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

Current Updates in Rectal Infusion of Fluids and Medications

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.

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

Provision of high-quality end-of-life care in a cost-effective work environment is the aim of all hospice organizations. This opportunity can be negatively affected when there is a limited supply of parenteral narcotics or administration routes are either not functional or fail to control symptoms. To combat these challenges, including a shortage of available parenteral narcotics, staff at a hospice organization adopted the use of a rectal catheter to deliver oral medications that were readily available. The implementation of a rectal catheter resulted in better control of symptoms, fewer titrations, and improvement in pain control and/or symptom management needs during end-of-life care management.

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

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.