HOME IV THERAPY PICC Portacath
Who To contact Cardio-Respiratory Integrated Specialist Services (CRISS) Office hours 0800 1630 hours Ph: 364 0167 Weekends and after hours, phone Christchurch Hospital operator and ask to be put through to Ward 25. Ph: 364 0640 Cystic Fibrosis Clinical Nurse Specialist (Robyn Beach) Ph: 027 213 8087 Emergencies Dial 111 If you have a medical emergency ring for an ambulance or contact Emergency Department Christchurch Hospital. General Practitioner Continue to access your GP as you would normally. You will be on leave from the ward and will be able to return if required. If you need to return to the ward, please contact the CF CNS or Ward 25 after hours to organise this. If you come back to the ward, bring your drug chart with you. Supervising Physician:
INTRODUCTION This booklet gives you information on how to draw up and self administer intravenous antibiotics (IVABs) independently. Learning how to give your own IVABs means that you may be able to have a shorter hospital stay, and once you are feeling better, complete your treatment at home. Home IVAB therapy is delivered through a central line either a PICC or a Port. The two types of line are explained below. PICC Line The Peripherally Inserted Central Catheter (PICC) is used for medium to long term drug therapy. It is a very flexible tube (catheter) that is put into a vein in your arm. This catheter is threaded along the vein and rests in the major vein, the superior vena cava, just outside the heart. The PICC is inserted in the radiology department A PICC can remain in your arm for a long period of time without needing changing. All of your IV medication and any blood tests required can be done through the PICC. Some activities should be limited, such as those involving repetitive movements of the arm (e.g. tennis). You cannot swim while you have the PICC in place. Your nurse can give you further information. Parts of your PICC Clamp Extension set Positive placement device (PPD) Catheter Caring for your Catheter: While in hospital your nurse will care for and help you learn about your catheter. Once you are discharged, the CF CNS will support you in the care of the catheter
Portacath A portacath (port) is an implanted device that gives access to your veins. One of the advantages of having a port put in is that when it is are not being used, it is completely under the skin, with no tubing or catheter visible. Ports are most suitable for people who need regular, long term intravenous treatment such as antibiotics. People who have difficulty with other types of intravenous access such as PICC lines or luers can also benefit from having a port. The port is accessed with a needle which is secured in place with a transparent dressing. All IV treatment and blood tests can then be done using the port. It is important not to get this dressing wet. When the port is being used for treatment the needle is changed once a week. When not being used the port is accessed and flushed once a month. This is to make sure the port does not get blocked. Parts of your Port Portacath Needle Extension Set Line clamp Positive Placement Device (PPD)
Temperature Adverse reaction: You may need to take your temperature if you feel unwell or if directed by your nurse/ doctor. If you develop a temperature above 38 C or develop chills or sweats. Action: Contact the CF CNS (Ward 25 after hours). When receiving drug therapy, a reaction may occur. This is very rare. 1. If you develop a rash, itchiness or swelling. Action: See a doctor immediately, or present to Emergency Department 2. Or suddenly become unwell, eg. develop a wheeze, short of breath, or experience chest pain. Action: Administer Adrenaline as instructed then Ring for an ambulance (111) Dressing: 1. If the dressing is loose, moist or falls off. Action: Cover the insertion site with sterile gauze and bandage and contact the CF CNS (Ward 25 after hours). 2. If you see any swelling, redness, blood, pus or other liquid under and around the dressing. Action: Contact the CF CNS (Ward 25 after hours). Catheter blockage: Resistance is felt when flushing the line. Action: This is checked with gentle flushing. Do not use force. Contact the CF CNS (Ward 25 after hours). Catheter or Extension set leakage: Fluid is seen coming from the catheter or extension set. Action: Check that the connections are tight and clamp the catheter. Cover area of leakage with sterile gauze /tape or bandage. Contact the CF CNS (Ward 25 after hours). Handwashing Before receiving any care or treatment for your catheter, you/the nurse must wash your hands. This is the most important way of preventing infection.
Clean Handling Technique - aseptic Dressing The administration of your drugs is done by a clean (aseptic) method to prevent infection. This is done by wiping the PPD with a sterile alcohol swab. The equipment used to give the drugs is sterile. The insertion site of your line (PICC or PORT) is covered with a dressing. The dressing is changed weekly or sooner if it becomes loose, moist or falls off. Your nurse will redress the site. Please contact the CF CNS if it requires changing while you are at home. The type of dressing materials used will allow for maximum protection of the catheter from infection. The dressing must remain clean, dry and stick firmly to the skin. Note: Don t get the dressing wet. You will need to cover your PICC dressing with a plastic bag and securely tape or use glad wrap to prevent it getting wet when showering. You can t swim while you have a PICC line in or when your port is accessed. Activities If your work or leisure pastimes involve a reasonable amount of activity, you will need to discuss this with your nurse. Activities that require strenuous exercise or contact sports could cause complications. Keeping the catheter useable The catheter requires a regular saline flush to stop blockage when it is not in use.
Giving medication through your line Whenever you access your line to give medication you must do the following steps 1. Saline pre flush using 10ml saline 2. Administration of medication (e.g. antibiotic push or infusion) 3. Saline post flush using 10ml pulsating push-pause flush 4. *Heparin flush if you have a port only *If you are taking blood samples from your line you must do a pre and post flush with x2 10ml saline flushes Set Up 1. Clean work surface. 2. Assemble equipment. Wash Hands Hand washing is essential prior to giving of your drugs. This is the best way to prevent infection. Prepare the saline flush x 2 With the syringe facing up, press on plunger to release the seal. Loosen protective cap but do not remove. Press on plunger gently to expel air from the syringe. Tighten cap on syringe. Open alcohol swab and leave on open packet. Your flush is ready
Preparing the Drug for Administration 1. Twist top off the sterile water polyamp. 2. Remove the syringe from its package. Attach a blunt drawing up needle to the syringe. Take care not to touch the tip of the syringe or the end of the needle that attaches to the syringe. 3. Remove the needle cap and insert the needle into the opening of the polyamp. 4. Withdraw the water by pulling back the plunger of the syringe 5. Expel any air remaining in the syringe. Check that there are no large air bubbles. 6. Repeat this step so that you have 20ml of water in the syringe 7. Remove plastic/aluminium cover from top of the drug vial. 8. Wipe the top of the vial with alcohol swab. Allow to dry for 30 seconds. 9. Insert the syringe containing the water into the vial and inject sufficient water to dissolve the powder. Do not force. 10. Leaving the needle and syringe in place, gently rotate the fluid in the vial. 11. When fully dissolved, withdraw fluid back into the syringe. Remove from vial. 12. Replace protective cap over needle. 13. Expel any air remaining in the syringe. Check that there are no large air bubbles. Your drug is now ready, if this is a syringe push.
For giving drugs as an infusion Injection Port 12. Wipe injection port on 100ml bag of Normal Saline with alcohol swab. Allow to dry for 30 seconds. 13. Remove needle cap and insert syringe with antibiotic into the injection Port on bag of Normal Saline. 14. Inject the medication from the syringe into the bag. Remove the syringe and dispose with needle into sharps container. 15. Gently rotate bag to mix. Prime your Line 1. Remove blue cap from 100ml bag of Normal Saline. 2. Close clamp on IV Tubing 3. Remove spike protector cap on IV tubing (remember do not touch the end) 4. Insert spike firmly into blue Port. 5. Hang up bag on hook. 6. Squeeze plastic chamber on IV tubing to partially fill with fluid. 7. Unclamp tubing and let fluid run through line to the end. (Check there are no air bubbles in the IV tubing). 8. Clamp the IV tubing. Your drug is now ready to infuse.
ADMINISTRATION Normal Saline Flush 1. Wipe the PPD valve with alcohol swab. Allow to dry for 30 seconds. 2. Unclamp the extension set, on catheter 3. Insert syringe containing normal saline flush into the PPD valve. 4. Saline flush. Firmly depress the plunger on the syringe using a quick push, pause, push pause technique. Stop if there is any inflammation, swelling, pain or you feel resistance. 5. Remove the syringe and discard into biohazard bag. Saline flush is now completed. Administration of Drug using Syringe Push 1. Detach the needle from the syringe and discard. 2. Insert the syringe containing the drug into the valve. 3. Gently depress the plunger on the syringe. Give the drug over..minutes. 4. Remove syringe and discard. *If you are administering more than one drug at a time, you must do a saline flush between each different medication. This prevents the drugs mixing in your PICC/port which may cause a reaction or block the line.
Administration of a drug in a 100ml bag of Normal Saline. Drip Chamber 1. Wipe end of the PPD valve with alcohol swab. Allow 30 seconds to dry. 2. Attach the end of IV tubing to the valve. 3. You will have been taught how to unclamp the blue roller on the IV tubing to regulate the flow of the infusion. 4. Your infusion should drip in over minutes. To get your infusion through in the correct time you should have. drops/minute dripping into the chamber 5. Detach IV tubing from extension set and discard into the biohazard bag Administration of Saline Pulsatile Flush 1. Insert the syringe containing normal saline into the PPD valve. 2. Saline flush. Gently depress the plunger on the syringe using push, pause, push, pause technique. 3. Remove syringe and discard. Administration of Heparin Flush (for portacaths only) 1. Insert the syringe containing the heparin flush into the PPD valve. 2. Gently depress the plunger on the syringe using push, pause, push, pause technique. Leave 1 ml of heparin in the syringe. 3. Remove syringe and discard. You have now completed the procedure
As part of your home IV treatment you may be required to take blood samples from your PICC. The ward staff / CNS will show you how to do this prior to you leaving hospital TO TAKE A BLOOD SAMPLE WITH THE VACUTAINER SYSTEM 1. You will need four normal saline flushes drawn up in 10ml syringes, a blood transfer device, a blood sample tube and alcohol swabs. 2. Flush the PICC with x2 10mls normal saline. After the second flush, leave the 10ml syringe attached and gently draw back 5mls of blood. Remove syringe and discard blood. 3. Attach the blood transfer device to the PICC and insert a blood sample tube. The blood will automatically be drawn into the blood tube. Remove the blood tube when it stops filling and repeat if necessary. 4. Remove the blood sample tube and disconnect the transfer device from the PICC and discard into the sharps box. 5. Saline flush the PICC with x 2 10ml saline flushes. Gently depress the plunger on the syringe using push, pause, push, pause technique. 6. If you have a portacath administer a heparin flush 7. Write the date and time the sample was taken on the label on the blood tube, and on the lab form 8. The blood sample(s) will need to be taken to the hospital laboratory
GETTING READY TO GO HOME Before discharging you home, we need to make sure you feel comfortable and safe with the equipment used to deliver your IV therapy. We do this by getting you to self administer your medication while in hospital. Either your ward nurse or the CF CNS will watch you mix up and administer your medication until you feel confident doing this alone. Usually this can take around 3 days if you haven t done it before. Your training will start before discharge and the CF CNS will continue to support you when you go home. On the day of discharge you will have several boxes of equipment and medication to take home, a drug chart with instructions on how to give your meds, and some medication information sheets for the medication you are on. Any medication you take, either by mouth intravenously has the potential to cause an allergic reaction. This is why before you go home on IVs you will always have had at least one dose of the medication under supervision. You will also have an adrenaline pen in your box of equipment to take home, in case you have a reaction at home. On the following page are the instructions for using the epipen, and you will be shown how to use it before you go home.