A Cost and Quality Analysis of Utilizing a Rectal Catheter for Medication Administration in End-of-Life Symptom Management

Latuga, Natalie M; Gordon, Mary; Farwell, Paula; Farrell, Megan

doi:10.1080/15360288.2018.1500509

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…While the administration of a drug via the oral mucosa is generally easy and convenient, it suffers several disadvantages, and is sometimes considered to be ineffective or not feasible in patients towards the end of their lives [ 88 , 89 ]. For example, terminal agitation is a common end-of-life symptom and agitated patients often cannot cooperate with taking orally administered medications including buccal and sublingual medications.…”

Section: Oral Transmucosal Deliverymentioning

confidence: 99%

“…Despite the merits of using the rectal route for systemic drug delivery, this route of administration is often neglected or avoided, mainly due to the lack of acceptance by patients and clinicians, privacy concerns, cultural barriers and the practical limitations of access, particularly outside home or hospital. Some clinicians may also perceive the rectal route as ‘nonaggressive symptom management’ or concern with the lack of clinical evidence for its efficacy [ 89 , 111 ]. In palliative care, it requires caregivers to be able or willing to administer drugs rectally, which they may be reluctant to do.…”

Section: Rectal Deliverymentioning

confidence: 99%

“…In palliative care, it requires caregivers to be able or willing to administer drugs rectally, which they may be reluctant to do. The rectal route is difficult with patients who use wheelchairs; it may not be suitable for patients with rectal tumours, rectal bleeding, or those who have recently undergone bowel surgery [ 89 ].…”

Section: Rectal Deliverymentioning

confidence: 99%

“…It enables the use of oral medications that are readily available at the bedside although the evidence of dosing and efficacy remains uncertain. Studies show that the use of a rectal catheter does not induce discomfort for the patients and is a cost-effective way to manage symptoms of patients in palliative care and should be further promoted [ 88 , 89 ]. The major concerns with the use of a rectal catheter is the lack of information regarding rectal pharmacokinetics and oral-to rectal dose conversions, which require further research.…”

Section: Rectal Deliverymentioning

confidence: 99%

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Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

Lam

Cheung

Chow

et al. 2020

Advanced Drug Delivery Reviews

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The Coronavirus disease 2019 (COVID-19) pandemic has led to a surge in need for alternative routes of administration of drugs for end of life and palliative care, particularly in community settings. Transmucosal routes include intranasal, buccal, sublingual and rectal. They are non-invasive routes for systemic drug delivery with the possibility of self-administration, or administration by family caregivers. In addition, their ability to offer rapid onset of action with reduced first-pass metabolism make them suitable for use in palliative and end-of-life care to provide fast relief of symptoms. This is particularly important in COVID-19, as patients can deteriorate rapidly. Despite the advantages, these routes of administration face challenges including a relatively small surface area for effective drug absorption, small volume of fluid for drug dissolution and the presence of a mucus barrier, thereby limiting the number of drugs that are suitable to be delivered through the transmucosal route. In this review, the merits, challenges and limitations of each of these transmucosal routes are discussed. The goals are to provide insights into using transmucosal drug delivery to bring about the best possible symptom management for patients at the end of life, and to inspire scientists to develop new delivery systems to provide effective symptom management for this group of patients.

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Section: Oral Transmucosal Deliverymentioning

confidence: 99%

Section: Rectal Deliverymentioning

confidence: 99%

Section: Rectal Deliverymentioning

confidence: 99%

Section: Rectal Deliverymentioning

confidence: 99%

See 2 more Smart Citations

Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

Lam

Cheung

Chow

et al. 2020

Advanced Drug Delivery Reviews

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Current Updates in Rectal Infusion of Fluids and Medications

Macy

Paxton

Lam

2023

Curr Emerg Hosp Med Rep

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Purpose of Review Rectal infusion is a feasible alternative for the immediate administration of medication and fluids when intravenous access is delayed, contraindicated, or unnecessary. Advances in medical device technology have made rectal infusion more practical and easier for medical care providers, and more comfortable for patients. This paper briefly reviews the history of therapeutic rectal infusion, including recent improvements in technology and the existing evidence for the use of this technique. Recent Findings While ultrasound-guided peripheral intravenous (PIV) access techniques and other alternatives to landmark-based PIV catheter insertion have recently improved the ability of providers to overcome challenges related to difficult vascular access (DVA), these challenges are increasingly affecting patient outcomes, emergency department throughput, and the cost of medical care. In recent years, waves of parenteral drug, fluid, and supply shortages have affected hospitals. Concurrently, advances in rectal infusion technology have made rectal infusion easier, more comfortable, and more cost-effective than many parenteral options. Summary The infusion of resuscitative fluids and medications via the rectal route has previously fallen out of favor due to concurrent improvements in IV access devices. However, this technique demonstrates the potential for a reemergence considering the current challenges facing healthcare providers and systems. Improvements in rectal infusion devices, coupled with an aging population, increased incidence of DVA, shortages in parenteral drugs, fluids, supplies and skilled staff, and the need for care improvements in the post-acute setting have contributed to a greater need for easy, safe and effective alternatives to IV infusion.

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Macy Catheter: Integration and Evaluation in a Hospice Setting to Provide Symptom Relief During End-of-Life Care

Quinlin

Schmitz

Jefferson

2020

CJON

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A Cost and Quality Analysis of Utilizing a Rectal Catheter for Medication Administration in End-of-Life Symptom Management

Cited by 3 publications

References 7 publications

Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic

Current Updates in Rectal Infusion of Fluids and Medications

Macy Catheter: Integration and Evaluation in a Hospice Setting to Provide Symptom Relief During End-of-Life Care

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