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A Family Guide to the Management of Terminal Secretions


Management of Terminal Secretions

What are terminal secretions?

Sounds made near the time of death as a result of fluid collecting in the throat and/or chest. Not all hospice patients develop terminal secretions however, it is best to know how to manage them if they do occur.


IMPORTANT

Your loved one is NOT in any discomfort, suffering, suffocating, or uncomfortable when experiencing terminal secretions.


What causes terminal secretions?

  • A build-up of fluid and mucus in the throat and airways

  • Decreased airway flow caused by inflammation or edema

  • Overhydration

  • Increased shallow breathing Decreased ability to cough or swallow

What to do when the secretions start?

Non - Medication Options

Non-medication treatments are the most effective and without the unnecessary side effects that come with medications.

  • Repositioning: Elevate head/upper body

  • Repositioning: Rotate from one side to the other

  • Regularly keep the mouth clean and dry (suctioning is not helpful)

  • Avoid forcing fluids even if your loved one "looks thirsty"

Medication Options

Start medications as soon as possible for maximum effectiveness. Medications PREVENT the build-up of secretions, they do not remove secretions already there.


  • Side effects include agitation, anxiety, increased heart rate, palpitations, dry mouth, flushing, drowsiness, headache

  • Medications are given by mouth, by injection, and by patches Patches may take up to 12 hours to work

  • Medications include Atropine, Hyoscyamine, Scopolamine, and Glycopyrrolate

Things to Remember

  1. Your loved one is NOT distressed, choking, or uncomfortable.

  2. Management of terminal secretion is primarily to decrease the distress of loved ones

  3. When deciding to use medications remember to weigh risks versus benefits

  4. Terminal secretions last only 24-48 hours

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