Beyond the Sound: Evidence-Based Nursing Care for Patients With Terminal Secretions

Terminal secretions, commonly referred to as the "death rattle," are oropharyngeal secretions that accumulate in patients nearing the end of life who cannot clear them. Although physiologically benign, these secretions can cause emotional distress to families, nurses, and care providers. They are presumed to impact the quality of death, relating to comfort and dignity. This document reviews interventions for managing terminal secretions, emphasizing evidence-based practices. It explores pharmacologic methods, like anticholinergic medications-though little evidence supports their benefit-suggesting their use be considered individually. Nonpharmacologic interventions are recommended as first-line treatments; these include repositioning, mouth care, hydration management, communication, and family education. These strategies align well with comfort care goals. Nurse-led communication can reduce family anxiety and improve understanding of the dying process. A standard nurse-led, evidence-based approach focuses on comfort, dignity, and presence at the end of life. Barriers to implementing nonpharmacologic measures and the emotional impact on families and clinicians are addressed. Reviewed resources include clinical trials, systematic reviews, palliative care guidelines, and nursing resource guides, advocating a collaborative, interdisciplinary approach to first-line, nonpharmacologic care for terminal secretions.