Send Feedback

Print

Ü Back

Canterbury DHB

Excessive Secretions

• Can be a symptom in advanced respiratory disease, head and neck cancers, and neuro-degenerative disorders.
• In people who are dying, this may be part of the terminal process known as "Death Rattle".
• Explanation and reassurance for the patient and family is very helpful.
• Deep suctioning should be avoided as this increases mucous production and is unpleasant for the patient but oral suctioning with yanker suction could be helpful.
• Re-positioning is often helpful.
• Attention to oral hygiene is essential – see section on Dry Mouth.
• Drug therapy may be indicated but drying of secretions is not always the most appropriate initial management.

When considering the appropriate drug therapy, note the following:

• Buscopan^TM does not cross the blood-brain barrier and therefore causes less sedation and confusion than Hyoscine hydrobromide and Scopoderm TTS^TM.
• Atropine is excitatory and should be avoided.

One of the following agents can be helpful. Do not use concurrently:

Hyoscine butylbromide (Buscopan™)

• 10 - 20 mg subcut 6 hourly.
• 40 - 120 mg/24 hours subcut infusion.
• Recommended for use in patients where avoidance of sedation is preferred.

Hyoscine hydrobromide

• 0.2-0.4 mg subcut 2-4 hourly.
• 0.6 -1.2 mg/24 hours subcut infusion.
• Recommended for use in the unconscious or semi-conscious patient.

Scopoderm TTS™ (Hyoscine)

• Apply patch every 3 days.
• Needs to be applied early to be effective.
• Available by special authority - see pharmac website http://www.pharmac.co.nz or check with the hospital pharmacist (often supply problems because of availability).

Glycopyrrolate

• More potent than hyoscine and better side-effect profile.
• 0.2 mg subcut stat.
• 0.2 - 0.6 mg/24 hours subcut infusion.

Topic Code: 4120