palliative pain management

ShayRN · Oct 30, 2008

It sounds like our CADD pumps. We use those a lot in Hospice care. I am sorry for your friend's loss and that her husband had to suffer. Unfortunately, there is a lot of misconceptions that continue even among health care workers about the use of morphine and end of life. It does not get used anywhere near enough, IMHO.

classicdame, MSN, EdD · Oct 31, 2008

We are taught the dangers of morphine so well, that we forget sometimes WHY we give it. The idea is not maintenance, like an antibiotic. Yes, the patient may develop respiratory suppression. But if he/she is dying anyway why not help prevent them from dying in agony and give the stupid medicine! Sorry. One of my pet peaves. I am also sorry that your friend, and by extension YOU as well, are having to grieve over this situation.

juliarn · Oct 31, 2008

Thank you for the responses.

The man in question did receive adequate morphine, it just the method of delivery that I am querying.

The hospice nurses sounded very caring but the insisted the morph had to be given orally...and I am puzzled why no thoughts of using a pump were considered and wondered perhaps is they are not used in the US for this purpose..

thank you again

leslie :-D · Oct 31, 2008

Thank you for the responses.
The man in question did receive adequate morphine, it just the method of delivery that I am querying.
The hospice nurses sounded very caring but the insisted the morph had to be given orally...and I am puzzled why no thoughts of using a pump were considered and wondered perhaps is they are not used in the US for this purpose..
thank you again

in hospice/palliative care, it is our goal to administer meds in the least invasive way.

morphine is well absorbed po/sl.

iv is often a last resort.

if using mso4 20mg/ml, you can give an effective dose in a minimal amt...

which is very well tolerated amongst many of our pts.

as long as they are receiving scheduled doses atc, there is no reason why pain cannot be well managed.

focusing on the amount is much more significant than the method in which it's delivered.

blessings,

leslie

juliarn · Oct 31, 2008

thank you for the response. I quite agree about dose and method.

But in THIS case, he could not swallow and aspirated the morphine more than once And his family would become distressed with the obvious gagging etc that ensued. Is this not a case to use a pump of some sort when patients cannot swallow?

leslie :-D · Oct 31, 2008

thank you for the response. I quite agree about dose and method.
But in THIS case, he could not swallow and aspirated the morphine more than once And his family would become distressed with the obvious gagging etc that ensued. Is this not a case to use a pump of some sort when patients cannot swallow?

absolutely!!

we do sc or iv infusions, or even suppositories when po would be contraindicated.

something sounds terribly amiss.

i'm so sorry he had to endure that...

leslie

NewWayofLife · Oct 31, 2008

but in this case, he could not swallow and aspirated the morphine more than once and his family would become distressed with the obvious gagging etc that ensued. is this not a case to use a pump of some sort when patients cannot swallow?

if he was aspirating it, then yes, sq could have been used. however, roxanol (which is sl/po morphine 20mg/ml) is absorbed sl, and often dosed in fractions of an ml (i.e.- 0.5ml). when i worked a ltc, we often saw it tolerated by patients with no ability to swallow. some hospices prefer it because it's the least painful (usually) way to administer it. also, the patches were likely fentanyl patches, which are usually excellent and also non-invasive, and do provide quite a bit of pain relief.