Hurrying death? - page 3

I really need some opinions please. I have a patient who is on hospice and did have some pain issues where roxanol was effective for them. However today it appears as if the doctor and family have... Read More

  1. by   tinks599
    Quote from mappers
    At the LTC facility where I teach, they frequently place a subQ line. They give ativan and morphine through that Q1-2 hours. Is that not common in other palliative situations?
    I have seen records from multiple states. I see some areas where Q1-2 hour orders is more common, others the orders are PRN. I think both are likely equally as common if you average them but it tends to go with the comfort level of the directing physician.
  2. by   johnys
    [/QUOTE]"Yes, when I worked in hospice we did use highly concentrated liquid forms of morphine and sublingual ativan on our patients who were actively dying. Most of them did not have veins that could support IV access. Besides, why cause a dying patient more pain with repeated sticks (IV, IM or SC)? Absorption/circulation of the drug may not be as efficient as oral mucosal route. [QUOTE)

    I know this is a mildly older thread, but I have seen discussion about the absorption of SL/PO morphine and more importantly, WHERE it is absorbed. Much (but probably not enough) research has been done (with healthy subjects - not dying people) on the bio-availibility of nebulaize, PO, SL, IV, SC, PR equianelgesic doses of morphine.

    [/QUOTE]Pharmacology: Sublingual administration of morphine is often used to treat breakthrough pain in an attempt to hasten analgesic onset and peak; however, available data do not support more rapid absorption of morphine through the sublingual mucosa when compared with the oral route (1-3). Indeed, a number of clinical studies have found no substantial advantage to the use of SL morphine over oral morphine (4-6).

    •Mean time to maximum concentration has been shown to be shorter following PO morphine (0.8 + 0.35hr) compared with SL (1.75 + 1.30 hr), indicating that SL morphine is likely swallowed and absorbed gastrointestinally rather than through the oral mucosa. From (Fast Facts from the EPERC).

    Morphine placed in the mouth is not well absorbed through the oral mucosa - something about its lipid insolubility and the pH of the IS absorbed via the GI tract, but is subject to 1st pass hepatic metabolism. I have not had much sucess with clients who are not able to swallow AND in pain - will go to PR, IV or SC route (preferably not PR but it can be effective) anytime I can.
    Just my .01 cent. BTW, hospice nurses rock!