This case study delves into the unfortunate demise of an adult patient diagnosed with stage IV mesothelioma, who was under hospice care. Despite escalating doses of potent opiates like fentanyl over a week, the patient’s pain remained unrelenting. The individual eventually succumbed to intractable pain and a gastric aneurysm.
Posthumously, it was discovered that a clot in their port-a-cath obstructed fluid and medication administration.
This case seeks expert insights into the standard of care provided and causation from a specialist in hospice and palliative medicine.
Questions to the expert and their responses
How often do you evaluate and manage hospice and palliative care patients?
As a board-certified professional in Internal Medicine and Hospice & Palliative Medicine, I regularly evaluate and manage patients requiring hospice and palliative care.
What are the most pertinent measures healthcare providers in the hospice setting can perform to minimize clots in port-a-caths?
In my experience, preventing clots involves maintaining a low yet adequate KVO (Keep Vein Open) rate, instilling a heparin flush when the port is de-accessed, adhering to sterile techniques strictly, and careful monitoring of the infusion pump for errors.
Have you ever reviewed a similar case? If yes, please elaborate.
Yes, I have encountered similar cases during my practice. Pain management is fundamental in hospice settings as patients depend on competent care for pain control.
Providing effective pain control requires diligent attention to all aspects of the medication delivery chain, including troubleshooting common problems such as IV access issues.
About the expert
This expert brings over 15 years of experience in internal medicine and hospice and palliative medicine, with board certifications in both fields. They have held significant roles such as attending hospitalist, clinical assistant professor of internal medicine, and medical director at various healthcare facilities. Currently, they serve as an attending hospitalist at a university-affiliated healthcare system, the medical director of palliative services at a long-term acute care hospital, and an adjunct assistant professor of internal medicine at a major medical school.
About the author