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If you want to know what’s better at home, home TPN versus nasogastric tube feeds for a patient that is malnourished and is not eating and drinking, stay tuned! I’ve got news for you.
So, currently we are having an inquiry where family has reached out to us and asking if we can do home TPN for their family member who has been malnourished and who hasn’t been eating for three weeks. They don’t want to go to hospital. They want to restart some form of nutrition at home. The dietitian that they’re working with has recommended home TPN.
Now, I’ve made videos about home TPN. We have clients at home on home TPN. TPN basically is total parenteral nutrition, it’s basically IV or intravenous nutrition. It can be given via central line, a PICC (Peripherally Inserted Central Catheter) line, a Hickman’s line or a port catheter. So, those things need to be in place. One of those lines need to be in place to get the TPN started and one of those lines needs to be put in. In a hospital, it can be done as an outpatient, but it still requires some form of skill, even if only a short hospital admission.
The alternative for someone that doesn’t have any digestive issues that doesn’t have an ileus or a bowel obstruction or anything malignant in their gastrointestinal tract, another option here might be a nasogastric tube. Let me explain.
A nasogastric tube is a tube that goes through the nose into the stomach that a nurse can actually insert. It needs to be followed up by a chest X-ray to confirm the position of the tube, so that the end of the tube is actually in the stomach and not in the lungs. For example, you don’t want to start any feeds that go into the lungs. Once the position is confirmed by a chest X-ray that the tube is not in the lungs, then nasogastric tube feeds can be started.
In this particular situation, we actually recommended this family that we should start with the nasogastric tube instead of TPN because TPN requires an intravenous line, there’s much higher infection risk. Whereas with the nasogastric tube, it’s much quicker, much less intrusive and there’s much less infection risk, and it can be done at home. We’re sending one of our critical care nurses with the doctor’s order to insert the nasogastric tube, do a home chest X-ray and then we can start the nasogastric tube feeds.
So, I hope that explains malnutrition at home for you and how we can help you.
Then, on a day-by-day basis, we can help feeding the patient with the nasogastric tube, manage the nasogastric tube because it needs a bit of maintenance. Also, monitoring the feeds, probably has to be started slowly, especially if someone hasn’t eaten for three weeks, you have to start slowly because otherwise there could be some refeeding syndrome, which could put a patient in danger as well. It needs to be monitored closely and needs doctor and nurse input in a situation like that.
So, to wrap this all up, with Intensive Care at Home, we are providing 24-hour critical care nurses at home predominantly for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure) ventilation without tracheostomy, tracheostomy without ventilation, home TPN, home IV potassium infusion, and home IV magnesium infusion. We’re also providing port management, central line management, PICC line management as well as Hickman’s line management. We’re also providing palliative care services at home and we’re also providing nasogastric tube management and PEG tube management at home.
We are also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of a program at the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home instead of going to ED.
We’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our service is between $2,500 and $3,000 per bed day, and we’re freeing up an ICU bed. So, it’s a win-win situation all around, not even mentioning the improvements for quality of life for patients and their families.
With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in regional and rural areas. We are a NDIS (National Disability Insurance Scheme) approved service provider all around the country, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, and Department of Veteran Affairs (DVA) all around the country. Our clients and we as a provider have also received funding through public hospitals, private health funds as well as departments of health.
We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2024. We’ve been achieving this accreditation since 2012. No other provider has achieved this high level of accreditation in the community and has created this much intellectual property for Intensive Care at Home nursing than we have that puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community. No other provider in Australia can take on a higher acuity in the community than we can.
If you’re at home already and you’re watching this and you realize that you don’t have the right level of support, I’ll give you a tangible example here. One of our first clients over 10 years ago was a client who was at home on a ventilator with a tracheostomy with a support worker model. Of course, support workers cannot keep a patient at home on a ventilator with the tracheostomy, that’s like flying the airplane with a cabin crew instead of the pilot because this client was at risk of dying, he was going in and out of ICU because support workers simply have no skill, no experience, no knowledge how to look after ventilator and a tracheostomy, that’s an intensive care nursing skill.
Then eventually, the client found us, and we were proving our concept there very fast. When we worked with the client, he never ever went back into ICU ever again and he was safe. We can do the same for you if you’re not safe at home. If you don’t have enough funding, let us do the advocacy. We can help you with all of it, otherwise, we wouldn’t be in business. We have always successfully advocated for our clients.
That’s also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS support coordinators and they have a wealth of knowledge. I will put into the written version of this blog to an interview that I’ve done with Amanda, which is one of our NDIS support coordinators. We’re also providing TAC case management and WorkSafe case management in Victoria.
If you’re a NDIS support coordinator or a case manager from another organization watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for a nursing care for your participants and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us. We can help you with the right advocacy. We also provide NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.
If you’re a critical care nurse and you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of two years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted to hearing from you.
I have a disclaimer though because we are offering a tailor-made solution for our clients, which includes regular staff. Our clients want to have the same staff coming over and over again because they are so vulnerable and so special, and that’s why we need regular staff. So, if you are looking for agency work where you can come and go, this is not the right fit for you. We are looking for consistency and our clients are looking for consistency, so please only apply with us if you can give us regular and consistent availabilities for shifts and if you are really keen on building relationships with us and with our clients, otherwise it’s not going to work.
If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We are currently expanding our medical team as well.
We can also help you eliminate your bed blocks in ICU and ED for your long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds, and in most cases, you won’t even pay for it. Even if you do pay for it, it’s much more cost-effective than what you’re paying in ICU or in ED for.
If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, etc., please reach out to us as well. We can help you fast.
If you’re in the U.S. or in the U.K. and you’re watching this and you need help, we want to hear from you as well. We can help you there privately.
Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to info@intensivecareathome.com.
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Thank you so much for watching.
This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.
Take care for now.