Saturday, August 16, 2014

TPN, Emergencies, and Manners

The last week has been absolute chaos. Over the course of this week not only have I been very busy with activism within the community of Ferguson as well as planning meetings with a representative here in Jefferson City to ensure that those who are supporting the Brown family's loss are being heard by Missouri's capital...

...but my apartment became infested with bed bugs...again.

So, so gross. I actually had to catch this booger, put him in a plastic bag (and believe me, if you are on long term TPN, you are swimming in plastic ziplocks and other useful garbage organized, of course away from your functional supplies...) and scare the jeepers creepers out of the front office staff.

I kid you not, I had to go to that much trouble to "prove" I had an infestation before they would allow a proper investigation. Manhandling vermin was on my list of things to not ever do in life.

But it's done. And I survived.

This put me in an awkward position called my mom's house. Meaning, in order to have a clean and safe area to handle my line and spike my IV bags, I had to stay there. My mom's house isn't one of my childhood houses (we moved so many times it was actually quite humorous...); rather, it is my step father's house where my mom and youngest brother also live. I got the guest bedroom, complete with ridiculously luxurious sheets, thick carpeted floor perfect for ruining with my insanely sugary TPN mixture, and a solid oak steamer trunk that I had to somehow make a safe station for line care.

That was fun, because I couldn't do any of the normal things I would have done at home.

The following is a rough guide for travel with TPN and other sensitive needs.

(Since this was an emergency situation and I was very preoccupied with intense activism in a likely historical event, please forgive the low quality photos).

Your TPN needs outweigh your wants. All of them: In short, your suitcase is going to be filled with sterile supplies, bags of whatever mixtures you have, and other necessary equipment so that you can maintain cleanliness, sterility, and most of for everyone involved.

Upon finding a place to stay I made a mad dash to the fridge and my sterile supply chest. Here again I am going to accentuate the absolute necessity for keeping your sterile supplies separate from non sterile: in an emergency situation, you don't want to be running from one end of the room to the next trying to gather what is necessary for your impromptu "vacation".

I then dumped everything that was sterile into my little suitcase. I do not own more than one of these. Why would I? I don't have much and I rarely go anywhere.

(yes, I am aware that the hanger is not sterile...)

I know what you're thinking: "If I load all of this in my suitcase, where do I put my clothes? My laptop? My iPad? My crystal ball?.."

The answer is: you will have to leave some of that at home. Sorry. This is an emergency, remember? Your primary focus is safety. If your primary focus is entertainment...I am very concerned about your ability to handle your IV supplies all alone. Maybe consult a nursing agency to share the load, as you may be under more stress than you can handle.

For clothing, if you have read past posts you may gather that I have a ton of backpacks. This comes in handy right about now. Since I had bed bugs, all that I could take with me was whatever had just come from the dryer. High temperatures kill bed bugs, and throwing clothing and linens is the best way to ensure that these items are free of nits. 

I tossed three shirts and a pair of jeans in a backpack. That ONE BAG I did dedicate to items that aren't essential as well. This included five books (all of which I am reading), my laptop (as I still had a ton of work to do while out of my home), and I do believe that is it.

Safety First: Yours, and that of others: Next, I grabbed a few items I personally would feel uncomfortable not having in handling my line and IV solutions. These are not necessities universally, but I would strongly recommend that you also consider having a short list of items you would take with you to ensure your safety as well as that of others while you are out of the privacy of your home and gracing the presence of others. For me personally, this included my sharps bin, a canister of Sani-Cloth, my box of surgical masks, my bottle of hand sanitizer, and a box of vinyl gloves (I have developed sensitivity to nitrile gloves)

PLEASE make sure that you keep your sharps container closed when not in use. Also note that these smaller ones that are exchanged week to week are not child proof. There weren't any small children where I was, but this may or may not be an issue for you.

Afterthought Products: Here are a few items I would recommend taking with you when taking TPN along for the ride:

Freezer packs

I am unsure of other individual orders, but when I get my weekly TPN it is packed with these long lasting freezer packs to ensure that the TPN is still cold when it reaches your refrigerator. I save these and put them in my own freezer (make sure this is ok with your infusion company) "just in case". I am glad I did, as it was quite awhile between the time I had everything packed until I reached my mom's house.

Flushes, Alcohol pads, and Heparin (if applicable)


For items like these, while they may seem to be a dime a dozen and altogether not very remarkable, they are the unsung heroes of proper line care. If you think you grabbed enough of these before you left, then grab some more. You should really take with you more than you need, but not so much that it takes up too much space that is displaces other items. You will not have issues if you have more than you need, but I can gurantee that you will have issues if you run out of these. Normal saline flushes aren't normal household items, and if you run out it isn't as easy as running to the grocery to get more.

Syringe tip caps

These are useful since some of the caps to saline flushes have been changed. I use them if I have to disconnect TPN from my line for any reason. I have been instructed (and this is not Gospel, so please don't take it as such) to not pause my infusion due to infection risk and I have already been septic three times, and all three times were very...serious. These are sterile and screw easily on the tips of the Vygon Lectro-Spiral tubing.

Being A Respectful Guest: My mom is easily overwhelmed by medical junk, and would not appreciate if any of her furniture got ruined by industrial cleaner. That oak steamer trunk is what I had to use as my station, so I asked her if she had a clean tray that I could use that didn't have any kind of paint that could be taken off easily by caustic chemicals. My mother has very, very nice...everything. 

I was happy to see she had something that was ceramic. If you opt to use a tray as sort of a "sterile field" (and I use that term loosely in the case of spiking IV solutions, since it isn't technically a sterile procedure) make sure that you choose something that is ceramic, stoneware, or another type of material that will not rust or otherwise be eroded by strong chemicals

If you opt to borrow a tray for this purpose, please be sure to offer to clean it for your host after you are finished. Once something like this has been exposed to hospital grade germicide, it is no longer food safe as is. Wash is hot water with plenty of liquid dish detergent. Ceramic isn't dishwasher safe.

Your host's refrigerator is typically where they keep their food. When you come over, please make sure that your supplies don't take up unecessary room in their space or otherwise encroach on their boundaries. While you must ensure your safety, you also must do your part in ensuring theirs as well. For potentially sensitive procedures, please do them in a quiet and private area so that you can focus and so they don't have to watch something potentially scary. Now is not the time to preach tolerance for "special needs". Save that for later.

Coat racks work just find as IV poles if you choose to have your bag suspended during the spiking process. Refrain from bringing an IV pole unless it is one that is easily portable.

Above all, make the most out of a crappy situation. I stayed with my family, so I got to catch up, chat with my mom, spend some time with my brother, and be somewhere semi relaxing as I tried to control strong emotions regarding a controversial event.

Be smart. Be safe. And have fun.

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