For a Safer Hospital Discharge Open surgical wounds Do not go home without registered nurse coverage from a licensed or certified home-care agency. Do not leave the hospital until you have received all the surgical supplies you will need. One of the treating doctors should write a prescription. You have the option to refuse to change the dressing and insist that the home-care agency provide a visiting nurse for daily dressing changes. Self-care is voluntary. Make sure that dirty dressing materials are disposed of in plastic bags—do not touch with bare hands. Maintain sterile technique with new dressing. Be careful not to dislodge any surgical drains. If there is any problem or doubt, call the nurse and/or doctor. Observe the wound for foul odor, redness of the surrounding skin, swelling, tenderness, or an increase in pain. Immediately call the nurse and/or doctor if you notice any of these symptoms. Unhealed skin grafts Same instructions apply as for open surgical wounds. Be careful not to touch skin graft. If you have to apply an ointment or a cream, do so very gently to avoid even the slightest trauma. Note the color of the graft. If it gets darker, call the nurse and/or doctor. Central intravenous lines inserted through the chest wall—single lumen (one tube) or double lumen (two tubes in one) Same instructions apply as for open surgical wounds. Make sure that the end of the catheter is capped and clamped at all times to prevent hemorrhage. Remember that self-care is voluntary. Observe the insertion site and immediately call the nurse and/or doctor if you notice any redness, swelling, tenderness, and/or pain. Central venous lines inserted in the arm (single lumen only) The same instructions apply as for central intravenous lines. The insertion site must be sealed off with a clear plastic dressing. Peripheral intravenous lines Only a registered nurse with certification may insert a new IV into your vein. And remember that self-care for administration of medications is voluntary. The vein catheter must be capped-off and clamped when not in use, with a small amount of anticoagulant inside to prevent clotting. If the next intravenous medication is not flowing freely, clamp or close off the line and call the nurse. Observe the insertion site and immediately call the nurse and/or doctor if you notice any redness, swelling, tenderness, and/or pain. Limb fractures with external fixators (pins sticking out of the legs or arms) Same instructions apply as for open surgical wounds. Keep the pin insertion sites clean and dry with sterile cotton swabs and prescribed solution (doctors usually prefer a mixture of one-half part hydrogen peroxide to one-half part saline). Do not allow scab formation at insertion site. Observe for signs of infection at pin insertion sites, such as pain, tenderness, redness, swelling, and fever. If you notice any of these, immediately call the nurse and/or doctor. Neck fractures with halo splints (multiple pins inserted in skull to immobilize the neck) Same instructions apply as for open surgical wounds. Unstable pelvic fractures requiring total bed rest Do not go home unless there is a family member or home-care agency able to provide care twenty-four hours per day. Do not attempt to get out of bed for any reason. Make certain that there is an emergency evacuation plan in case of fire or another emergency. You must have the following equipment: electric hospital bed with trapeze, reclining wheelchair, Hoyer lift, bedpan, and urinal (for men).