Scrub up.
Many medical tasks once reserved for bedside nurses — giving IV medicines, packing gaping wounds, delivering kidney dialysis — are now done at home by patients or family caregivers. Unpaid, unheralded and undertrained, people are taking on treatments requiring precision, careful technique and strict attention to hygiene. Certain treatments, like suctioning a loved one’s airway to keep it clear, can be intimidating. Whether it’s during recovery after hospital discharge or part of lifelong care for a chronic condition, here are just some of the skills people are managing at home.
Kidney dialysis
Instead of traveling to a dialysis center several times a week, some patients with kidney failure opt for hemodialysis at home to clear waste and excess fluid from the blood. That can be done by machine or a lower-tech, self-managed system. At the hospital, a soft tube, or catheter, is placed into the abdominal cavity. At regular intervals at home, patients release sterile cleansing fluid, called dialysate, from a plastic bag into the permanent catheter. After the bag empties, waste-filled fluid gradually drains back in and the bag is discarded, completing the exchange.
Intravenous treatment
Antibiotics are just one type of IV treatment that people manage at home. People with chronic conditions such as cancer, blood disorders and digestive diseases may learn techniques to infuse medicine through tubing — often connected via implanted ports — to veins in their chest or arm. Patients, parents and others learn to flush IV tubing, give the medication correctly, dispose of used needles and other objects safely and watch the skin site for signs of infection, such as redness, swelling or bruising.
Tube feedings
People have feeding tubes to maintain nutrition while coping with conditions such as cancer, abdominal adhesions or neuromuscular conditions that leave muscles too weak to swallow, says Karen Stacher, a visiting nurse with VNA Texas. One feeding tube is known as a PEG, because it’s surgically placed in the stomach with a procedure called percutaneous endoscopic gastrostomy. Some people can take tube feedings like Ensure as separate “meals” with a large syringe. Other people are put on a slow, continuous feeding through a pump, Stacher says, if they have trouble tolerating larger amounts. Pumps are fairly simple to use once patients and caregivers are trained.
Wound care
Wound care at home goes way beyond placing a Band-Aid, and it’s not for the squeamish. People are cleaning, packing and dressing “every kind of wound you can think of,” Stacher says. “From dehisced surgical wounds where you have a gaping hole in your abdomen, wounds from pressure sores or ulcers that are to the bone, amputations; bites that turn into terrible wounds,” like spider bites. Nurses teach and reinforce infection-prevention skills and advise caregivers about signs such as redness, excess drainage or odor that they need to report to health care providers.
Multi-medication management
In the landmark Home Alone report, which surveyed family caregivers about complex chronic care they perform, managing medications, including injections and intravenous therapy, was the No. 1 response. Nearly half of caregivers help people taking up to nine medications a day, the survey found, while nearly 20 percent help with 10 or more daily prescriptions. Nearly 30 percent who responded to the survey, conducted by the AARP Public Policy Institute and the United Hospital Fund, reported being afraid of making a mistake and harming their family member. When asked what would help, caregivers wished for fewer medications, another person pitching in, more training and more cooperation from the person receiving their care.
Airway suctioning
Operating medical equipment you’d expect to see in a hospital is another complex task that people do at home. Equipment and procedures managed by caregivers include mechanical ventilation, tube feeding, home dialysis and suctioning, the Home Alone survey found. For adults or kids who have tracheostomy tubes to keep their airway open, patients or caregivers master skills such as cleaning the trach tubing and suctioning the person’s airway, which can be daunting. “It’s overwhelming, not only in being uncertain if you’re doing a task correctly, but there’s an emotional component as well,” says Kathleen Kelly, executive director of the Family Caregiver Alliance.
Solo caregiving
By default, caregivers take on complex, repetitive tasks that must be done. “Nobody asked if they were performing these tasks,” Kelly says. “Nobody asked them if they need more training. Everybody assumes that they all go home with a home care nurse.” That’s usually not the case, she says. Even if caregivers are taught needed skills before a patient leaves the hospital, once home, there’s nobody to follow up to observe and reinforce how skills are performed. “Families are pretty isolated doing these tasks,” she says, and with the level of complexity involved, it’s no longer just about asking a friend or neighbor to come over and sit to give them some respite.
Ostomy care
After surgery to remove the colon, or colectomy, people learn to manage the opening in their abdomen, called an ostomy; the intestinal portion or stoma; and the pouching system that’s used to collect bodily waste. Medical conditions that can lead to colectomy include colon or rectal cancer, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, and diverticulitis. Specialists called wound, ostomy and continence nurses teach patients how to troubleshoot problems and care for their skin as well as provide emotional support. Eventually, people become confident about owning their ostomy care. Some family members take on ostomy care for loved ones with disabilities.
Physical transfers
It takes good body mechanics to help a disabled person transfer from a bed to a chair, or in and out of the car. Nurses learn how in nursing school, but family caregivers don’t have that luxury. Back strain and other injuries can result when caregivers do their best to help loved ones move safely. In some cases, for those whose can’t move at all, caregivers must operate durable medical equipment, such as hospital beds, geri chairs and mechanical lifts.
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When Health Treatments Go From Hospital to DIY originally appeared on usnews.com
