Resolving Status Epilepticus in Minutes and Allowing for Caregiver Involvement at the Bedside

As a clinician, I felt very frustrated that both the patient and family were in distress and knew I needed to come up with a solution as quickly as possible.

Anna Brammer

Case Manager, Heart ‘n Home Hospice & Palliative Care

Anna’s Nursing Background

I have been an RN for 2 years. I started my career in a pediatric ICU and recently transitioned into hospice.

I am a Case Manager at Heart ‘n Home Hospice & Palliative Care in La Grande, Oregon where I cover a very large rural area.

Symptom Chasing Gets Frustrating and Expensive

My patient was a 70-year-old female with a primary diagnosis of COPD and comorbidities of CHF, CAD, and DM. We had been successfully managing her dyspnea and pain for 6 months when she took a big decline. As she transitioned, she started having seizures, which quickly escalated to status epilepticus and left her unresponsive.

The onset of seizures were extremely distressing for the family, who were her primary caregivers.

Because of my background in critical care, I was very comfortable treating status epilepticus, and had done so many times. My first instinct was to use Diastat rectal gel; however, due to the high cost of the drug, it wasn’t available. IV meds were also not an option due to the time it would take to order and arrive at this rural location.

I first attempted to sublingually administer Xanax and Ativan (which I had at the bedside). However, I was not successful at controlling the seizures due to copious oral secretions, which prevented the absorption of the sublingual medications.

As a clinician, I felt very frustrated that both the patient and family were in distress and knew I needed to come up with a solution as quickly as possible.

The Macy Catheter Proves Easy to Use and Effective

Out of options in the home, I reached out to my Heart ‘n Home Clinical Director who recommended placing the Macy Catheter and administering the medications rectally.

After introducing the Macy Catheter as a way to help facilitate symptom relief, the family was very open to trying it with their loved one.

Though I had not received any formal training, I found it very easy to use and administer the meds just by following the Instructions for Use Manual in the kit.

After quickly inserting the catheter, I immediately gave a dose of the Valium through the catheter and her seizures subsided within 10 minutes!

Caregivers can Administer Medications via the Macy Catheter

I was impressed and relieved at how quickly this route of administration worked.

Most importantly, the family was extremely relieved to see their loved one resting comfortably for the first time in 6-8 hours.

At Heart ‘n Home, caregiver education is extremely important; we want the caregivers to feel confident in their ability to provide care. I taught the family how to administer medication via the catheter to keep the patient comfortable and treat breakthrough seizures if needed.

They were completely comfortable giving medications and were able to keep their loved one at home until she passed peacefully several hours later, seizure-free and surrounded by loved ones.

Rectal Catheter Enables Patient to Build Log Cabin While on Hospice Care

Rectal Catheter Enables Patient to Build Log Cabin While on Hospice Care

Rectal Catheter is the Most Dignified Administration Option

Rectal Catheter is the Most Dignified Administration Option

Rectal Catheter Provides More Reliable and Dignified Administration Than Sublingual

Rectal Catheter Provides More Reliable and Dignified Administration Than Sublingual

Rectal Catheter is More Effective Than Pain Pumps & Sublingual

Rectal Catheter is More Effective Than Pain Pumps & Sublingual

Rectal Catheter Decreases Cost & Nursing Time at Unity Hospice

Rectal Catheter Decreases Cost & Nursing Time at Unity Hospice

Hospice Director Champions Rectal Catheter After Device Helps His Mom

Hospice Director Champions Rectal Catheter After Device Helps His Mom

Rectal Catheter Empowers Both Nurses and Families at Unity Hospice

Rectal Catheter Empowers Both Nurses and Families at Unity Hospice

Rectal Catheter Helps Patients Remain in Their Setting of Choice

Rectal Catheter Helps Patients Remain in Their Setting of Choice

A Hospice Nurse Explains How a Rectal Catheter Empowers Nurses

A Hospice Nurse Explains How a Rectal Catheter Empowers Nurses

Rectal Catheter Reduces Cost While Improving Patient Care

Rectal Catheter Reduces Cost While Improving Patient Care

The Rectal Route– More Dignified than Sublingual

The Rectal Route– More Dignified than Sublingual

Navigating a Medication Shortage Using a Rectal Catheter

Navigating a Medication Shortage Using a Rectal Catheter

Rectal Catheter Proves More Effective Than Sublingual Administration

Rectal Catheter Proves More Effective Than Sublingual Administration

Caregiver’s Burden of Care Decreased by Rectal Catheter

Caregiver’s Burden of Care Decreased by Rectal Catheter

Rectal Route Proves Simpler and More Effective Than Oral

Rectal Route Proves Simpler and More Effective Than Oral

How to Introduce a Rectal Catheter to Concerned Caregivers

How to Introduce a Rectal Catheter to Concerned Caregivers

Hospice Nurse Finds Rectal Catheter More Effective Than IV

Hospice Nurse Finds Rectal Catheter More Effective Than IV

VP of Clinical Excellence Advocates for Rectal Catheter

VP of Clinical Excellence Advocates for Rectal Catheter

Patients are willing to try the rectal route. Are nurses?

Patients are willing to try the rectal route. Are nurses?

If Your Patient Can’t Swallow, Try the Rectal Route

If Your Patient Can’t Swallow, Try the Rectal Route

Using a Rectal Catheter Despite Cultural Pushback

Using a Rectal Catheter Despite Cultural Pushback

Trying the Rectal Route Because It Works

Trying the Rectal Route Because It Works

Reduce Medication Waste by Trying the Rectal Route

Reduce Medication Waste by Trying the Rectal Route

Rectal Catheter Allows for More Caregiver Involvement

Rectal Catheter Allows for More Caregiver Involvement

Patient’s wish to receive hydration and remain at home realized by using the Macy Catheter

Patient’s wish to receive hydration and remain at home realized by using the Macy Catheter

Rectal Catheter Allows Patients to Remain in Their Setting of Choice

Rectal Catheter Allows Patients to Remain in Their Setting of Choice

Gastroparesis Patient Controls Her Own Pain and Nausea Using the Macy Catheter

Gastroparesis Patient Controls Her Own Pain and Nausea Using the Macy Catheter

Resolving Status Epilepticus in Minutes and Allowing for Caregiver Involvement at the Bedside

Resolving Status Epilepticus in Minutes and Allowing for Caregiver Involvement at the Bedside

Supporting Families of Distressed Patients and Circumventing Rectal Route Stigma

Supporting Families of Distressed Patients and Circumventing Rectal Route Stigma

Nausea Resolved in 20 Minutes Without the Oral Route

Nausea Resolved in 20 Minutes Without the Oral Route

The More Dignified Way: Pain Controlled in 20 Minutes

The More Dignified Way: Pain Controlled in 20 Minutes

The Easy Route: Distress Controlled in 10 Minutes

The Easy Route: Distress Controlled in 10 Minutes

Wondering how to teach caregivers about medication administration via the Macy Catheter?