"butter bullets"--narcotics mixed with butter for rectal administration

[pammyf]

Have any of you used butter, which when cold molds like a suppository?

When a patient is no longer able to swallow, but still requiring larger doses of pain meds, and when IVs are too costly, I use this route. I mix the pain meds such as methadone (for the SRs we do not crush obviously). The family is told to administer every 8 to 12 hours and the patient is comfortable, the family relieved, and the hospice nurse happy the symptoms managed. There may be a first pass issue: ie the oral route goes via hepatic so the pain effect is reduced. The rectal avoids this so the pain effect may be potentiated. On the other hand, it is a valid and cost effective way to manage pain at the VERY end of life (usually only the last few days are when the pt cannot swallow the larger doses and the pain itself peaks) Any takers? I am looking for journals to support this since my work place is asking for more literature. IS ANYONE FAMILIAR WITH LITERATURE TO SUPPORT BUTTER RECTALLY AS A VEHICLE FOR ENDSTAGE PAIN MANAGEMENT

[Lorie P.]

i just ocmpleted my first orientation day for a local hospice. i asked about the "butter" being used and was told yes! it works and they don't have a problem with it. the rn that did ( doing) orientation says" what can be used for the good of the pt" use any and everything!!

was also told that the pharmacist told them that almost any pill you give po can be given pr, except the enteric coated and a few others.

i learn something new everyday!!

[RNnamaste]

OK, now be careful with that advice of the nurse telling you that "whatever is takes for the patient". She is wrong. You WILL lose your license if you are a rouge creator of different methods. Please understand that I was that way once and then learned to comply within the system. I did VNA homecare hospice for many years and you have to detach your emotion at times so you can think clearly when the family is dire for assistance. With true compassion it means to meet them at their experience, but you were brought in for clarity and service. Yes, maalox on wounds, pineapple juice in peg tubes and olive oil on pills is fine, but the efficacy of meds is very different in the pr route. You must speak to Hospice Pharmacia first. This is gentle advice and my hope is that your service is graced with the beauty I have seen for many years.

[RNnamaste]

Long conversations with Hospice Pharmacia, enabled us to do with with a couple of meds, not many. Plus, most families will not choose to adminster meds via rectum. I rarely advise this, esp if you stimulate the vagus and then they are nauseous. It rarely is effective.

[Lorie P.]

I didn't say that I was going to give po meds pr, jut mentioning what was told. I know better than to just take some one's word for anything , I always research and go by the Policy manual.

Thanks so much!

[RNnamaste]

Perfect! I know I got a bit preachy! Have a wonderful day!

[shrinky]

We have used them when patients are in pain and unable to swallow, we can't wait on SL meds when we are standing there watching a patient in pain. I don't know of any literature but will look around to see if anything is available. It does work well but not too many of the newer nurses use this method because of the availability of SL drugs which are not as readily available right now. We even have that in our 485 orders that we can give oral meds rectally if patient is unable to swallow.