As we approach the end of a loved one's life, it becomes even more necessary to be prepared for various circumstances that may arise. Among these is the occurrence of terminal secretions, a natural process that often catches many family members by surprise. Below, we will address what Terminal Secretions are and five common questions about terminal secretions:

1. Is it bothering the patient?

   No. There is no evidence that shows these sounds – made by passing air through the pooling secretions as the patient becomes less responsive and loses the ability to swallow – cause any distress for the patient. However, this sound (which is also often referred to as the “death rattle”) can be disturbing for the caregivers and loved ones.  

2. Do these secretions mean death is near?

   Yes, the pooling of these secretions and the lack of the patient’s ability to swallow is indicative of the patient passing within hours (most likely) to days.

3. Can you suction out the secretions?

   Deep suction is NOT recommended as it can cause distress for the patient. However, very gentle suction around the mouth can be used with a soft tip catheter to avoid spilling out or pooling of saliva.

4. Are there any medications that can be given to help decrease the amount of secretions?

   • Yes, there are a few anti-cholinergic medications that can be given to decrease terminal secretions. However, some may work better than others depending on the patient.

   • Scopolamine patches are commonly used but can take up to 12 hours to take effect which is not ideal in the imminently dying patient.

   • Glycopyrrolate is fairly fast acting (30 minutes to take effect) but poorly absorbed when given orally. It is recommended to give IV/SQ (1 minute to take effect) but is more expensive.

   • Hyoscyamine (Levsin) is a common medication for secretions which works fairly well and quick (30 minutes to onset) but can be moderately sedating for the patient

   • Atropine is perhaps the most commonly used medication and can be given orally (ophthalmic drops given sublingually) or IV/SQ.

   • Decrease or discontinue any IV fluids.

5. What can I do as the caregiver to help?

   Frequent repositioning the patient can be helpful as well as continuing medications listed above on a routine basis to provide comfort for the patient.

Jaymie Wilson, MSN, APRN-CNP, ACHPN
Chief Operating Officer | PDC Rx