Question regarding nursing care...

Specialties Hospice

Published

I have a question about standard nursing care on an inpatient hospice unit. I used to work on an inpatient hospice unit connected to the hospital. We often would get patients with tracheostomies...one of the nurses I worked with felt it was unneccesary to use sterile technique when suctioning and would often use the same suction catheter through out the shift. This question was posed to the hospice medical director and he felt that this wasn't a problem and was actually "okay" to do. Most of my fellow co-workers didn't see anything wrong with it either.

It bothered me immensly...I don't think the dying should have different standards of care just because they are dying.

Any feedback??

Up Vote Up Vote ×

Wow! That's pretty unreal. I would think that if this trach pt developed an infection they would be LESS comfortable, which kinda goes against the whole "comfort care" thing!!! GRRR :(

Up Vote Up Vote ×

It is my understanding that standards of care are to be exactly the same for hospice pts as for any other pt in a health care facility. This is legally mandated, though it may differ from state to state.

-Briar

Up Vote Up Vote ×

That is harmful.

Up Vote Up Vote ×

The patients that I was referring to were in the active phase of dying, comatose. So they felt the justification was that death was iminient so they were so point in suctioning using sterile technique. I don't think there ever is a justification.

Up Vote Up Vote ×

at that stage of life/dying, is to use a scopolomaine patch behind the ear to dry up all secretions. No longer need to section or hear a death rattle.

Up Vote Up Vote ×

Sometimes scopolamine doesn't work on tracheal congestion. For the most part, suctioning is only done when it's occluding the airway.

Up Vote Up Vote ×
Specializes in dialysis icu.
That is harmful.

hello

why is that harmful?

Up Vote Up Vote ×

I have used small doses of atropine also to help dry up secretions or those death rattles. I have also heard that the more you suction a dying pt the more secretions they produce. I agree that all patients should be treated with the same level of care so probably should use a new suction tube each time.

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

Standard of care in homecare and most hospice porgrams is clean technique using one new suction kit/day. Need for suctioning individualized, only done when absoulutely necessary. Inpatient hospice should follow same standard of care if individual room; those sharing rooms may need to utilize sterile techniquw to prevent cross contamination.

Focus on: new vs old trach.

Most patients with trachs several months/years duration only need daily cleaning inner cannula. room humidification if dry. They are used to own flora germs (you'd be shocked at how some older trached patients lived/cared for trach)

Patients wwith new trachs or those with copius secretions might need occasional suctioning. If actively dying, atropine or scopalamine indicated.

Up Vote Up Vote ×

We don't worry about sterile technique when a patient is in their own home. You are correct in that pt's are used to their own germs and flora in the home, but at a facility they are not surrounded by their own germs. There is an abundance of everyone elses germs in an ICF, just as there is in a hospital or nursing home and sterile technique should be used. On an imminent patient, I would not worry too much, but facilities should have policies in place.

Up Vote Up Vote ×

I have a daughter who has had a trach for the last 9 years, & what I was taught by the doctor who placed it & his nurse was what others here are saying..in the hospital the patient has "other" germs around..so the chances of them catching something is tenfold where as in the home or a smaller environment they are not. At home we use clean technique & my daughter has never had a trach infection from reusing suction catheters....we reuse the same one several times and suction sterile water through it after suctioning so it stays clear from secretions in the catheter which could harbor germs. They have in line suction kits for people,although we don't use it in my house (because I find it annoying & in the way) which gets changed 1x per 24 hours so thats re using if you want to get "technical" & without cleaning the catheter after use too.

They only time we change suction cathers with every use is if there are secretions that are not clear/white or just don't look right..or of course if there is a respiratory infection going on. All patients with trachs colonize funky germs like serratia and the whole lot....you could culture 100x and they will always have it...just the way it is. So relax ..I know it is drilled into your brain to use a new catheter every single time BUT that only applies to the hospital really when you are going to several different patients, more for decreasing cross contamination.

Also keep in mind insurance companies put a limit on supplies also....they allow for us at home 150 suction catheters a month which is about 5 per day...so you improvise.....what do you say .." oh sorry, I've already suctioned with your 5 allowed catheters today, no more suctioning for you!"

Just to make you aware!

I actually have 2 new nurses who started at my house recently & they just look at me like I have 10 heads when I try to explain the insurance limits & such to them & that you don't have an "unlimited" supply like in the hospital....once you're out thats it unless your time is here for new supplies to come...just the way it is..it's all $$$$.Unfortunately! So relax & try not to let that bother you...you'll be fine!;)

Up Vote Up Vote ×
+ Add a Comment