Clinical FAQ

Find answers to the most common questions regarding use of the Macy Catheter® and rectal administration for pain relief and symptom management.

Which medications can be used via the rectal route?

Most medications used for symptoms such as pain, nausea, agitation, and shortness of breath and even some antibiotics can be given effectively with rapid onset of action via the rectal route.

Hospi has curated a list of medications and bioavailability as reported in the literature.

Do I need to change dosing when using the Macy Catheter?

Sometimes, depending on the medication. Dosing is the same as oral for the majority of medications.

The prescriber is responsible for the route and the dose of delivery. If you have specific questions, ask a pharmacy specialist.

Hospi has curated a list of medications and bioavailability as reported in the literature.

Which fluids can be administered via the Macy Catheter and at what rate?

Per the literature, hypotonic solutions such as water, Pedialyte, ½ NS, and ¼ NS are typically used, and infusion rates of 250ml/hr are tolerated well.

Hospi’s Policy and Procedure template includes a fluid administration procedure.*

The template is for illustrative purposes only. Further modification by the agency and its prescribers is intended/expected.

Will I need to change my policies and protocols? Do you have templates?

Hospi has developed a template policy and procedure manual that meets surveyor requirements. For a copy of our policy and procedure template, please contact us.

How can staff be trained to use the Macy Catheter?

Training is fast and easy; it can often be accomplished in a 30-minute Zoom session or with a link to a prerecorded session. Hospi also offers in-person training for large agencies. Contact us to get started today.

How long can the Macy Catheter remain in the rectum?

The Macy Catheter can remain in the rectum for up to 28 days. If it is removed for (or expelled by) defecation, the catheter can be immediately reinserted or a new catheter can be placed, depending on your institution’s policy.

What if the patient has to have a bowel movement?

The Macy Catheter is designed to be expelled with a bowel movement. If requested by the patient, the catheter may also be removed by a clinician or a trained caregiver prior to a bowel movement. The Macy Catheter will not inhibit normal bowel function and if expelled, can be immediately reinserted per agency protocol.

How is the device discarded after use?

After use, this product may be a potential biohazard. Handle in accordance with local, state, and federal laws and regulations.

How often should the balloon inflation be checked?

The balloon only needs to be checked if leakage is noted from the rectum.

Is it necessary to wear gloves during medication administration?

Medication administration into the Macy Catheter is not a sterile procedure and gloves do not need to be worn for administering medications. As always, the user should perform proper hand washing before and after patient contact.

What are common Macy Catheter patient use examples?

The Macy Catheter is used to administer medications and fluids to patients whose oral route is compromised and for whom parenteral access is difficult or not indicated. Rectal administration is a proven route of delivery and can be particularly relevant for patients presenting with dehydration, pain, agitation, seizures, fever, or nausea/vomiting. It has been used in hospice and palliative care, skilled nursing facilities, home health, and emergency departments.

Hospi has curated testimonials from clinicians and caregivers who discuss how the Macy Catheter impacted their agencies as a whole and/or interactions with specific patients.

When should I introduce the Macy Catheter into a patient’s care?

Introducing the Macy Catheter to a patient’s care upon admission can help prevent symptom crisis.

Educating the patient about the Macy Catheter early can facilitate introduction of the device during a later symptom crisis.

Overall, the Macy Catheter is especially relevant when the oral route is compromised and sublingual is either not working or not possible.

If leakage occurs from the Medication Administration Port following medication administration, what should I do?

Quickly inject 3 ml of water over less than 1 second using the 3ml enteral syringe.

Can Routine Perineal Care be performed with the catheter in place?

Yes, per your facility’s protocol, routine perineal care may be performed with the Macy Catheter in place.

Can the Macy Catheter be used if my patient has a Colostomy?

The Macy Catheter can be used for medication administration in any patient with an intact rectum.

Note: The Macy Catheter should only be placed in the rectum. Never place the Macy Catheter in an ostomy or a stoma.

What are the contraindications for using the Macy Catheter?

The device should not be used for patients with rectal lesions, tumors, active rectal bleeding, recent bowel surgery (less than 6 weeks), or if the rectal mucosa is compromised.

Diarrhea (more than 1 liquid stool per day) is not strictly a contraindication. However, patients who are having frequent bowel movements will continually expel the catheter and therefore medication may not be absorbed.

What if leakage of medication is noted from the rectum?

Leaking of medication from the rectum can occur in infrequent circumstances. Follow the steps below only if leakage is noted.

Tug lightly on the Macy Catheter to ensure that it is snug against the rectal sphincter.
Check the balloon inflation to ensure that the balloon is inflated to 15ml (by deflating the balloon into a graduated luer syringe and noting the volume). Re-inflate the balloon to 15ml, tug lightly to assure the balloon is snug against the rectal sphincter, and recheck inflation in a few days.
If medication is still leaking from the rectum once the previous steps have been completed, the patient’s rectal sphincter is compromised. Additional water can be added to the balloon until 30 ml (absolute maximum), but, as with any titration, increase in small increments until the leakage has abated.