Giving pain meds thru a colostomy?

txspadequeenRN, BSN, RN · Nov 22, 2005

You can also use morphine solu-tabs or morphine topical gel.

GLORIAmunchkin72 · Nov 25, 2005

When the patient's respiration is already low, which route is best as to not depress it further and still suppress the pain?

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.

suebird3 · Nov 27, 2005

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.

i was thinking of the remaining rectal area, also. of course, i would want to know where the colostomy is located; i would ask the local hospice about the colostomy site route....:)

suebird

saribeth · Dec 18, 2005

hi...our medical director says it is difficult to know how much is actually being absorbed when given in the stoma of the colostomy, but we are giving a pt a 3mg dilaudid suppository and it is really helping her...she has big issues with n & v...hope this helps :rolleyes:

Chaya, ASN, RN · Dec 18, 2005

We give morphine sub-cu to our "care-and-comfort" patients but a patient who is still able to take oxycontin orally will receive a more even level of pain control.

Trauma Columnist · Dec 18, 2005

What about sub-buccally? That is how our hospice gives many liquid meds - painless and quickly absorbed and can be titrated easily to effect.

sjrn85 · Dec 18, 2005

If you switch from long-acting to short-acting, that's going to require more frequent dosing; not optimal.

We gave MS Contin/OxyContin rectally quite often, and I didn't see any appreciable difference in pain control. If your doc doesn't want to do it that way, then maybe try switching to methadone.

compassion1 · Dec 18, 2005

In the hospice I work for, we often maintain a base dose of MS Contin po or pr q12h then use Roxinol prn for breakthrough pain as often as q1h prn. This is usually pretty effective. I've used the colostomy route, before, with good results

Hellllllo Nurse, BSN, RN · Dec 18, 2005

I like the sc route for administration of MS for breakthrough pain best.

In my experience, it's sometimes hard to get Roxanol under the tongue, and sometimes it dribbles out or to other areas of the mouth. Plus, the little dropper gets contaminated from touching the person's motuh, and you have to put it back into the Roxanol bottle that way.

An IV gelco can be inserted sc, with an opsite on top. These sites usually stay good for weeks to months.

Then, the sterile sc dose is drawn up, given in the sc gelco, and flushed with about 0.5cc of NS.

This can be done with the pt asleep, and does not stimulate or "bother" the pt like giving sl/buccal meds sometimes does.

ray2512 · Dec 19, 2005

There is absolutely nothing wrong with putting a slow release morphine pill in a colostomy, and you don't have to put it in a gel cap. That would be better and easier than using a pump to deliver it sc or any other route. Remember using pump can restrict the movement of clients or make them feel like they are on a leash.

Nemhain · Jan 2, 2006

i was thinking of the remaining rectal area, also. of course, i would want to know where the colostomy is located; i would ask the local hospice about the colostomy site route....:)
suebird

i was wondering too about the position of the colostomy. hmm...if you put meds in, wouldn't they be on their way back out soon after? maybe something that absorbs quickly....

ray2512 · Jan 2, 2006

You don't need to put Roxinal in anything it asorbs in the oral mucosa but you can if the client is able to swallow soft foods.