Supporting Families of Distressed Patients and Circumventing Macy Route Stigma

Kay’s Nursing Background and Introduction to the Macy Catheter

I have been a nurse since 1986. My experience has ranged from med/surg, geriatrics, oncology, pediatrics, homecare and now hospice, where I have worked for the past 3 years.

I originally learned about the Macy Catheter through an in-service at the facility where I work.

My team and I were excited to use the Macy Catheter to assist with symptom control necessary for the 10-20% of patients whose oral route is compromised at end of life.

90-Year-Old Patient in Severe Pain

I was taking care of a 90-year-old female patient diagnosed with End Stage Alzheimer’s and Osteoarthritis.

Unfortunately, the patient had been experiencing severe pain, agitation, and constipation that were difficult to control due to the patient’s severe dysphagia.

The patient was refusing to open her mouth and was frequently spitting out her medications.

The patient’s daughter was becoming increasingly distressed witnessing her mother’s severe discomfort and frequent moaning.

Introducing the Rectal Route in the Right Way

I immediately introduced the option of the Macy Catheter when I first witnessed the patient’s level of pain and agitation.

Initially, the daughter was reluctant to try the catheter with her mom because she was worried it would be uncomfortable and was unsure about having a catheter inserted rectally.

Over the course of a few days, I continued to educate the patient’s daughter about the advantages of the Macy Catheter and that it was very easy to insert and not uncomfortable.

I pointed out to the daughter and other family members that we had nothing to lose because the patient was so uncomfortable with what we were currently doing. The patient had lost the ability to swallow and suppositories were ineffective and agitating.

After providing education, the patient’s daughter decided the Macy Catheter was a good option for her mom.

The Appreciation that Comes with Quick Palliation

I was able to quickly insert the catheter and administer Morphine and Haldol with no sign of discomfort.

Within 20-30 minutes of administering the medications, the patient was resting comfortably. The patient was able to keep the catheter in for 3 days until she died peacefully at home.

The patient’s daughter and family were extremely thankful for the comfort that the Macy Catheter facilitated over the last days of the patients life. The daughter even wrote a letter of appreciation to our agency thanking us for the care her mom received.

The Macy Catheter helped this patient quickly reach a state of comfort and allowed the family and patient to experience a state of peace during this difficult transition.