Neuro ICU - Withdrawl of life this so wrong? - page 3

I am a traveler and had my first withdrawl of life support at this facility. Well I recieved the order to Extubate, turn off Dopamine, give 5mg Morphine IVP and to leave Diprovan on for comfort. My... Read More

  1. by   nurseabc123
    I haven't read much of this thread, but I have taken care of several patients of which we have withdrawn support on my shift. I did this just yesterday.

    I find it extremely rewarding to help someone 'die with dignity' and support a family in a time of terrible grief. It's especially refreshing when a family member actually acts upon their family member's (the patient's) wishes and does withdraw.

    I find it more difficult to take care of a patient that did not want to be re-intubated/full-code, etc. and the family goes ahead against his/her wishes.

    I have worked with both of these types of situations.. I would rather help someone die, than keep them alive against their wishes.

    Upon extubation, I give as much ativian/morphine as I can and as frequently as I can, as ordered.
  2. by   newohiorn
    I'm new to neuro ICU but, in my opinion, I don't think you did anything morally wrong but I'm not familiar with the law with regard to Diprivan in this situation.

    I do think that Diprivan provides comfort because it is a sedative-hypnotic and this to me indicates that it would help with relaxation, which I consider comfort. I do not think providing comfort always means pain relief as in a narcotic. In fact, to me, if the patient does not appear to be in pain I think it makes more sense to provide comfort in the form of anxiety relief and relaxation than it does to snow someone with narcotics.

    My interpretation of the original post was that the patient didn't seem to be in pain, although I realize we can't know that but I think we have to treat as best we can based on our assessment. I don't think we know for sure that dying from withdrawal of care would necessarily be painful but to me it seems that it would be more anxiety and even panic producing, which I think is better controlled with meds for those conditions than meds for pain like narcotics.

    Just my 2 cents
  3. by   Designer NP
    My sediments exactly. This is the point I've been trying to get through to everybody else who thinks my position on this was wrong. Thanks
  4. by   newohiorn

    You're welcome. I wasn't sure I was getting my point across but it sounds like maybe I did.

    I formerly worked on a spinal surgery floor where EVERYBODY is in pain. One of my biggest surprises in neuro ICU is how many of the patients deny pain. I realize they have brain issues so maybe they aren't able to express themselves but pain seems to be a relatively rare issue in neuro ICU compared to where I came from where I jokingly described myself as a licensed drug dealer.

    I guess my thought is that if I were A&O and having care withdrawn from myself I wouldn't want to be snowed on narcotics but rather I would like anti-anxiety meds so that I'm alert (if possible) but not panic-stricken.
  5. by   lorilou22RN
    I was not involved in this but, heard about it when I came in on Sunday. This patient was having life support withdrawn, and the CCP pushed 300mg of fentanyl, after extubation...he of course died within minutes. Now that could be considered euthenasia. (none of the nurses would push that amount, hence the doc did.)
  6. by   SuesquatchRN
    I think you are a kind and compassionate person and I would want you to take care of me when my times comes.

    Keep them comfortable even if it does mean hastening their death (and I'm not saying this did).
  7. by   lorilou22RN
    Quote from Suesquatch
    I think you are a kind and compassionate person and I would want you to take care of me when my times comes.

    Keep them comfortable even if it does mean hastening their death (and I'm not saying this did).

    FYI OP, I think you did right too. Not a prob here. Some people in nursing wouldn't see it that way.
  8. by   gasmaster
    Double check this but I'm pretty sure that per FDA only a CRNA or MDA can use propofol on a non-intubated patient. As I'm sure you are all aware, we as RN's can't push propofol for conscious sedation. I ran into this situation a few years back: the doc wanted propofol for conscious sedation & it was a big to-do, resulting in a CRNA being at bedside to do so. The PharmD stated that it was because RN's can only use propofol on patients who have protected airways because it is an induction agent. I'm not sure if it was just our hospital policy or if he was correct so double check.
  9. by   Designer NP
    I completly understand this. I would never give Diprovan to a non intubated pt. I can see in this instance thought that it is a very fine line about what is right or wrong. I just wanted to know what others thought of this situation. Thanks.
  10. by   ProfesseureTournesol
    The use of Diprivan is seen more and more in palliative care, especially in oncology, therefore, on non-intubated patients. It's used for conscious sedation with patients who respond poorly to benzo, or as a treatment for severe nausea and vomiting. As for who can or cannot give Diprivan to a non-intubated patient, I suggest you double-check. In my facility, we can, but its not in USA. We often have a Diprivan perf for our non-intubated patients, to be titrated according to a prescribed RASS score.
    IMO, I think you did right ! :spin:
  11. by   oneillk1
    Quote from cardiacRN2006
    Propofol has nothing to do with comfort. How sad.
    Could it have been for the comfort of the family rather than the comfort of teh patient?
  12. by   skinnyNurse
    I am a new grad nurse. I have not seen someone removed from life support yet. I had no idea that this could happen (meaning the patient struggles). I am thankful for the article because it taught me something. I hope that you will go on and continue your nursing career, like everyone else has said, you will know how to prepare other families and now, thanks to you, so will I.
  13. by   10MG-IV
    When in the situation of a terminal dying human, most are not comfortable. We at times avoid the room, do the q 1 hour turn and assessment, look at the family gathered around the bedside and offer words of comfort some how. We have all the tools we need to allay suffering. we know the outcome, yet we are never ready. I have pushed more morphine Diprovan ativan inapsine than a narc box can hold and until the soul/spirit is ready to leave the body, will death occur. just my observations of watching the last breath sitting at bedside and being there with the families. I have seen patients receive ungodly amounts of the above and none have taken their last breath while large doses of morphine was pushed. Many refused to die till they were good and ready... till a wedding was over, and the bride and groom came to their room, till the day of their pension would go into effect so their spouse could get benefits, till a brother sister mother father made it to the bedside. We give so much credit to ourselves and the medications we administer. We tear each other down with out seeing the whole picture. You have to live with yourself and your actions. Be true to yourself. Just remember the spirit is strong even though the shell is weak. Slow down and hold their hand talk softly and don't be afraid of the dying, don't be afraid to give the medication to keep them out of pain, physical or mental. That is what being a nurse is. relieving fear, pain and anxiety and helping one die with dignity. NurseCutie it sounds like you have insight and concern for your patients. Asking 4 opinions will get you many.
    Last edit by 10MG-IV on Dec 3, '08 : Reason: spelling