[20] Respiratory Secretions at End of Life Flashcards
What does the current best practice for the management of respiratory secretions at EoL involve?
Combination of nursing and pharmacological management
What do respiratory secretions at the end of life cause?
Noise produced by air moving through secretions in the upper airways, often referred to as ‘death rattle’
What causes the production of respiratory secretions at the end of life?
The mechanism by which secretions are produced is not well understood, but they are thought to arise from the salivary gland and bronchial mucosa
Why does saliva accumulate at the end of life?
Thought to be related to a decline in consciousness and swelling
Why does secretions from the bronchial airways accumulate at the end of life?
Weakness or reduced consciousness meaning the patient is unable to cough effectively
How long does the accumulation of bronchial secretions take at end of life?
Thought to accumulate over several days as the patient deteriorates
What is the prevalence of respiratory secretions at the end of life?
Considered a common occurrence, but reported prevalence varies from 12-92%
What is the impact of respiratory secretions at the end of life?
There is little evidence to suggest the unconscious patients are distressed by the presence of respiratory tract secretions, but some families find it distressing and are concerned it is contributing to the patients suffering
What is involved in the management of respiratory secretions at the end of life?
- Reposition patient to move secretions within the airway
- Explore any family concerns, providing reassurance and explanations as necessary
- Reduce or discontinue artificial hydration
- Regular oral care
- Administration of anti-muscarinic medications
What is the role of deep suctioning in the management of respiratory secretions at the end of life?
Should be avoided
Why should deep suctioning be avoided?
Because it is likely to cause distress to the patient, and may increase the production of secretions
What should the drug choice in managing respiratory secretions be based on?
Clinical requirements and drug characteristics
How should drugs to manage respiratory secretions be given?
Efficacy should be assessed using PRN dosing, before moving on to a continuous infusion
How can the risk of unwanted side effects be minimised when using drugs to manage respiratory secretions?
Medication that is shown to be ineffective should be discontinued
What are the options for medication to manage respiratory secretions at the end of life?
- Hyoscine butylbromide
- Hyoscine hydrobromide
- Glycopyrronium
