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Friday, July 10, 2009

Giving IV Antibiotics at Home

I decided to show this post because we have talked about giving Megan IV antibiotics at home after two hospitalizations. We gave antibiotics from May 14-25, 2009 and from June 26-July 6, 2009.

During the first round of IV antibiotics, we administered vancomycin every 6 hours (4 times per day). During this last round of IV antibiotics, we administered vancomycin every 8 hours (3 times per day) as well as gentamicin every 24 hours (once per day).

I have made a pictoral representation of the process for those who are curious about how giving IV medicine works in the home as opposed to the hospital.

This first picture is of Megan's PICC line-this type of IV is placed in the hospital and is more stable to be used in the home than a peripheral IV (shown in this post), which many of us are more familiar with. PICC lines are typically placed when an IV is needed for usage on a long term basis and when the patient is unable to sustain peripheral IV access (both of these reasons applied to Megan).

The first step in the administration process is to gather your supplies. This picture shows our method of putting all the supplies on a plate. The medication is placed in these "Q-balls" and programmed to infuse automatically for the specified time. Because the medication is refrigerated, it needs to be taken out of the fridge 2-3 hours before it is to be given. (We just refill the plate after each dosage to get it ready for the next one). In addition to the medication, you need sterile alcohol swabs, two or three sterile saline flushes (depending on if you are giving one or two different "Q-balls"), and a heparin flush.

The vancomycin took one hour to infuse each time (larger ball). The gentamicin took 30 minutes to infuse each time (smaller ball).

After the supplies are ready, you need to wash your hands thoroughly. This is important to reduce the spread of germs, especially since the IV exposes the patient's veins to outside elements. Next, you locate the cap of the IV port and hold it upright.

Then, you clean the cap thoroughly with a sterile alcohol swab. And then a second time with another sterile alcohol swab. After the cap is sterilized, make sure that nothing touches it.

Then, you use a sterile saline syringe to flush the IV. Since they come pre-packaged, you just unwrap the syringe, remove the cap (being careful not to touch the sterile tip), and remove any air pockets in the fluid. After the air is removed, the syringe pushes into the tip of the IV cap and turns to lock into place. After the syringe is locked into place, you unclamp the IV and push the saline into the IV until empty.

Next, you unlock and remove the syringe and pick up the connector at the end of the tubing on the medication "que ball" and remove the protective cap before locking the connector into place the same way the syringe locked into place.

Now you are ready to open the clamps on the IV and the medication "Q-ball." Once both of the clamps are open, the medication will automatically infuse for the amount of time the ball has been programmed at the pharmacy. This picture shows the entire ball and tubing with the clamps open.

You can tell the ball is finished infusing by looking at the core. It is a little spongy but will look like a solid line instead of having a clear bulge around it.

After the medication has finished infusing, you disconnect the ball's tubing, clean the cap with a sterile alcohol swab again (because it has been 30 minutes or an hour since you started), and flush the rest of the medication through the IV tubing with another saline-filled syringe.

If you have a second medication to administer, you attach it next. If not, then you flush the IV a second time with a heparin-filled syringe. It comes pre-filled like the saline syringes. The heparin stays in the IV tubing and prevents it from getting clogged with any clots. (If you notice, the saline syringes come with a white cap and label and the heparin comes with a blue cap and label for easier identification. The adult dosages of heparin have a different colored label and cap.)

After the heparin is administered, you just clamp the IV tubing and throw away your empty supplies.

It is an easy process to learn. However, I was nervous in the beginning because I felt a higher level of caution (responsibility) because I was putting something into Megan's blood stream. After a few dosages, I was more comfortable with the process and developed a routine.


Leigh Summers said...

Your post about giving iv antibiotics at home is just amazing. My boyfriend has a bacterial infection in his spine and has been in hospital for the last 2.5 weeks. He needs at least another 4-6 weeks os iv antibiotic treatments and I was scared I wasn't going to be able to do correctly for him. Your step by step procedure has given me the confidence to believe I can and I know he'll be happier at home than in the hospital.

Thank you,
Leigh (leigh_bowes@hotmail.com)

Jennie_x93 said...

Hi, Can you tell me a window time frame for giving IV antibiotics at home. If on Vancomycin 1500mg BID for an adult, Can you administer same 830am and then 710pm? 

SpecNeedsLife said...

The picc line is put in at the hospital under florouscopy (like a video x-ray). There is additional nursing care that supervises the care of the picc line and re-dressings that it require. We never used it for parenteral feedings (intravenous feedings), just to deliver medications/antibiotics on a longer term at home instead of in the hospital.

Nickybrown74 said...

For the picc line how is that put in? I have a little boy with very complex needs and we're in the hospital every three months for chest infections and it's so hard the family being split up so offen so this is somthing that really would help us. xx

Smartsynnd said...

nice very helpfull

Kasie said...

Wow.. I will be doing this today! Love the illustrastion on this!! Even though Mine has came home with a PIC line she will need antibiotics this time and its kinda scry for me! I know this post is very old but still love the fact of it!! Thanks so much for sharing your personal experience :)

Corning,NY said...

   I just finished LPN school, and you cover this in more detail than my class and clinical did!  Thanks!

grace2244 said...

Thanks so much for sharing this process. I am going to have to go through this next month and appreciate being able to see all that is involved. Was worried the PICC line would need to be relocated a few times. Am hoping it is once and done for the month long treatment.

Synnd said...


Can I print this and show to my patients

Sheri said...

I am taking care of my husband and I am using the Q-balls.  Tonight we forgot to take one out of the refrigerator prior to administration.  Is it critical that it's room temperature or is it just for patient comfort?
Please advise asap. 

Tom said...

Have you done manual drips, too. We're getting lots of tiny bubbles in the line. They make me crazy. We' ve been removing bags from fridge an hour ahead and will try 2 hours tomorrow. At the end of infusion we pull a fuzzy ml of bubbles out of the cap and extension before flushing. May have better luck with metered balls that are available. We liked controlling rate so could slow it on tough days.

Your blog is great. All the best to your family. Hugs are my favorite medicine.

glenda webb said...

just got iv shipment and they sent mediballs nstead of bags. no instructions. it does not look like it is going down after 45 min. you are in my prayers

Rich b said...

Great thank you, I got the instructions at the hospital but was nervous also, your description was a great help