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.
