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Tom Sharon
Who will take care of the wound at home?


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Wound Care at Home

Whichever decision you make, you will need to know a few things about the conditions listed in order to make an informed decision. Surgeons usually leave wounds open if there is an infection. The rationale is to allow the purulent material to drain out. The main difficulty here is that the person providing the wound care has to have a strong constitution. Not everyone can handle removing a dressing with foul-smelling drainage and then cleaning out a large gaping hole in some part of the anatomy. You will also need to learn about handling and disposing of contaminated biohazard material without spreading the infection to another part of the body, like the eyes, or to another person.

Going Home with Skin Grafts
Skin grafts that are healing are very delicate. If they get infected or damaged, they are likely to be irreversibly ruined. You will have to be well trained in sterile technique. If the doctor ordered ointments or creams, you will have to apply them very carefully because the slightest injury can destroy the graft.
 
Going Home with Chest Catheters
People who need long-term intravenous therapy go home with chest catheters. There are several different types of devices, and there is a different method for accessing the line for each one. You will need to be thoroughly familiar with your setup. Ask for the manufacturer's insert. This contains diagrams and instructions. The makers usually provide patient booklets. You should get one if it is available. The recipients of these items are usually people with cancer, AIDS, Lyme disease, or other chronic illnesses who need long-term intravenous feeding, medication, and/or fluids. You must have a registered nurse on call twenty-four hours per day. You can arrange that with a licensed or certified home-care agency.
 
Going Home with Central Intravenous Lines
Central lines inserted in the arm are percutaneous intravenous catheters (PICs). They are about twenty-four inches long, and many doctors favor them because they are good for long-term use. PICs require meticulous cleansing and dressing changes, with sterile technique, at the insertion site. There is a high risk of infection. This is an alternate choice to chest insertions. With this device also you will need to have a registered nurse on call around the clock.
 
Going Home with Peripheral Intravenous Lines
Peripheral lines are for short-term use. All of the possible complications discussed in the chapter about mishaps in ICUs can occur at home. Again you will need twenty-four hour coverage. Your discharge planner should give you the choice of at least three agencies that have a home intravenous program. Many hospitals have their own agency and will keep out the competition. This is wrong, because competition is one way of getting good service. Moreover, hospitals that deprive you of free choice of vendors are trampling on your rights.
 
Going Home with an External Fixator
External fixators are tricky. The presence of these devices is a clear indication that the fracture was nasty, with multiple bone fragments. The fixator holds the fragments in place after extensive orthopedic reconstructive surgery. If you neglect the maintenance, the infection will go right down to the bone. This would result in a high risk of gangrene. Thus the pins require meticulous cleaning daily, usually with hydrogen peroxide and saline. I would recommend that most people get a home-care nurse to do this, but if you must do it yourself, learn the proper technique and do not miss any days.
 
Going Home with a Halo Splint
Regarding neck fractures, once the halo splint is in place, the situation is pretty stable. The only real problem is the awkwardness of this contraption. The patient will need a lot of custodial help with activities of daily living. Additionally, the pins that hold the halo in place are partially screwed into the skull, so you will have to clean them daily with aseptic technique.
 
Going Home with a Pelvic Fracture
With unstable pelvic fractures or any other condition that requires total bed rest, you are taking home a person who is going to be completely dependent upon a caregiver. Be certain that you and the discharge planner make all necessary arrangements for extra help, or you will be stuck day and night.

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