Ways to Administer Medication
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WAYS/ROUTES TO ADMINISTER MEDICATION
Macy Catheter/Per Rectum (PR) Some medications are given via the rectum, like supposi- tories. The rectum has a lot of blood vessels and medica- tions are absorbed very well via this route. As patients near the end of life, often it becomes hard to swallow, especially large pills. In addition, the upper GI tract slows down and medications aren’t absorbed by the body as well as they were before. A Macy catheter is a small, flex- ible tube inserted into the rectum and is held in place with an inflatable balloon. These catheters generally do not cause discomfort and are able to be easily reinserted if they get dislodged during a bowel movement. Medi- cation that is normally given orally can be given via the Macy catheter without having to worry about swallow- ing or how well the medication is being absorbed. Transdermal (TD) Transdermal means through the skin. These medica- tions are used for a variety of reasons, including pain control and smoking cessation. Medication is admin- istered via a patch that sits on the skin for a specified amount of time. You may see fentanyl patches for pain control that last for 72 hours, lidocaine patch- es for pain control that last for 12 hours or nicotine patches for smoking cessation that last for 24 hours. Inhaled (INH) These are generally medications for trouble breath- ing. You may hear it called a nebulizer as well. A small amount of liquid medication is connected to oxy- gen and is aerosolized for you or your loved one to breathe in. This can be with a “pipe” apparatus that is held, or by a facemask if a pipe can’t be held.
Oral (PO)/Sublingual (SL) This is the most common way to administer medica- tions. You or your loved one is given a pill or liquid to swallow. Sometimes we can crush meds and mix in applesauce or pudding for people that have a hard time swallowing whole pills. Sublingual administra- tion is when a medication is either liquid or a pill is crushed and mixed with a small amount of liquid. This liquid is placed under the tongue or in the pocket of the cheek to absorb through the mouth without hav- ing to swallow. Intravenous (IV) This is a common route of administration in hospi- tals. If there is already an IV in place, usually after transferring from a hospital, we will use this route while we can maintain access. If the IV starts to leak or looks infected, we will likely take it out and use a different route. If you or your loved one has a port, You may not have heard of this route before as it is usually specific to Hospice patients. As a way to avoid the potential discomfort that comes with starting an IV, we utilize a very small needle to place a catheter into the subcutaneous, or fat, tissue. These are usu- ally placed on the back of the arm, belly or thighs, although the nurse can choose from a variety of loca- tions. We can use the same medication that we would give IV in the SQ button. These buttons are usually good for 5 days before needing to be changed. we can access it to give IV medications. Subcutaneous Button (SQ)
END OF LIFE SYMPTOMS
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