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Managing intractable pain with neuraxial infusion at home

Shirley E Jones1, Katherine Bird2, Linda Maynard3

  • 1Clinical Nurse Specialist, East Anglia's Children's Hospices.

International Journal of Palliative Nursing
|August 24, 2023
PubMed

Insights

This case study highlights successful home-based end-of-life care for a child with metastatic liver cancer using intrathecal drug delivery (ITDD). It emphasizes multidisciplinary support and risk management for pediatric palliative care (PPC).

Area of Science:

  • Pediatric Palliative Care (PPC)
  • Pain Management
  • Oncology

Background:

  • Complex pain management in pediatric oncology is challenging.
  • Metastatic liver cancer presents significant symptom burden.
  • Home-based end-of-life care (EoLC) is a priority for many families.

Purpose of the Study:

  • To describe a case study of a 9-year-old child with metastatic liver cancer requiring intrathecal drug delivery (ITDD) for complex pain.
  • To outline multi-modal symptom control strategies for home-based EoLC.
  • To provide recommendations for nursing practice in pediatric palliative care.

Main Methods:

  • Case study methodology.
  • Implementation of multi-modal symptom control, including ITDD.
  • Focus on achieving patient and parental wishes for home-based EoLC.

Main Results:

  • Successful home-based EoLC was achieved using ITDD for complex pain.
  • Challenges were safely addressed through robust risk assessment and mitigation.
  • The case demonstrated the feasibility of extending PPC home care boundaries.

Conclusions:

  • Rigorous risk assessment, clear communication, and specialized training are crucial for safe ITDD nursing practice in PPC.
  • 24/7 access to specialist palliative care teams is essential for home-based care.
  • This case supports the expansion of advanced home care services for children with complex needs.

Keywords:
complex painintrathecal drug deliverypaediatric palliative care

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