A study published in the Journal of Pain and Symptom Management demonstrated that use of Hospi Corp.’s Macy Catheter resulted in improved absorption of the sedative anticonvulsant phenobarbital, as compared to administration via suppository.
The catheter is a specialized device that enables rapid and discreet administration of medications via the rectum. The results showed the absorption kinetics of Macy Catheter-administered phenobarbital were superior to phenobarbital suppositories based upon the rate of early absorption, overall absorption, variability, and comfort of administration. The study was funded by the National Science Foundation and completed in partnership with the University of Texas Health Science Center at San Antonio.
“These results are extremely important to hospice care in the home setting as phenobarbital is used extensively in the care of patients experiencing severe symptoms such as agitation, seizures or intractable suffering,” Brad Macy, RN, BSN, CHPN, Hospi Corp.’s president, said in a press statement.
The study was a randomized, open label, cross over study with three arms: A phenobarbital suppository (194.4 mg) and two different micro-enema suspensions with the same dose of phenobarbital tablets administered via the Macy Catheter. The catheter-administered doses were crushed and suspended in 6 ml (MC-6) and 20 ml (MC-20) of tap water, respectively. The results showed:
- After 10 minutes, the mean plasma concentrations were 12 times higher for the MC-20 and 8 times higher for the MC-6 demonstrating a more rapid early absorption compared to the phenobarbital suppository. Concentrations achieved in 30 minutes via MC-20 took almost three hours to achieve by suppository
- Less variability in the extent of drug absorption for both MC administrations (1.4-fold to 1.9-fold difference) compared to a 4.4-fold difference with administration via suppository
- Participants of the study described the Macy Catheter to be a “comfortable” way to give medication compared to suppository, rated to be “mildly uncomfortable”
In 2014, the Institute of Medicine (IOM) released an extensive and detailed report on “The State of Dying In America,” highlighting that the last few months of life are characterized by “frequent hospital and intensive care stays.” IOM reported that the health care system has room for improvement in meeting “the needs, values and preference of our patients” and that the healthcare system spends too much on end of life care in “unneeded and unwanted acute care services” rather than other ways to improve the quality of end of life care.
Hospi Corp. executives said the catheter presents potential cost savings in medication costs and gives hospice clinicians an option for medication administration that allows for dignified end-of-life care in the home setting when the oral route is compromised. They added that it also has applications in the emergency room and other acute care settings as a bridge to IV access or to facilitate discharge to a lower acuity setting.
