premature infant hyperalimentation

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  1. Would it be safe for us to take care of him?

    • 2
      yes
    • 1
      no

3 members have participated

I work for a small home health agency that is not affiliated with a hospital. We got a referral for a premature infant coming home with hyperalimentation. Our agency very rarely takes care of infants or children and none of the nurses working here have peds or NICU experience.

My coworkers and I are considering refusing to care for the infant, as the risk is too high and we do not have the resources available to hospital-affiliated home health agencies.

Are we over-reacting?

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Specializes in Complex pedi to LTC/SA & now a manager.

In my opinion, no there are pediatric agencies better suited

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Can anybody else weigh in on this? I think I'll ask in the Peds forum too,

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I asked this in the home health forum but haven't got much feedback so I'm cross-posting.

I work for a small home health agency that is not affiliated with a hospital. We got a referral for a premature infant coming home with hyperalimentation. Our agency very rarely takes care of infants or children and none of the nurses working here have peds or NICU experience.

My coworkers and I are considering refusing to care for the infant, as the risk is too high and we do not have the resources available to hospital-affiliated home health agencies.

Are we over-reacting?

He's coming home on the 15th. He was born at 25 weeks because his 16 year old mother was in a car accident. When he comes home he'll be 4 months old. There are not any pediatric home health agencies in our area but I think they'd be better off using a hospital-affiliated home health agency because the nurses there will have more resources.

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If none of the employees want to take the case, then the patient's family should be referred elsewhere. Now, if the hospital wants to provide sufficient training and resources, a different story. I was informed by a nursing supervisor that in times gone by nurses went to the hospital to get specialized training for soon-to-be-discharged patients, but that does not seem to be in the realm of the possible of late.

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Specializes in Maternal - Child Health.

Thank you for considering the well being of this little guy!

I'm not sure that a simple yes or no answer will suffice. He will be at 40-41 weeks gestational age at discharge, which, unfortunately doesn't tell us much about his clinical course or current status.

It is unusual for a healthy, growing preemie of that age to still require IV nutrition, so I assume that there is more to his story. Did he have necrotizing enterocolitis (NEC) requiring a bowel resection that left him unable to meet his nutritional needs by mouth? Does he have severe chronic lung disease which prevents him from taking food orally? Even if so, the most common method of feeding a baby with chronic lung disease would be by g-tube, so I'm leaning toward some type of significant bowel dysfunction, possibly involving an ostomy. Does he receive his nutrition via a PICC line? Do your staff members have experience in management and troubleshooting of PICC lines? Where will the IV fluids be prepared? How often will labs be drawn to assist in determining the composition of his IV fluids? Are your staff members proficient in drawing labwork on infants? As a compromised preemie, he will likely come home with an apnea monitor. Is that something your staff is familiar with? Who will provide his medical and other follow up care? Preemies discharged following long term NICU stays often require speech therapy to learn to feed orally, and PT and OT to overcome neuromuscular deficits. While not nursing functions per se, are there specialists in your agency who can address these needs?

These considerations concern me at least as much, if not more than the delivery of IV nutrition, which in and of itself is a basic nursing skill.

I would strongly encourage a visit to the hospital to meet with the parents, medical team, primary nurse and discharge planner. Perhaps seeing the baby with your own eyes and meeting with his parents and current caregivers would give you a much better picture of his needs and likelihood of success with your agency staff. On a final note, the NICU team tends to be very possessive of babies in its long term care. If they don't feel that your agency is ready for this little one, I believe they will speak up and insist on in-service training or a referral to another agency.

Thank you for your conscientiousness!

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Specializes in Nephrology, Cardiology, ER, ICU.

Merged threads

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