Home care vs ICU

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Hi. I have a couple questions for home care nurses. I am an RN working in a NICU, I have been out of school a little over a year now. For the past three months in the NICU I have been primary to a little guy who is finally going home soon. He has a g-tube and trach (both due to a progressive mitochondrial disease). Mom is 16 but has been doing outstanding with him. All the nurses are constantly praising her and commenting how wonderful she has been doing with him (we all only wish the secondary caregiver, grandma, was doing as well). Of course in the hospital she has learned all the ways we do things, sterile technique, new feeding bag with every feed and every 6 hours during the nighttime continuous feeds, my question is how are things different in the home environment so I can prepare her for needing to learn possibly another way of doing things, specifically related to:

Trach suctioning...sterile? clean? are sterile gloves provided? are gloves even worn?

Feedings: I looked at the home care orders and it looked like only enough bags were ordered to have one each day, so if he is to receive 4 bolus feedings during the day and continuous overnight is the same bag used all day long? Does she need to clean it between feeds?

I guess I'm also wondering if it is normal for someone to show up and orient them to all the new equipment and home care way of doing things?

Thanks for the info! I don't know a lot of what happens outside the ICU but mom keeps asking me and I wish I could tell her more

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Basically clean technique in the home unless the doctor orders sterile for some reason. Of course, there is no reason the caregivers can not use sterile technique if desired, just more troublesome and expensive if the cost of sterile supplies are not provided by whoever is paying for all of this. Same bag used all day long, no cleaning, just replace after 24 hours. The equipment provided in the home will have an orientation by the DME provider who does setup in the home. As for anything else, if there are any questions, these should be raised with the RN who does the intake assessment/interview. The first nurse(s) assigned to the case can do follow-up, but the nursing supervisor is the first source for questions to be answered until you get semi-permanent/permanent daily nurses assigned.

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Thank you so much for the info! It's nice to know these things so I can better prepare families for heading home with that kind of stuff. Mom now has all her home equipment, and home nursing lined up, she is rooming in until Saturday and we are hoping for a weekend discharge :-D

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I would think a discharge on Monday would be better due to easier accessibility if there are any questions or problems. Sometimes you can't get hold of anybody on a weekend.

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I would think a discharge on Monday would be better due to easier accessibility if there are any questions or problems. Sometimes you can't get hold of anybody on a weekend.

Might be a monday discharge afterall...he pulled his g-tube out! :eek: kids:rolleyes:

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