Training of Children’s and Adolescents’ Family Members in Home Parenteral Nutrition Care

Abstract

Objective: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital.Methods: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death.Results: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death.Conclusions: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.

Effects of Adipose Plasma Transfusion Compared with Normal Plasma Transfusion on Adverse Transfusion Reactions, Important Functional Indicators, and Clinical Safety in Patients with Parenteral Nutrition: Based on a Retrospective Cohort Study

“…In order to avoid the waste of blood, most scholars are studying how to control the production of fat plasma from the source of blood collection, such as strengthening the publicity of unpaid blood donation knowledge, popularizing the physiological knowledge of unpaid blood donation, strict physical examination consultation, and other methods [10]. However, under the condition that blood resources are still so precious, it is particularly important for clinical blood transfusion department to control clinical scientific and rational use of blood, save blood, and protect limited blood resources through fine management of clinical blood use [11]. Scientific and rational blood transfusion should proceed from the actual situation of patients and formulate individualized blood transfusion plan.…”

Preparing caregivers for dehospitalization of technology-dependent patients: perspective of Home Care professionals

“…Destarte, monitorar os efeitos do treinamento na aquisição de conhecimentos e sua aplicação na prática é essencial para a qualidade do cuidado, além de favorecer o direcionamento e planejamento de novas atividades. Isto foi confirmado em pesquisa que constatou que a aplicação de um instrumento 15 dias após o treinamento teórico-prático permitia avaliar, formalmente, o processo de aprendizagem do cuidador, sendo que àqueles que não apresentaram resultados suficientes foram submetidos a novo treinamento, de modo a propiciar à família maior segurança em suas ações (11) .…”

“…O acompanhamento dos cuidadores na realização e implementação dos cuidados no domicílio, sobretudo, nos primeiros dias após a alta hospitalar, permitirá aos mesmos sanar dúvidas e dirimir inseguranças, e aos profissionais, validar a efetividade dos treinamentos ofertados (8,11) .…”

Outcomes of the First 54 Pediatric Patients on Long-Term Home Parenteral Nutrition from a Single Brazilian Center

“…The program is composed of pediatric gastroenterologists, pediatric surgeons, nutrition specialists, nurses, pharmacists, dietitians, psychologists, social workers, physiotherapists, speech and language therapists, and administrative staff. The program is conducted in collaboration with the patients’ municipality of origin, which provides local nurses with supervision of the HPN process (13). All patients discharged on HPN followed standard protocols with formal training of parents and local health professionals regarding CVC care, infusion pump handling, and PN care.…”

“…PN training and patient discharge: The minimum socioenvironmental criteria assessed for HPN were as follows: household location, presence of a sewage system, tap water, and electrical energy in the environment. All mothers and other close relatives were formally trained by specialist nurses during a period of not less than 2 weeks for PN care (13). Nurses from the respective cities were trained before hospital discharge.…”