

Many hospices use sc push and Clysis.

Clysis and sc push are great methods, imo, and are not new. I don't know why they are not utilized more.

http://www.iasp-pain.org/PCU93b.html

http://www.aafp.org/afp/20011101/1575.html

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Specializes in Transplant, homecare, hospice.
IM route is not recommended for MS administration. It is the most painful route, andMS is poorly absorbed IM.

A method of giving MS in NS with an IV bag and tubing, but with the Jelco inserted SC is called CLYSYS adminstration.

Many hospices use sc push and Clysis.

Clysis and sc push are great methods, imo, and are not new. I don't know why they are not utilized more.

http://www.iasp-pain.org/PCU93b.html

http://www.aafp.org/afp/20011101/1575.html

Like I said, learn something new every day. I think I was....or thought I was talking about morhine...not realizing that MS Cotin is a derivative to morphine..Hmmm...thanks...this is interesting.

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Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS.

Our Hospice frequently orders it given rectally when the patient is unable to swallow. I don't think a colostomy would be that different. We don't use gelatin capsules, just the pill and lubricant. It seems just as effective as oral.

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I would avoid injects if at all possible. Patches, sl, pr and topicals are what we use most. We did the mscontin pr before....you should have seen the looks I got when suggesting it.

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