In my previous post, I outlined the criteria for what patients have to do before going home from the hospital after an operation. Even when you meet all those criteria, though, you won’t be going home completely healed — that process can take weeks or months. Many patients go home with, and will need to take care of, dressings, drains, or ostomies while they heal from the operation. The best time to master managing these things is while you’re in the hospital with people around to help.
In this post, I’ll outline some common situations that require training in the hospital to manage at home, and review some good strategies for making sure that when you go home, you’re ready.
What Types of Things Might You Need to Care for At Home?
For many operations, patients go home with just a dry dressing over a wound that’s been closed by staples, sutures, or glue. But even those dry dressings have to be managed, and sometimes patients have more elaborate arrangements that require real training.
Here are a few examples of common situations. Of course, this is not a comprehensive list, and the actual management of your situation is unique to you and should be directed by your surgical team.
Dry dressings: After an operation, patients usually have a dry gauze dressing over their incisions. This can typically be removed after a day or two, leaving the wound open to air (which is not dangerous and actually can speed healing). Until then, it should be kept clean and dry.
Steri-Strips: These small adhesive tapes help hold incisions closed and protect them for longer than dry gauze dressings. They usually stay in place for 7-10 days and then wrinkle up and fall off on their own. They can get wet, but shouldn’t be scrubbed or soaked in the bathtub, or they will come off.
Staples: Staples are also used to hold incisions together. They require no special care, though sometimes a light gauze covering can keep them from catching on clothes.
Wet-to-dry dressings: If a wound can’t be closed, usually because of infection risk, you may have to do dressing changes one to three times a day with moist gauze packed into the wound while the incision heals from the inside out. This usually doesn’t hurt and the final scar isn’t much bigger than a wound closed with stitches, but managing these wounds definitely takes some training and some getting used to.
Foley catheters: Some patients go home with a catheter in their bladder because they are not able to urinate on their own after surgery. Sometimes a catheter is needed because of the operation itself, or because of side effects of medication or inflammation. A Foley catheter is a thin rubber tube that goes up the urethra and is held in place in the bladder by a balloon at the tip filled with saline. Foley catheters empty into a bag that can be worn around your leg and is covered by your pants. Periodically you will have to empty the bag into the toilet.
Ostomies: For some intestinal operations, it may be necessary to bring the intestine or bladder up to empty though the skin of abdominal wall. These are called ostomies and take some getting used to. Ostomies are an upcoming blog post to themselves, but for now know that there are special wound/ostomy nurses who will help train you in how to manage an ostomy in the hospital.
Gastrostomy tubes: Some patients who cannot swallow go home with a feeding tube that delivers liquid nutrition into the stomach through the abdominal wall. These require flushing and learning how to use the pump and tubing.
IV lines: Sometimes patients require long-term IV access to get nutrition or medications (usually antibiotics that cannot be given in pill form). The most common type of long-term IV line is called a peripherally inserted central catheter or PICC (pronounced as “pick”) line. These are placed while patients are in the hospital, and patients and their caregivers are taught how to keep the line clean and how to connect it to an IV pump.
Blood thinner shots: After some operations, your surgical team may want you to go home with blood thinner injections for a month or so. These are usually once-a-day injections, using simple, single-dose, pre-filled syringes.
When To Start Learning about Home Care
It’s never too early to start learning and preparing for home care after an operation. Many operations are known to require a drain, for instance, and the training process for that can start during your clinic visit with your surgical team before the operation. Ask your surgeon if he or she plans to leave any drains after your operation, and ask whether you’ll be expected to manage them at home afterward.
Sometimes wound or drain care can’t be anticipated beforehand, though, and anyway it’s easier to learn how to manage them when you’ve got them in place. So, the real learning starts after your operation.
How To Learn about Home Care
There are lots of different resources out there to learn about drains, wound care, catheters, and all the other things that patients manage in the hospital. Ask your surgical team for resources that they recommend for your specific situation. Be careful about advice from resources outside the hospital. For example, there are many internet resources that can show you how to manage IV lines or ostomies, but not all of them are reliable or accurate.
Your best resource is your caregivers in the hospital. Your doctors and nurses have long-term experience working with all sorts of dressings and drains, and can teach you and your caregivers how to manage them. As discussed above, there are also special wound/ostomy nurses who can teach you about more complicated dressing and ostomy care.
The key to learning how to manage all these things is doing it yourself or with the assistance of the people who will be helping you at home. Watch the nurses and doctors and ask questions the first couple of times, but then insist on doing it yourself with them observing and offering pointers. You don’t want your first experience of doing it yourself to happen at home, without anyone to help or answer questions.
Keys to Preparing for Successful Self-Care
- Ask questions. Be sure you understand what you’ll be doing at home.
- Do it yourself, early and often. Practice makes perfect, so be sure to have your efforts watched by your care team, so they can tell you what you’re doing wrong before you develop bad habits. Be sure that any caregivers who will be helping you at home come to the hospital to learn in person how to manage things from your care team.
- Take notes. Things that seem obvious when you watch them or do them under supervision can be complicated when you try to do them by yourself. Write down the steps involved, make a checklist of supplies, and stay organized.
- Take pictures or make a video. Most cell phones have cameras or even the ability to take videos. Take photos or a video of the key steps in maintenance for later reference at home.
By the time you go home, you should be comfortable managing the care that you’ll have to do there. If you’re not, talk to your surgical team. It may be that you would be better suited spending another day or two in the hospital to get up to speed, or transferring to another facility, such as a skilled nursing facility (SNF) or long-term acute care (LTAC) hospital where you can continue to get skilled assistance. The best way to figure that out, and to be sure you’re ready to leave the hospital, is to talk to your surgical team early and often about your discharge plan.
By the way, this post was suggested by a reader. If you have any questions you’d like me to take a stab at answering in the blog, please put them in the comments below or let me know on Twitter at @jekohler.
This story originally appeared in the Health Dialog Care Compass Blog.