To Suction or Not To Suction, End of Life & Hospice Patients

I recently was at a nursing conference where some nurses stated they do advocate suctioning on their dying patients. This article examines both schools of thought and finds a middle ground of common sense suctioning. Nurses General Nursing Article

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  1. In End-of-Life Care, which side of argument you are on "To Suction" or "Not To Suctio

    • 22
      To Suction
    • 13
      Not To Suction
    • 6
      impartial

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I've been an ICU RN for 15yrs, so I have dealt with End of Life Care plenty. I was always taught to either oral suction or deep suction with a suction catheter if your patient sounds like he or she needs suctioning. But of recent, I have run into some nurses with a different school of thought, in which they do not believe in suctioning of the dying patient.

"NOT to Suction"

Some nurses believe suctioning of the dying patient is actually more harm than good. They believe it is uncomfortable and goes against the comfort care principles. They feel suctioning is unnecessary because it is not a curative treatment of the dying patient, but only symptom mangement. Some think it makes the family feel better but does nothing for the patient.

  • Nasal suctioning can cause Pain, Trauma, and Bleeding in your fragile End-of-Life Patients.
  • Many patients in the active phase of dying are not aware of their surroundings and therefore bite down on or "tongue-out" suctioning equipment.

"To Suction"

Some nurses believe they are not only dealing with the patient but also the whole entire family, therefore treating both is of most importance. They think it only seems reasonable to suction a person who is in need, even if it is only considered symptom mangement. They want to give patients a dignified death, not one where they sounded like they were drowning in secretions as the family looks on.

  • The Death Rattle is common and can be a very unnerving experience for families as well as caregivers.
  • Medications and patches used to dry up secretions causing the Death Rattle do not always work... Some patients still require pharyngeal or subglottic suctioning, for example: pneumonia patients.

My Conclusion "Suction with Dignity"

Although I can understand not wanting to do excessive suctioning to a dying patient, some suctioning may be necessary. I would not consider any suctioning comfortable, but there are techniques and methods of suctioning that make it much more comfortable such as No-Bite V suctioning with the use of a red rubber catheter. Red rubber suction catheters are much softer and minimize any insertion trauma. And the No-Bite V allows you to introduce a catheter orally and avoid the nose altogether. I think everybody basically considers nasal suctioning an act of torture at this point, especially repetitive nasal suctioning. But if suctioning can be done in a minimally invasive manner, it increases the patient's comfort level once suctioned properly. And I definitely think suctioning a dying patient brings a calmness to the room, as well as the family. I would never want a family to take away that their loved one suffered or went through some difficulty breathing, in that they actually heard the patient's breathing difficulties in the form of the death rattle. This is something a family would never forget. A nurse's goal is to minimize any degree of suffering, physically and mentally, to both the patient and the families.

PLEASE COMMENT and share which side of argument you are on "To Suction" or "Not To Suction" your End-of-Life Care / Hospice Patients

Hospice and Palliative Care provides humane and compassionate care for people in the last phases of an incurable disease. The focus is on patient comfort and symptom management. One symptom, the death rattle, which refers to the gurgling noise of excessive secretions, can be misinterpreted as the sound of gagging or choking to death. The death rattle occurs in up to 92 percent of people actively dying and can be an unnerving experience for the patient's family as well as the caregivers.

One way to treat the death rattle is to dry up the secretions with medication. But that does not always work and some patients still require pharyngeal suctioning.

Specializes in Critical Care.

From what I can tell, the reason for invasive suctioning of secretions is that it's a way of putting the family at ease, instead of appropriately educating family about the dying process?

When I worked in hospice we strongly advocated against suctioning, in fact it could trigger the gag reflex and cause more distress. We advocated for/ and encouraged drying meds such as levsin and atropine but secretions at eol are usually much more distressing to the family than the patient themselves, so we'd educate family but no we never suctioned hospice patients.

I am not a hospice nurse, but I provided hospice care to many patients ..and my best friend. If the meds didn't dry up the secretions sufficiently, I would deep oral suction. I would not NT suction as it could be painful.

I just didn't want to see her die , BECAUSE she was drowning in her own secretions.

Was that selfish?

Specializes in CVICU, MICU, Burn ICU.
For those that believe suctioning a death rattle is appropriate, maybe you could share your rationale.

I wouldn't put myself in the 'should-suction-death-rattle' camp, but I will say that I think it really depends on if you really know you are dealing with terminal secretions. I have cared for people who have not yet been deemed "comfort care", but probably should have. This happens a lot in acute care. That's why goals-of-care discussions are so important.

Defining end goals is crucial. If a patient is truly comfort care and obtunded, anticholinergics should be ordered and any suctioning kept to a minimum (and certainly no NT). My .02 -- as an ICU nurse (not always the best at giving Hospice-type care even though we end up doing that) whose seen many patients pass -- some with comfort measures in place.

Specializes in CVICU, MICU, Burn ICU.
I am not a hospice nurse, but I provided hospice care to many patients ..and my best friend. If the meds didn't dry up the secretions sufficiently, I would deep oral suction. I would not NT suction as it could be painful.

I just didn't want to see her die , BECAUSE she was drowning in her own secretions.

Was that selfish?

I'm sorry you found yourself in this situation. I can't imagine how difficult that must have been. Regardless of whether she "needed" the suctioning (none of us were there, you were) you most certainly were not selfish. Selfish does not describe those who care for their loved ones in the way you did for your friend.

I came across this article on Facebook and registered for this site just so I could chime in! I work in an ICU where we use the no bite V and it truly is a game changing product. I highly recommend that you speak to your supervisors about getting it in your hospitals if you do not have it already.

Specializes in Critical Care.
I came across this article on Facebook and registered for this site just so I could chime in! I work in an ICU where we use the no bite V and it truly is a game changing product. I highly recommend that you speak to your supervisors about getting it in your hospitals if you do not have it already.

The No-bite V does not make suctioning less uncomfortable, it only prevents the patient from being able to defend themselves by biting down on the tube.

If any of you decide to suction me while I'm actively dying, I promise to do everything possible to haunt your remaining days with any form of torture I can muster in the afterlife.

My mother passed away 13 years ago today. The reason I am researching suctioning is that I still wonder if we should have allowed it. My daughter and I sat with my mom, and as her rattles became louder it was distressing to us. She seemed at peace. Our concern was her strangling, or feeling as if she were strangling, on her secretions. We asked her nurse what she advised and she said "if it were my momI would suction". So she grabbed a catheter and suctioned deeply. My mom gagged and her entire body lunged forward from the bed. She went completely limp, palms up...I wouldn't want anyone to have my experience with a loved one being suctioned.

Specializes in ICU.

"Always and never.....the enemy of good Medicine!!!"

From what I've gathered here the grand consensus is to do assessment based suctioning and then "Suction with Dignity", PRN.

Although, some clinicians here are insisting that they NEVER EVER Suction, no matter what. My friend's mother was let go at a hospice facility, sounding like she was drowning on her own secretions, and when he asked to get her suctioned, the staff said they do not suction here. He said this haunts him to this day. (His exact words)

again: "Always and never.....the enemy of good Medicine!!!"

I get it..., nasal suctioning is considered torture at End-of-Life, but if you need to suction, at least use a No-Bite V and insert a suction catheter into the oral airway. This suctioning is the least traumatic suctioning you can do for your comfort care patients. This is the definition of "Comfort Care" and "Suctioning with Dignity", as long as it is on an assessment based, PRN basis. I don't think anybody was ever advocating for suctioning on ALL End-of-Life Care.

Specializes in Critical Care.
"Always and never.....the enemy of good Medicine!!!"

From what I've gathered here the grand consensus is to do assessment based suctioning and then "Suction with Dignity", PRN.

Although, some clinicians here are insisting that they NEVER EVER Suction, no matter what. My friend's mother was let go at a hospice facility, sounding like she was drowning on her own secretions, and when he asked to get her suctioned, the staff said they do not suction here. He said this haunts him to this day. (His exact words)

again: "Always and never.....the enemy of good Medicine!!!"

I get it..., nasal suctioning is considered torture at End-of-Life, but if you need to suction, at least use a No-Bite V and insert a suction catheter into the oral airway. This suctioning is the least traumatic suctioning you can do for your comfort care patients. This is the definition of "Comfort Care" and "Suctioning with Dignity", as long as it is on an assessment based, PRN basis. I don't think anybody was ever advocating for suctioning on ALL End-of-Life Care.

Again, the "no-bite" suction catheter does not in any way make suctioning less traumatic, if anything it makes it more traumatic. All the "no-bite" part of it does is prevent the patient from being able to defend themselves. It's like saying if you're going to punch your patient in the face, you should tie their hands down so they can't defend themselves, because that's less traumatic.

I have worked as an RT for over 30 years. I am in total agreement with your "Suction with Dignity" option. There are ways that it can be done with minimal discomfort, as you have mentioned. One must assess each situation on its own merits. I am more inclined to not NT suction as this is generally a more traumatic option. The option that provides relief & comfort to the patient should be the one chosen.

Specializes in LTC Rehab Med/Surg.

I only suction the dying patient when the family insists. I try, try, try, to convince them it's pointless and uncomfortable, but sometimes it's all about how the family feels. Not the patient.

I've always considered suctioning a form of torture. Secretions build up, suction them out, secretions build up, suction them out. A cycle that simply prolongs the dying process. Not everybody thinks the way I do, so I keep my belief about torture under my hat.

I feel the need to explain the torture thing. That's a personal observation. I'm not saying the nurse who suctions is evil and sadistic. Not saying that at all. I'm sure the nurse who thinks suctioning makes the patient more comfortable thinks I'm evil and sadistic. I've even had one or two tell me they thought I was wrong headed about this issue. Maybe when I'm dying, and I'm rattling enough to raise the roof, I'll know which one of is right.