Hospital and Program Description

Good Samaritan Hospital Medical Center is a 537-bed (including 100 nursing home beds) MAGNET designated community hospital, located in West Islip, New York. The Palliative Care Program is a consultation service supported by an interdisciplinary team providing acute palliative care in a dedicated 11-bed acute palliative care unit and throughout the hospital.

Problem

Severely ill, end-of-life patients with history of intractable nausea and/or vomiting, in spite of aggressive pharmacologic interventions.

Processes to resolve problem

The Palliative Care Interdisciplinary Team, in conjunction with family members, brainstormed ideas to symptomatically treat our patients who have intractable nausea and/or vomiting due to bowel/ gynecologic malignant obstructions. Due to their disease process and terminal diagnoses, surgical interventions were thought not to be appropriate. Prior aggressive pharmacologic interventions were unsuccessful. Question raised: How to manage patients’ symptoms of nausea and vomiting in an effective and minimally invasive manner?

Outcomes

In cooperation with Interventional Radiologists and discussion with patients/families in respect to goals of care, these patients underwent Percutaneous Endoscopic Draining Gastrostomy technique. This solution was a relatively simple method of decompressing obstructions and providing the patient the ability to enjoy nourishment without the feeling of fullness or nausea. This procedure increased the patients well being and quality of life, provided comfort measures as well as decreasing family distress.

Lessons Learned

Percutaneous endoscopic drainage is a beneficial procedure for our patients. The procedure, once completed, requires no advanced skills. After insertion, the tube can be attached to a drainage bag, facilitating continuous emptying of gastric contents, thus enhancing patient comfort. Family members can maintain this intervention in the home setting, supporting discharge from the acute care setting.