suctioning

[busy-bee]

A patient sick for more than a week with pneumonia, took a terrible turn for the worst. We called in hospice and all. The last few days she was drowning in white thick mucus. Terrible thing to watch and to listen to. She really looked so uncomfortable struggling to breath due to the secretions were so thick and copious. We got an order to suction PRN (already had atropine, Roxanol, and Ativan Intensol as well)from hospice. She appeared much more comfortable after suctioned. Anyhow, the night supervisor came in and really got upset...stating suctioning her was cruel. The family might I add wanted us to suction and I guess the supervisor was told this, the supervisor told the nurse on duty, "then the family needs education". I guess she directed the nurse to remove the suction machine from the room but the nurse would not do it ( she told her twice to remove it). Later the supervisor called another supervisor telling her all about it. I took report and was told about the supervisor comments. I suctioned the little lady x1 prior to her dying several hours into my shift. Ya know I worked with this little lady for months and would of done nothing CRUEL to her. And if the supervisor really thought this was such a big issue, why didn't she call hospice and get the order DC'd and go "educate" this family herself. This really burns my behind. I think this is her OPINION, and her opinion/how she feels about it should of taken a side seat. I guess she never even went in an assessed the patient, nor had any communication with the family. If the family wanted this done, and it made the patient more comfortable then what was her deal. I really hope she does not speak to me on this matter.:angryfire I had an order, the family wanted it and the patient appeared comfortable....get over it.

[wearingmanyhats, RN]

I too would have suctioned. Drowing is a terrible way to die.

We can't stop the dying process, but we can provide comfort, and suctioning is a comfort measure.

(((Hugs)))

Faye

[racing-mom4, BSN, RN]

I would be flaming mad:angryfire:angryfire !!!!

Let me get this straight, your patient? With Drs orders for suctioning and family wanted pt suctioned???? And the "supervising" nurse said NO???

When did nurse supervisors become Drs and have the right to change orders?

And What education??? What is there to educate on. "we can either remove the secretions from her air way, or let her drown in them"

Hospice is a wonderful wonderful x10 organization and if they said suction, by all means suction.

Lord help me if I am ever in your facility and she is the supervising nurse.---at least she didnt withhold the pain meds on the chance of the pt becoming "addicted" to them!!!!!

Boy this really burns me up.:angryfire

[nrsang97, BSN, RN]

Suctioning is a comfort measure. Drownding like that is miserable. What a terrible thing for that nursing supervisor to say.

If I was asked to remove suction equipment from the room I too would not have done as asked by that supervisor. I would have stood my ground as a good patient advocate, as were yourself and the nurse you received report from.

Remember comfort measures are subjective. This nursing supervisor needs to be educated that just because she thinks suctioning is not a comfort measure, some do believe that and she should respect their wishes.

[CaLLaCoDe, BSN, RN]

I had a patient just last night who when I first assessed her needed to be suctioned via yonkers ASAP. Family complained that the day nurse had been told repeatedly to suction the patient. The family was denied any sort of suctioning measures five times. I hope that race wasn't at issue: family black and nurse was white. This to me is outrageous. What was the day nurse thinking?!

I got copious amounts of white yellowish sputum out of this lady when I suctioned her with the yonkers. So the xray was clear in the morning shouldn't the upper respiratory track be addressed as well?:angryfire I told the family that they can always request another nurse to take over or bring this issue up to the charge nurse.

PS. Just a thought. Wouldn't having access for the general public for a suctioning device make sense? Yonkers away! One wouldn't have to use so many Kleanex, save trees and have less raw noses. Besides, when you are in a weakened state such as with a respiratory infection; sometimes it's hard as heck to spew as much sputum as one might like; and, having a device to make that process any easier would simply be great!

[JGBSNRN]

If this supervisor decides to discuss this matter with you I would remind her of what the job of a HOSPICE nurse is. I feel the outcome would have been worse if you went against the Dr.'s orders to suction PRN. She had no right to impose on something she did not see first hand. Was she involved at all with this patient???Anyway, I hope when my time comes and if I am drowning and choking on my own secretions I hope a nurse like you will save me from that. You should be praised for your patient advocacy:yeah:

[leslie :-D]

sorry guys, but deep suctioning is highly invasive and uncomfortable.

increase the atropine, or change to levsin or scopolamine.

these products work superbly.

sometimes light suctioning is ok.

but in hospice, it's always a last resort and seldom necessary.

we avoid it like the plague.

leslie

[leslie :-D]

here's a few links, discouraging suction in eol.

Respiratory Secretion Management

http://www.aahpm.org/cgi-bin/wkcgi/view?id=674&search=002&status=A+

scroll down to Non-pharmacological Treatments

Preparing for Approaching Death

http://www.hospicenet.org/html/preparing_for.html

scroll down to congestion

As The Time of Death Nears

http://www.oncolink.com/coping/article.cfm?c=2&s=7&ss=7&id=516

scroll down to congestion

leslie

[Jacobero]

And What education??? What is there to educate on. "we can either remove the secretions from her air way, or let her drown in them"

I agree. There was nothing creul about suctioning her. Sxn is uncomfortable, to say the least, but so it drowning in one's own secretions.

[MiaKeaRN]

As a person who recently lost my mom to lung cancer, I appreciated that the nurses suctioned my mom almost up until the end. It sounded to us as if my mother was drowning, she would open her eyes every once in a while with a look of horrid fear because she had to feel as if she was drowning or choking.

[leslie :-D]

why suction when there are meds that dry secretions very effectively?

there is no reason for one to drown in their own secretions.

scopolamine, levsin and sometimes atropine, are the standards of care in hospice.

i cringe at the thought of those being suctioned, at end of life.

there is absolutely no need for it in this day and age.

leslie

[leslie :-D]

it is worth noting, however, that oropharyngeal secretions can be lightly suctioned.

most secretions in the dying, however, are below the larynx and cannot be effectively suctioned.

also, the anticholingergic agents i mentioned (scopolamine, levsin, atropine) s/b given at the first sign of congestion.

they will not dry up existing secretions.

repositioning the pt in a lateral, recumbent position, w/hob slightly raised, will help and prevent aspiration.

but deep suctioning is greatly discouraged and is not of benefit to the pt.

it should be done as minimally as possible.

finally, the pt is usually not even aware of the "death rattle".

we intervene more for the sake of the family.

leslie