Daily Routine Our room setup video can be watched at youtube https://www.youtube.com/watch?v=rw-4mp8IVcg https://www.youtube.com/watch?v=81MpTfgAdPs |
Daily Routine (What we follow...)
Listing here our daily routine we follow for home care management.... This may help caregivers/family to take reference for bedridden patient with any kind of disease. Besides what we are listing here .. there are many other important activities/procedures which must be followed weekly, monthly, Qtrly and therefore need to be adjusted in this same daily activities for any particular day. Currently we are detailing our time schedule with activity/procedure performed along with brief steps. We know it might be difficult to understand the complete activity unless there is complete information available. So, we will try to capture video of the activities and include here in sometime. In case patient is using urinal catheter (your lavotary PAN and diaper setting activities will be reduced). And if using HME filter instead of humidifier machine, 3 hourly filling of chamber and weekly cleaning of chamber will also gets avoided). We are not using urinal catheter for mumma and neither HME filter as mumma breathing gets distress using that. Please note : We are sharing details of what we considered were the best for Mumma from our experience and knowledge we researched from medical procedures/internet information available .. and there are many improvisation and new procedures we added ourselves from the day one to the stage what we reached here today. |
As there are procedures and monitoring which need to be active throughout 24*7... we cannot say when we start our day. However as per anybody regular routine, we are starting time schedule 7 AM. Activities which are repeated, their frequency values are highlighted with blue color. Most important and urgent procedure is highlighted in red i.e. trachea suction.
From -till Mins(time taken) Frequency(in a day) Procedure
Brief steps for that activity/procedure
=================================================================================================================
Start with Oral suction; Go to vent side table; Open 5 ltr distilled water can to fill around 300 ml of 0.5 l water bottle; Tightly close 5 litre can.Carefully monitor breathing cycle from ventilator screen; Just at the moment its on lower side(breath is exhaling) -Open Vent tube circuit from the side which is attach to Vent(other side of this tube is attached to Humidifier); Carefully pour water into tube, holding tube high and shake it slightly so water goes down to Humidifier chamber completely.Fill it just upto the chamber water mark or below it. Close the tube back to Vent. This opening and re-attching circuit should take <8 seconds. Vent will give LMV, HRR & HMV (Low Minute Ventilaton, High respiratory rate & High Minute Ventilation) this time for 5-10 seconds. Do oral suction at end.
Preparation of required things(Hand towel, luke warm water in Mug, wet cotton rubbed on dove soap or few drop of dove liquid facewash); First dip of towel to clean deposits formed after night around eyes; Cleaning around eyes, wipe face/neck with soapy cotton; wipe face & ears with towel dipped & squeeze in water twice
cleaning of nose with sheets of rolled tissue 4 times; Oral suction 2-5 times during this process
.
Preparation- 2 person are must for this procedure.
Cleaning of hand with antiseptic soap; wear gloves on; Fill 1 ml NS solution in 2ml syringe; Take out & attach Ambu bag; Do thorough oral suction and then dry oral tube with clean tissue; Preferably switch on Oxygen concentrator machine for 5 mins before and kept it on after 5 minutes of suction procedure.
Person 1-Take out 1 new nelcath trache suction tube from wrapper making sure it should not get touch anywhere; Attach nelcath to Oral tube mouth and dip the suction tube end in 500 ml NS(Normal Saline) bottle to check suction pressure and making nelcath tube's wall wet. Now take it out from NS bottle and get ready for T.suction with folded nelcath for building right value of suction pressure.
Person -2 Get the bed straight, open vent tube circuit from trache tube, detach needle from 2ml syringe, pour 1 ml NS in trache, Attach Ambu to trache portex tube -give 2-3 manual ambu breath to mix the NS with secretion.Detach Ambu.
Person 1- Now insert nelcath tube in trache slowly without any manual pressure by keeping folding intact, when down below in trach -release nelcath fold so pressure now can bring mucus into tube, slowly take out tube by revolving it around and immediately other person should attach vent circuit back to to Trache tube.
Person -1- Put the nelcath which is attach to oral yonkur set back to 500 ml NS bottle to clean suction in the nelcath and oral tube.Detach nelcath tube from oral set and throw it.
Half bucket of luke warm water, one Large Mug, 2 small sponge towels for wet cleaning , 1 Big towel for dry cleaning. One set of front open shirt & one pajama, one diaper & one set of polysheet with cloth sheet for setting.
As it involves side turns, we usually do sponge at 8:15 AM after face wash and before any main feed started for the day.
We keep upper half towel(dipped in bucket) and lower sponge towel (Mug) separate. Start at one side(right) which suits you. Take out the shirt on that side and let it remain below arm to avoid weting of bedsheet. If you have helper –let her start at legs but on opposite direction to avoid interruptions. Take squeezed towel each time and clean in small portion –first time with only arms & fingers rubbing atleast twice every section , second squeeze with front half of that side + under arms. Dry each time with clean dry towel. Go to other side(left). Let helper hold and lift patient slightly above so you can pull out shirt from below. Follow same procedure this side.
Let wear one side shirt in left side arm and front. Layered it on top and keep front portion in covered and hold with right arm to support PEG tube while side –turn. Pull and curve legs in V- shape for turning. Always do oral suction thoroughly before side turn to avoid any coughing. Let helper turn body (keep cushion on curve portion below legs to support) and give her support to hold of Vent tube carefully so it doesn’t shake and avoid patient coughing. Keep dry towel on bed sheet and start cleaning with wet towel on left side back and left hip. Clean and dry that side. Take the layered shirt and place it below so as to pull from right side turn. Come on right side, keep legs in same position and let helper turn body on other side so as to clean right side back. Follow same procedure for this back side by taking full precautions on PEG tube support, Pull the shirt and neat below clothing, bed sheet while doing that. Straighten legs. Now wear the right side arms and close shirt buttons.
Follow “Diaper setting” procedure as in steps above. Change towel below Trache, PEG support and Saliva support towel to finish sponge procedure. Now you can give first main feed (tea/biscuits/Rusk).
It may take another 15-25(sometime an hour & remove and place diaper if urine/motion not done ) as required by mom.
Preparation : around 300 ml of luke warm water in mug +5 drops of savlon liquid; 7-8 cotton wipes 3inch*4inch, one polybag.
Wear examination gloves, While PAN is still placed on, dampen each cotton wipe with savlon water liquid, clean hips with 2 cotton wipe cleaning of private parts with lighly wet cotton wipes, pour 10 ml of water from upper side till private parts for final cleaning soft wipe with clean wipe to absorb extra water remaining.soft wipe with clean wipe to absorb extra water remaining.
Note : every 3rd day we also add any PH balance soap solution for cleaning private parts e.g. Lactacyd or V-gel)
Cleaning Part 2
Call domestic helper to get on to bed, so she hold both legs and hip and pull it upwards, keep it there for 5 seconds, During this 5 seconds take out PAN safely ( as it contains urine/motion) and clean quickly from hips to clean remaining of motion & urine attached at bottom with atleast two ready dampened cotton wipes
Open hairs and massage head slowly all over, keep hairs open for 10 mins. And do combing and neatly tied both sides.
Apply drop of ghee(refined butter) all over the lips with one finger; apply light talcum powder with sponge; apply lipstic with lip brush & place matching bindi on forehead. Show mom her ready face with hand mirror, keep it hold for 2-3 mins and scroll it at various position slowly to let mom see places all over the bed & room.
Pull Bed from legs side to create more than bucket size space on head side. Place full water bucket on stool and empty bucket below head portion. Roll over bed upper portion in 50 degree. Pull patient upwards with proper pillow support (one person P1 should apply force from head side bed so bed should not move back) so as to reach pillow along with head position just outside bed rod. Person P1 should hold head and other should take out pillow, fold bed sheet below shoulders, place lengthy polysheet below neck in a way so excess water during washing hair should not flow below back. Cover neck with color rounded polysheet for double protection.
Let P2 keep holding head so P1 can start shampooing hair. Massage fingers throughout head, let P1 hold and shampoo below portion by taking patient head support from P2 in between. Once shampoo is done, wash hair in sections to carefully to avoid ears. When hair are clear, take small amount of coconut oil and massage it throughout head and hairs especially below portions. Do final wash with 3-4 mugs of water and squeeze water from hair create a bun. Place dry towel below and fold it by cleaning face and ear thoroughly. Place pillow below beneath head covered with towel. Now pull patient downwards (again support from P1 to hold bed in opposite force). Open towel and bun and spread hair to let them dry. Slightly comb in moist hair to straigten all. Move back bed in same position.
Once hair gets dry after few hours , masaage with oil, Do side turn and cleanly part hair in two sections and detangle and tie braid.
Take 2 cotton 3*4 inch size, dampen it with sprinkling droplets of water, Ask helper hold mom's both legs upwards, Carefully remove PAN and clean the bottom with 2 moist cotton wipes, Slowely place both legs on bed again. Take PAN to wash room and flush the urine/motion, add two mugs of water to clean the PAN, wipe it with 3-4 pieces of toilet tissue and place it in verandah over rubber foot-mat to let it dry.
Sprinkle antibacterial powder(we use ABSORB) every time whenever new diaper is getting changed (usually every 2-3 hours), This procedure also needs two person, one holding each side of diaper. Hold upwards each side of leg by each person and quickly place diaper beneath. Turn over mom lower back from each side to clear any diaper foldings which may hurt body. Close diaper very loosely so it should not leave marks on mom's body. Take 3 ft/2ft poly sheet and similar size double or thick cotton cloth.Using same procedure, place below the diaper. Hold bedsheet from below legs, pull it while holding legs upwards to clean any bedsheet foldings. Hold mom's shirt corner from each side , Pull it to make it straight (so folding of shirt clothing should not keep hurting body) One person to hold Mom neck with complete support from shoulder and other should pull pillow to give complete neck support. Hold bedsheet from sides of hips and around neck, pull it above with force so mom also moves upwards to place her in proper position on bed.This will take bedsheet upwards and after few times of such setting new bedsheet required to be placed on feet side which move upwards and bedsheet gets changed automatically.
Take 350 ml of very hot porriage (prepared with pulses and seasonal mix vegetable in morning- detail preparation of which is available in another page in this website) around 10:45 AM. Add one slice of heated bread(may alternate with brown/white bread), keep this mixture aside for 15 mins to get bread soften and slightly cool. After 15 mins , add 2 caps of ensure powder(complete dietary supplement) and put in container & use hand blender to blend it. Sieve it properly and pour final mixture(custard like consistency) slowely in feeding glass to make sure there are no lumps there in final mixture. Take this final prepared 300 ml mixture & 100 ml water , both in lukewarm temperature for the feeding in Mom room
Follow the PEG feeding procedure as explained in above Tea feed around 9 AM. However this feed should have such consistency so the feeding time takes atleast 10-15 mins.
This will still include every 5 min proper monitoring like oral suction number of times, Trache suction as required, watching eyes, complete setting, vent setting, taking action based on any vent alarms.
Take 150 ml of water in glass, add pinch of salt, stir thoroughly, add 1 teaspoon of sugar, stir till it dissolve completely, clean PEG feeding syringe. Fix the nozzle of syringe on top of PEG tube, pour prepared solution, open PEG lock , let it flow, keep adding till solution finishes in glass. Keep monitoring it till it reached at bottom of nozzle of PEG syringe, when it just passed to PEG tube -quickly close the PEG lock and detach the feeding syringe.
This will still include every 5 min proper monitoring like oral suction number of times, Trache suction as required, watching eyes, monitoring complete setting, vent setting, taking action based on any vent alarms.
Follow the same steps as given in morning Tea feed preparation and feeding.
Place 2 hourly alarm in your mobile or alarm clock for complete night to fill humidifier water, monitor Vent reading, do trach suction, oral suction 5-20 times during night may be required. Sleep with mind alert stage to listen to Vent alarm for High minute Ventilation & high respiratory rate specially which is reflection of trach suction requirement -but depends. Around 3-4 AM , remove cushion to have legs straight (also depends).
Whole night will still include regular monitoring like oral suction number of times, Trache suction as required, watching eyes, complete setting, vent setting, taking action based on any vent alarms.
From -till Mins(time taken) Frequency(in a day) Procedure
Brief steps for that activity/procedure
=================================================================================================================
- Full day 1-2 mins any time-day/night generally 80-100 times/day Oral suction
- 7 - 7:10 AM 10 min 1 Morning wake up
- 7:10 7:15 AM 2-5 mins 7-8 times(every 3 hourly) Humidifier chamber -water filling
Start with Oral suction; Go to vent side table; Open 5 ltr distilled water can to fill around 300 ml of 0.5 l water bottle; Tightly close 5 litre can.Carefully monitor breathing cycle from ventilator screen; Just at the moment its on lower side(breath is exhaling) -Open Vent tube circuit from the side which is attach to Vent(other side of this tube is attached to Humidifier); Carefully pour water into tube, holding tube high and shake it slightly so water goes down to Humidifier chamber completely.Fill it just upto the chamber water mark or below it. Close the tube back to Vent. This opening and re-attching circuit should take <8 seconds. Vent will give LMV, HRR & HMV (Low Minute Ventilaton, High respiratory rate & High Minute Ventilation) this time for 5-10 seconds. Do oral suction at end.
- 8- 8:05 AM 5 min 1 time Water feed
- 8:05 8:15 AM 10 min 1/day Teeth cleaning
- 8:15 8:25 AM 10 min 1/day Face, eye and nose cleaning
Preparation of required things(Hand towel, luke warm water in Mug, wet cotton rubbed on dove soap or few drop of dove liquid facewash); First dip of towel to clean deposits formed after night around eyes; Cleaning around eyes, wipe face/neck with soapy cotton; wipe face & ears with towel dipped & squeeze in water twice
cleaning of nose with sheets of rolled tissue 4 times; Oral suction 2-5 times during this process
.
- 8:25 8:35 AM 10 min 4 to 15/day as per secretions quality during the day Trache suction
Preparation- 2 person are must for this procedure.
Cleaning of hand with antiseptic soap; wear gloves on; Fill 1 ml NS solution in 2ml syringe; Take out & attach Ambu bag; Do thorough oral suction and then dry oral tube with clean tissue; Preferably switch on Oxygen concentrator machine for 5 mins before and kept it on after 5 minutes of suction procedure.
Person 1-Take out 1 new nelcath trache suction tube from wrapper making sure it should not get touch anywhere; Attach nelcath to Oral tube mouth and dip the suction tube end in 500 ml NS(Normal Saline) bottle to check suction pressure and making nelcath tube's wall wet. Now take it out from NS bottle and get ready for T.suction with folded nelcath for building right value of suction pressure.
Person -2 Get the bed straight, open vent tube circuit from trache tube, detach needle from 2ml syringe, pour 1 ml NS in trache, Attach Ambu to trache portex tube -give 2-3 manual ambu breath to mix the NS with secretion.Detach Ambu.
Person 1- Now insert nelcath tube in trache slowly without any manual pressure by keeping folding intact, when down below in trach -release nelcath fold so pressure now can bring mucus into tube, slowly take out tube by revolving it around and immediately other person should attach vent circuit back to to Trache tube.
Person -1- Put the nelcath which is attach to oral yonkur set back to 500 ml NS bottle to clean suction in the nelcath and oral tube.Detach nelcath tube from oral set and throw it.
- 8:30-9:15 AM 45 mins alternate day Body Sponge
Half bucket of luke warm water, one Large Mug, 2 small sponge towels for wet cleaning , 1 Big towel for dry cleaning. One set of front open shirt & one pajama, one diaper & one set of polysheet with cloth sheet for setting.
As it involves side turns, we usually do sponge at 8:15 AM after face wash and before any main feed started for the day.
We keep upper half towel(dipped in bucket) and lower sponge towel (Mug) separate. Start at one side(right) which suits you. Take out the shirt on that side and let it remain below arm to avoid weting of bedsheet. If you have helper –let her start at legs but on opposite direction to avoid interruptions. Take squeezed towel each time and clean in small portion –first time with only arms & fingers rubbing atleast twice every section , second squeeze with front half of that side + under arms. Dry each time with clean dry towel. Go to other side(left). Let helper hold and lift patient slightly above so you can pull out shirt from below. Follow same procedure this side.
Let wear one side shirt in left side arm and front. Layered it on top and keep front portion in covered and hold with right arm to support PEG tube while side –turn. Pull and curve legs in V- shape for turning. Always do oral suction thoroughly before side turn to avoid any coughing. Let helper turn body (keep cushion on curve portion below legs to support) and give her support to hold of Vent tube carefully so it doesn’t shake and avoid patient coughing. Keep dry towel on bed sheet and start cleaning with wet towel on left side back and left hip. Clean and dry that side. Take the layered shirt and place it below so as to pull from right side turn. Come on right side, keep legs in same position and let helper turn body on other side so as to clean right side back. Follow same procedure for this back side by taking full precautions on PEG tube support, Pull the shirt and neat below clothing, bed sheet while doing that. Straighten legs. Now wear the right side arms and close shirt buttons.
Follow “Diaper setting” procedure as in steps above. Change towel below Trache, PEG support and Saliva support towel to finish sponge procedure. Now you can give first main feed (tea/biscuits/Rusk).
- 8:00- 8:10 AM 10 min 2/day Making tea for morning feed
- 8:30 -9:00 AM 30 3-6/day Lavotary PAN
It may take another 15-25(sometime an hour & remove and place diaper if urine/motion not done ) as required by mom.
- 9:00- 9:10 AM 10 2/day Tea Feed preparation
- 9:00-9:15 AM 15 1/day Urine/motion Cleaning
Preparation : around 300 ml of luke warm water in mug +5 drops of savlon liquid; 7-8 cotton wipes 3inch*4inch, one polybag.
Wear examination gloves, While PAN is still placed on, dampen each cotton wipe with savlon water liquid, clean hips with 2 cotton wipe cleaning of private parts with lighly wet cotton wipes, pour 10 ml of water from upper side till private parts for final cleaning soft wipe with clean wipe to absorb extra water remaining.soft wipe with clean wipe to absorb extra water remaining.
Note : every 3rd day we also add any PH balance soap solution for cleaning private parts e.g. Lactacyd or V-gel)
Cleaning Part 2
Call domestic helper to get on to bed, so she hold both legs and hip and pull it upwards, keep it there for 5 seconds, During this 5 seconds take out PAN safely ( as it contains urine/motion) and clean quickly from hips to clean remaining of motion & urine attached at bottom with atleast two ready dampened cotton wipes
- 9:15- 9:20 AM 5 mins 2/day Giving Tea PEG feed
- 9:20- 10:00 AM TV
- 10-10:10 AM 10 min 4 to 15/day as per secretions quality during the day Trache suction
- 10:10-10:15 AM 2-5 mins 7-8 times(every 3 hourly) Humidifier chamber -water filling
- 10:15- 10:30 AM 10 mins 1 Combing
Open hairs and massage head slowly all over, keep hairs open for 10 mins. And do combing and neatly tied both sides.
- 10:30-10:40 AM 10 mins 1 Making ready
Apply drop of ghee(refined butter) all over the lips with one finger; apply light talcum powder with sponge; apply lipstic with lip brush & place matching bindi on forehead. Show mom her ready face with hand mirror, keep it hold for 2-3 mins and scroll it at various position slowly to let mom see places all over the bed & room.
- 10:40-11:15 AM 25 mins 3 to 5 times whenever required Lavotary PAN placing
- 10:50-11:30 AM 40 mins 1/10 days Head Wash
Pull Bed from legs side to create more than bucket size space on head side. Place full water bucket on stool and empty bucket below head portion. Roll over bed upper portion in 50 degree. Pull patient upwards with proper pillow support (one person P1 should apply force from head side bed so bed should not move back) so as to reach pillow along with head position just outside bed rod. Person P1 should hold head and other should take out pillow, fold bed sheet below shoulders, place lengthy polysheet below neck in a way so excess water during washing hair should not flow below back. Cover neck with color rounded polysheet for double protection.
Let P2 keep holding head so P1 can start shampooing hair. Massage fingers throughout head, let P1 hold and shampoo below portion by taking patient head support from P2 in between. Once shampoo is done, wash hair in sections to carefully to avoid ears. When hair are clear, take small amount of coconut oil and massage it throughout head and hairs especially below portions. Do final wash with 3-4 mugs of water and squeeze water from hair create a bun. Place dry towel below and fold it by cleaning face and ear thoroughly. Place pillow below beneath head covered with towel. Now pull patient downwards (again support from P1 to hold bed in opposite force). Open towel and bun and spread hair to let them dry. Slightly comb in moist hair to straigten all. Move back bed in same position.
Once hair gets dry after few hours , masaage with oil, Do side turn and cleanly part hair in two sections and detangle and tie braid.
- 11:15- 11:20 AM 5 min Cleaning
Take 2 cotton 3*4 inch size, dampen it with sprinkling droplets of water, Ask helper hold mom's both legs upwards, Carefully remove PAN and clean the bottom with 2 moist cotton wipes, Slowely place both legs on bed again. Take PAN to wash room and flush the urine/motion, add two mugs of water to clean the PAN, wipe it with 3-4 pieces of toilet tissue and place it in verandah over rubber foot-mat to let it dry.
- 11:20- 11:30 AM 10 min 4 to 7 times Diaper Setting
Sprinkle antibacterial powder(we use ABSORB) every time whenever new diaper is getting changed (usually every 2-3 hours), This procedure also needs two person, one holding each side of diaper. Hold upwards each side of leg by each person and quickly place diaper beneath. Turn over mom lower back from each side to clear any diaper foldings which may hurt body. Close diaper very loosely so it should not leave marks on mom's body. Take 3 ft/2ft poly sheet and similar size double or thick cotton cloth.Using same procedure, place below the diaper. Hold bedsheet from below legs, pull it while holding legs upwards to clean any bedsheet foldings. Hold mom's shirt corner from each side , Pull it to make it straight (so folding of shirt clothing should not keep hurting body) One person to hold Mom neck with complete support from shoulder and other should pull pillow to give complete neck support. Hold bedsheet from sides of hips and around neck, pull it above with force so mom also moves upwards to place her in proper position on bed.This will take bedsheet upwards and after few times of such setting new bedsheet required to be placed on feet side which move upwards and bedsheet gets changed automatically.
- 10:40-11:30 AM 30 min 1 Breakfast feed
Take 350 ml of very hot porriage (prepared with pulses and seasonal mix vegetable in morning- detail preparation of which is available in another page in this website) around 10:45 AM. Add one slice of heated bread(may alternate with brown/white bread), keep this mixture aside for 15 mins to get bread soften and slightly cool. After 15 mins , add 2 caps of ensure powder(complete dietary supplement) and put in container & use hand blender to blend it. Sieve it properly and pour final mixture(custard like consistency) slowely in feeding glass to make sure there are no lumps there in final mixture. Take this final prepared 300 ml mixture & 100 ml water , both in lukewarm temperature for the feeding in Mom room
- 11:30- 11:45 AM 15 min Feeding through PEG
Follow the PEG feeding procedure as explained in above Tea feed around 9 AM. However this feed should have such consistency so the feeding time takes atleast 10-15 mins.
- 12:00- 14:30 PM Rest time/TV
This will still include every 5 min proper monitoring like oral suction number of times, Trache suction as required, watching eyes, complete setting, vent setting, taking action based on any vent alarms.
- 13:30-13:35 PM 2-5 mins 7-8 times(every 3 hourly) Humidifier chamber -water filling
- 14:40 14:50 PM 10 min 1 Water(salt+sugar) feed
Take 150 ml of water in glass, add pinch of salt, stir thoroughly, add 1 teaspoon of sugar, stir till it dissolve completely, clean PEG feeding syringe. Fix the nozzle of syringe on top of PEG tube, pour prepared solution, open PEG lock , let it flow, keep adding till solution finishes in glass. Keep monitoring it till it reached at bottom of nozzle of PEG syringe, when it just passed to PEG tube -quickly close the PEG lock and detach the feeding syringe.
- 15:10 15:20 PM 10 min 3-6 times Diaper Setting
Repeated procedure explained already above.
- 15:15- 15:45 PM 30 3 Afternoon feed
- 15:45- 18:30 PM Rest time/TV
This will still include every 5 min proper monitoring like oral suction number of times, Trache suction as required, watching eyes, monitoring complete setting, vent setting, taking action based on any vent alarms.
- 16:45-16:50 PM 2-5 min 7-8 times(every 3 hourly) Humidifier chamber -water filling
- 18:30 18:45 PM 20 min 2 Tea+Biscuit feed preparation& PEG Feeding
Follow the same steps as given in morning Tea feed preparation and feeding.
- 19:00 19:15 PM 15 1 Finger pus dressing.
This is specific to mom case, so not explaining steps here. We are performing this since last 3 years as many skin and surgeons were called at home but this recurrent pus is not getting resolved. Auto-immune condition of ALS could be one of the explanation of this condition.
- 19:20 - 19:45 PM 25 min 3-6 times Lavatory PAN placing
- 19:55- 20:00 PM 2-5 mins 7-8 times(every 3 hourly) Humidifier chamber -water filling
- 20:00- 20:20 PM 20 1 Exercise
- Legs
- Press gently all over legs mainly all think muscles, keep it doing for 2 mins for avoiding any blood jam in nerves.
- Slowly pick from both of your hand bend upwards in 'V' position, come down-repeat 10-15 times.
- Massage foot, hold with your palm , slowly bend inwards without any force. Relax, repeat for 8-10 times.
- Repeat all above steps for other leg.
- Hands
- Press gently all over arms mainly all think muscles, keep it doing for 2 mins for avoiding any blood jam in nerves.
- Hold one arm with both of your hand, slowly bend it inwards in 'V' shape and outwards. Repeat 10-15 times.
- Hold upper arm and slowly stretch side-ways to form reverse L, repeat 10 times.
- Hold arm in slight bend position and roll it inwards 8-10 times and repeat outwards 8-10 times.
- Fingers got curled due to ALS, so massage the palm and finger specially, slowly hold and try to cross our fingers with mom fingers without extra force.
- 20:30- 21:30 PM 60 min 1 Side-Turning (Karwat)
- Get both legs in V shaped, Keep one cushion in that side of position where 'V' shaped legs will be turning.
- One person holds side along with support from hip , slowly bend towards one side. Need to make sure ventilator circuit pipe should be hold in position so it should not move in respect to neck placement while doing side turn, otherwise this would be very uncomfortable and lead to lot of coughing.
- Second person will keep two pillow-one by one on back till neck to give full support to body. Cushion will give support to front(side where turning was done) Place the foot with toe in proper comfortable position as this will be hurting doing side turn. Keep extra muffler below head to give proper support to head.
- Add think cushioning between the knees if that looks comfortable.
- 21:30- 21:50 PM 20 min 3 Lavatory PAN placing
- 21:50 22:00 PM 10 min 5 Diaper setting
- 22:00- 22:10 PM 10 min 1 Trache cuff deflate/inflate
- 22:10- 22:20 PM 10 min 4 to 12 Trache suction
- 22:00-22:30 PM 30 min 6 Dinner feed preparation & PEG Feeding
Follow the same procedure as in Lunch feed preparation and PEG feeding steps.
- 23:00- 23:30 PM 30 min 1 Night setting
Place 2 hourly alarm in your mobile or alarm clock for complete night to fill humidifier water, monitor Vent reading, do trach suction, oral suction 5-20 times during night may be required. Sleep with mind alert stage to listen to Vent alarm for High minute Ventilation & high respiratory rate specially which is reflection of trach suction requirement -but depends. Around 3-4 AM , remove cushion to have legs straight (also depends).
Whole night will still include regular monitoring like oral suction number of times, Trache suction as required, watching eyes, complete setting, vent setting, taking action based on any vent alarms.
- 23:15- 23:20 PM 2-5min 7-8 times(every 3 hourly) Humidifier chamber -water filling
- 3:30- 3:35 AM 2-5 min 7-8 times(every 3 hourly) Humidifier chamber -water filling
=============================================================================
Summary of procedures
Besides the daily procedures which are listed above, there are various weekly, monthly, Qtry and yearly procedures,
which we follow and need to be accommodated in daily routine as required.
Summary of procedures
Besides the daily procedures which are listed above, there are various weekly, monthly, Qtry and yearly procedures,
which we follow and need to be accommodated in daily routine as required.
S.No Procedure Time taken(in minutes) Frequency
- Oral suction(mouth saliva cleaning) 1-2 min 80-120/day
- Trache Suction 5-7 mins 3-12/day
- Trache Dressing 15 mins 1/day
- PEG Dressing 10 mins 1/day
- PEG Tube maintenance 2 1/day
- Exercise 20 1/day
- Humidifier :Water re-filling 2 min 10/day
- Trache tube cuff- > deflate/inflate 5 min 1/day
- Eye care (cleaning sides with moist cotton wipes) 2 min 5/day
- Circular movement of catheter mount to remove excess water 1 min 10/day
- Diaper change and complete setting 10 min 7/day
- Lavotary PAN placement and cleaning 10-45 min 5/day
- Oral bottle cleaning 5 min 3/day
- Suction machine chamber cleaning 10 min 3/day
- Vent & Oxygen machine Filters cleaning 5 min 1/day
- Oxygen machine –water change 5 min 1/day
- Brushing, face wash & making ready 30 min 1/day
- Sponge 45 min alternate day
- Hair washing 60 min 1/10 days
- Trache Tube-Change 10 min 1/3-4 weeks
- Back-care/Side turning 45 min 1-2/day
- Cleaning of Humidifier water chamber Exhalation valve(whisper) 20 min 1/week
- Sterilization/cleaning of re-usable equipment-Vent hose pipe(Re-usable heated wire )60 min 1/month
- Sterilization/cleaning of re-usable equipment- Nebulizer kit 20 min As needed.
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Home page Life Learnings and Procedures Tips Contact us Testimonials/Blessings Video Gallery Image Gallery Analytics
Dressing Home Vent care management (equipments, procedures and regular supplies) Feed preparation and PEG feeding
Ventilator Shout Out!!! ICU -Build safe ICUs, save lives. Open letter to Indian Government on ALS C & S group demands
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