Sunday, November 9, 2014

Transitioning to Home Care, Equipment and Supplies

Transitioning to Home Care series

While it is exciting to be leaving the hospital for the first time with your complex child, it can be overwhelming.  One of the stressors is making sure you have all the equipment and supplies needed, for home care.  These are lists of commonly used equipment and supplies for children, including those with any/all of the following: Tracheostomy, Feeding tube, Vent dependent.  The hospital social worker or discharge co-ordinator can help set you up with a DME (durable medical equipment supplier).  For personal recommendations of a DME near you, try asking in your local fb groups.  You will need physician scripts for all home care equipment and supplies, which the co-ordinator can supply to the DME.  Your home care physician should supply the DME with future equipment/supply orders. 

Home Care Equipment:

Air Compressor~ This is to support the function of the Fisher Paykel humidification system. Specific supplies needed to operate: o2 tubing, filter(s). 

Apnea monitor~ Machine used to monitor apnea (pause in breathing) events.  Supplies needed to operate: mask, sensors

Co2 monitor~ Positive air pressure usually used for sleep apnea or airway obstruction.  Supplies needed to operate: trach connector, sensor, mask. 

Concentrator~ A concentrator is oxygen that is continuously being "made" by pulling from the surrounding air.  This is used to either support the Fisher Paykel system, or can be used individually for 02 support in the home. Specific supplies needed to operate: o2 tubing, filter(s). 

Cough Assist~ 

CPAP machine~ Supplies needed to operate: mask, travel bag, car charger, 

CPT wand~

Humidified air system~ called the Fisher Paykel.  This system is used to humidify the tracheostomy airway.  While our noses have hair (filters) to keep humidity in our upper airway, our trachea (mid airway) does not have a natural filter to keep humidity in the airway.  The Fisher Paykel system supplies humidity to keep the airway from drying up, which can cause mucus plugs and/or collapsing of the airway.  Specific supplies needed to operate: heated (coiled) tubing kit, humidified chamber, o2 tubing, sterile o2 bags. 

Mechanical lift (and slings) 

Nebulizer~ a device that delivers breathing treatment medications. Specific supplies needed to operate: nebulizer kit, filter(s).

Oxygen (02) tanks~ portable tanks used for transit, or in the home when a vent and/or humidification is not needed for moments in time. It is good to have o2 tanks for back up in the home as well (for when power goes out).  Tanks come in many sizes, where the higher the alphabetical number, the bigger the tank (more oxygen it holds).  The size "H" tank is too large to use in transit, but hold enough oxygen for back up supply at home.  Another o2 tank option is liquid o2.  This must be prescribed specifically by the physician, and carries extra risks in home care use.  Specific supplies needed to operate: o2 tubing, on/off key, regulator, portable cart and/or wheelchair tank holder.  

Oxygen analyzer~ gives accurate reading of percentage of o2 output. 

Portable concentrator~ a rechargeable concentrator that holds o2.  This can be used in home for emergency backup, or on an airplane (02 tanks are not allowed on the flights).  Specific supplies needed to operate: o2 tubing, battery, wall plug, car charger. 

Pulse oximeter (pulse ox)~ There are two types of pulse ox machines.   Portable (can take with you outside of the home) and Stationary (stays at bedside).  Depending on the pulse oximeter, you are able to monitor oxygen saturations (o2 levels) in the blood, heart rate (some with visual rythm), and/or Co2 levels. The Pediatrician, Cardiologist, and/or the Pulmonology specialist can write the script for this device(s). Specific supplies needed to operate: pulse ox sensors. 

Scale~ If the patient's in/outs are being measured, you will need a scale to weigh diapers/nappers/briefs.  

Shake Vest~ 

Suction machine~ There are two types of suction machines.  Portable (can take with you outside the home) and Stationary (stays at bedside).  The suction (sx) machine is used to clear the airway of secrections (saliva/drooling).  The pediatrician or PCP (primary care physician) can write the script for this device(s).  Specific supplies needed to operate: filter, sx canister, sx tubing, car charger, wall charger, extra battery, sx catheters (oral and/or deep suctioning for trach).

Ventilator (vent)~ Used for dependent breathing support.  Specific supplies needed to operate: white circuit tubing, swivel trach adapter, battery, car charger, bag (for in travel). 

Home Care Supplies: 

Trach/vent care
Trach ties
Surgi lube (or KY jelly)
Trach cleaning kits
HME's (heat and moisture exchangers)
Gauze (for stoma), split 2X2 
Medical tape (to secure split gauze)
Trach collar (mask) 
o2 tubing
Heated/coiled tubing 
Humidfied Chambers (for Fisher Paykel/vent systems)
Vent connector pieces
Scissors (to cut trach ties) 

Feedings/GI care
Feeding bags
Ferrell bags
Mic Key or Mini buttons
Gtube extensions
Syringes (for venting and flushes) 
Chux pads
Colostomy bag
Double stick Colostomy tape
Tape measure (for girth) 

Medication care
Crushing syringes/Pill crusher
Pill cutter
Nursing drug book

General Care
Cotton tipped applicators (sterile qtips) 
Saline bullets
Medical tape (paper, transparent, or silk)
Distilled water
Face masks (for care takers)
Protective gowns (for care takers)
Adhesive remover pads
Blood pressure cuff/kit
Extra batteries for machines 
Hydrogen Peroxide 
Sterile Gloves

Respiratory Care
Suction tubing
Suction filters
Nebulizer filters
Little Suckers (with or without covers), Nasal suckers, yankauers
Suction catheters (for trach suctioning) (can be sleeved or un-sleeved)
Pulse Oximeter sensors
Sterile water bags for the Fisher Paykel system
Nebulizer kits
Ambu bag
Passi Muir valve
Posey wraps
O2 tanks
Generator (for back up)

Urinary Care
Urinary catheters 
Foley/indwelling with a small bag 
Diaper liners

Wound Care
Sanitary napkins (to absorb blood)
Tega derm
Abdominal pads 

Pharmaceutical items
Alcohol wipes
Heparin syringes/flushes
Gauged needles (for PICC lines, and Ports)
Glucose monitor, needles, and strips
Chest port surgical kits
IV supplies (caps, butterfly needles, surgical kit) 
Ketone strips
Sterile water

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