Pain Controlled in 20 Minutes
After seeing the Macy Catheter work and dealing with patients at end of life, it seems that the more dignified way, especially at home, is the Macy Catheter.
I have worked as a nurse in Fairbanks, Alaska since 1997, both in the ICU and hospice units of a local hospital. I was initially reluctant to try the Macy Catheter until another nurse shared a situation about a patient whose pain was tolerable, but not eliminated with the use of oral medications for two weeks. A Macy Catheter was placed and the same medications given rectally. The patient’s pain went away quickly and she asked her nurse, “Why didn’t I do this sooner?” I have since used it successfully in patients who are unable to take medications orally, and it has worked every time.
A metastatic lung cancer patient in his mid-50s was experiencing symptoms of pain and agitation escalating over several days. His morphine and haloperidol doses were being titrated upward, but symptoms continued to get worse. He was in a lot of pain and became increasingly confused, agitated, was climbing out of bed, and now refusing to take medications. His wife was also incredibly stressed and needed tremendous support and education.
When I initially proposed the Macy Catheter the patient’s wife objected saying, “He would not want that.” I told her about the catheter and suggested that we give it a try as we could make his last days more comfortable. I explained that he would not even know it was there, and suggested that if it didn’t work, I would take it right out. She agreed, and we administered the same dose of morphine and Haldol via the catheter.
Within 20 minutes the patient was calm and relaxed with no sign of pain. Once comfortable the patient’s wife turned to me and asked, “Why didn’t we do this sooner?” The Haldol was administered every six hours initially, but once the patient was comfortable we were able to titrate the Haldol to twice daily. The Macy Catheter remained in place for five days, until he died peacefully and comfortably at home. His wife’s stress was much relieved and she was able to use the catheter easily.
With being in the ICU, I always thought that intravenous delivery was the best way to go. After seeing the Macy Catheter work and dealing with patients at end of life, it seems that the more dignified way, especially at home, is the Macy Catheter.