Patient Picking At Clothing/Bed Linens

Specialties Home Health Nursing Q/A

Has anyone ever seen this? I work in home health and have a patient with multiple serious health conditions. During a visit the other day, she seemed normal clinically---all VS normal for her, her O2 Sat and everything else on her exam was OK.

She was resting on her bed, but opened her eyes and talked to me and answered appropriately when I spoke to her. The only thing different was that she seemed distracted (for lack of better term), and kept moving her hands around like she was picking at her clothing and the bed linens.

When I called her daughter to update on mom's condition, the daughter mentioned that patient had been talking about having seen her brother.....the patient's brother that passed away 30 years ago. I didn't say it to the daughter, but know that shortly before death, many people see and speak to loved ones that have already died.

Thoughts? Is this picking behavior unusual? Wasn't even sure how to chart it, what would you say?

34 Answers

Specializes in ICU, Ortho, LTC, Hospice, Anesthesia.

As a former certified hospice and palliative nurse, this "picking" behavior (the official term is carphologia) is commonly seen in delirious patients near the end of life. Based on this patient's condition, plus talking with people who have been long dead, this may be just a sign of impending death.

Specializes in hospice.

We see it all the time in Hospice, sometimes they will just put their hands in the air, pretend they are eating something, or other things with the hands. Also talking to and about people who have already passed, and about 95% of the pt's, if they can communicate will see little children, regardless of the diagnosis, they will talk about children, babies. It is not scary to them, but they all seem to see the same thing.

A long time ago they used to say it was caused by lack of oxygen, but when they checked, the 02 sats are fine. Some say it's because of the narcotics, but I see the same thing with people who are not taking any medication.

People with dementia can "pick" for years, but when combined with other symptoms, we can tell when it is getting to the end of their life. It may be time for a hospice consult.

Specializes in Rehab, Med Surg, Home Care.

I have heard "picking" described as a archtypical end-of-life behavior and have seen it on occasion in pts that were getting close (ie-weeks to days).

Specializes in Acute Care, Rehab, Palliative.

Yes I have seen the picking motion in patients with dmentia, most often Lewy Body.They will also make a motion that is like picking threads off of things.

Specializes in Acute Care, Rehab, Palliative.

The picking will be part of the decline.

Specializes in PACU, pre/postoperative, ortho.

Besides dementia pts, I've seen something similar in a pt that had what I consider kind of an absence seizure in the chiro office I worked in. The treatment table uses hydraulics to raise vertically for the pt to step on. When it was raised up so she could turn to her back, she just stood on the platform with a blank look on her face, mumbling to herself & picking at the towel that covered the table. It lasted for probably 2-3 minutes while the doc & I looked at each other like "what the heck?" Pt didn't recall anything when she "came to". We immediately set her up for a neuro consult & turns out she had a brain tumor. She had come to us following an MVA which she had caused & seems that she probably had one of these "episodes" at the time of the accident.

Many of my Alzheimer's and dementia pts 'pick' as if they are picking lint off something. I've also seen it in pts who's health declined and they were heading for the "Celestial Discharge" and right before some of my patients started actively dying.

Specializes in Medical-Surgical.

I've only worked with a few residents who were actively dying but all of them had the "picking" symptom, they would pick at things on their clothing, their skin, even my skin when I held their hands and whatnot. It wasn't always immediate to their passing, one of my residents started this a few months ago and just passed a couple nights ago (:(). Very weird.

I found these:

floccillation /floc-cil-la-tion/ (flok″sĭ-la´shun) the aimless picking at bedclothes by a patient with delirium, dementia, fever, or exhaustion.

Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

carphology

(kăr-fō-lō′jē-ă)

[Pronunciation]

(-fŏl′ō-jē)

[Gr. karphos, dry twig, + legein, to pluck]

Involuntary picking at bedclothes, seen esp. in febrile delirium.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

People who are in the pre-imminent to imminent stages of dying often exhibit that type of restless behavior as well as seeing and speaking to deceased loved ones.

Does her overall level of decline support the thought that she may be nearing death? Is she still swallowing? How is her peripheral perfusion? What is her functional status?

This is called plucking. It is a sign of kidney failure. Acid in urine is entering the blood stream which causes them to see something as they have open eyes but looking up or away. I forget the actual medical term. This comes with 2 other signs that the end is near. It can also be painful. Ativan does help to keep patient calm. We call 2 other signs for lack of better words, the "O" and the "Q". O is when patient has open mouth, shape of O and breathing sounds like they are snoring. The other is "Q". The mouth is open but with the tounge out to the side. The plucking can come and go and at times having ativan on hand will help to slow or stop "plucking".

Sorry about my spelling folks, long week with a friend who is near her end and having these symptoms now. Please ask a doctor to explain plucking to get proper medical term and make sure i am explaing it all correctly. This is the basic explanation i reveived from a retired dr. Just today.

"Picking" is not always in relation to hospice patients. I work on a Neuro Critical Care unit and many patients (who fully recover), exhibit the picking behaviors. Usually it's a hyper focus on one item, such as a SAT PROBE, straightening the bed linens, or pulling at the nape of their gown. It's related most often to frontal stroke injury, and is common within the first week or so after a stroke or re-bleed.

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