This week’s QuickHit! comes from an Enteral Feeding module that Connected Care provided for home care nurses. During the module, several home care nurses asked about when and how to do routine safety checks of a child's G-tube balloon.
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This week’s QuickHit! comes from our community/home care partners who have asked us to confirm what we tell families in hospital about ‘how often to clean and change feeding supplies’ when their child is in home care.
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This QuickHit! comes from a home care nurse who consulted Connected Care Live to ask if it is appropriate to mix Polyethylene Glycol (PEG) 3350 with formula and administer it in a continuous enteral feed?
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This QuickHit! comes from a family caregiver who asked why we teach that they don’t need to wear gloves when giving medications via Central Venous Access Devices (CVADs) at home, but they see SickKids nurses doing it in hospital. The family caregiver also shared that their home care nurses sometimes do, and sometimes don’t wear gloves when performing this activity.
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This QuickHit came from a home care nurse who contacted Connected Care to ask for our recommendation on how to treat and monitor this child’s G tube stoma site. This low-profile balloon type tube had been in place for > 8 weeks and was starting to look slightly pink/red, shiny, slightly swollen and wet. This child was comfortable, tolerating feeds and no fever was present.
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The onset of the 'viral season' is a good time to promote the routine and ‘as needed’ maintenance of all home care equipment, including suction and other respiratory equipment that may be contaminated/infected. A suction machine is a device used to help clear the airway of mucus which is especially important to keep clean as the close proximity of dirt and bacteria to a child's airway may increase the risk of a child becoming sick.
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Cola and other carbonated and acidic beverages are still sometimes being used in practice to unblock enteral feeding tubes, however this is not recommended.
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Use the appropriate size insulin syringe and double check the dose when administering subcutaneous Low-Molecular Weight Heparins (LMWH).
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When engaging in patient-specific consults, Connected Care Resource Nurses (CCRNs) will use the PAT to confirm that the encounter is not an emergency. This is achieved by partnering with the home care nurses in completing a PAT.
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This QuickHiT comes from Connected Care Resource Nurses who identify it as a potential risk when they receive consults from home care nurses seeking up-to-date orders for a child with medical complexity/technology dependence.
Connected Care Live is a service delivered by SickKids nurses who have expert knowledge and access to high-quality resources, but as Registered Nurses, they cannot give an order to be carried out as part of the child’s medical plan of care.
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This QuickHiT was identified through a consult a home care nurse initiated with Connected Care Live regarding a patient that presented to a community hospital emergency department for a dislodged G-tube. This hospital visit became necessary because there was no emergency dislodgment kit present in the child’s home. The kit has the equipment necessary to maintain tract patency when an enteral feeding tube is dislodged accidentally.
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At a recent Connected Care CVAD workshop, home care nurses told us that they were removing CVAD caps to access a CVL line for blood work and/or to heparin lock the line. They shared that they didn’t know that syringes (including saline flush and heparin lock syringes) attach directly to the cap.
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At a recent Connected Care Central Venous Access Device (CVAD) workshop, home care nurses identified that they were unsure about what is included in an emergency CVAD kit and identified that some families do not have an emergency CVAD kit at home.
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This QuickHiT! came from a consult initiated by a home care nurse who texted Connected Care Live! for clarification about the use of normal saline drops via tracheostomy. In this situation, the child's family had previously learned to routinely instill saline prior to suctioning but this practice differed from the nurse's employer's policy.
This Quick hit alert was identified by a family caregiver in the home setting. It was identified that the pressure gauge of the suction machine (portable or standing) should be checked every time a child is suctioned. Dials and settings on suction machines (older and newer types) can change or “slip” between uses resulting in inadequate suction power.
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At recent Connected Care education sessions, home care nurses described being unsure about what is included in an Emergency Tracheostomy Kit
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