CF & Home IV treatment

Kristine Colpaert

CF Nurse, UZ Leuven Belgium

Home IV treatment

(Multiresistant) pathogens

Exacerbationhemoptoe

IV

Choice of venous access

Antibiotics

Home iv : a balancing act

How to teach the patient/ relatives

How we do it

Hospital ?

Home ?

Choice of IV access

peripherally inserted catheter

peripherally inserted central catheter (PICC) / midline

totally implantable venous access device (TIVAD)

Frequency of IV antibiotic need / venous access possibility

Peripherally inserted catheter

• Easy to place

• Cheap

• Difficult vene access

• Not foolproof

PICC / midline

• Foolproof

• Comfortable

• Frequent placement : damage to vene, occlusion

• Expensive

TIVAD

• Foolproof

• Easy access

• Foreign-body / invasive to place

• Needs flushing when not in use

• Visibility

Choice of IV access

Intermittent on gravity over 24h

� 4 x antibiotics in 100 ml over 30 min

including 1 x aminoglycoside in 100 ml, over 30 min

Continu over 24h

� antibiotic in 250 ml / 23h by iv pump ( CADD)

� aminoglycoside in 100 ml over 30 min on gravity

Choice by

� bacterial resistance to antibiotic

� stability of the solved antibiotic

Antibiotics

Frequent iv antibiotic need

Good venous access

Knowledge and competence of iv treatment in patient / carer

Non – adherence, exacerbation is more than antibiotic deficiency

Benefit / Burden of home iv treatment

Decision by doctor, nurse & patient

Community nurse availability

Home iv : a balancing act

How to teach the patient/ relatives

Brochure

General information

Solving an antibiotic with transferneedle

Solving an antibiotic with needle and syringe

Preparing a liquid antibiotic

Inserting an infusion line into an infusion bag

Use of iv – pump / continu infusion (CADD)

Administering antibiotics

By periferal catheter

By PICC / Midline

By TIVAD

Problems and solutions

How to teach the patient/relatives

Educatie patiënten: educatieprogramma

Need to evaluate patients’ knowledge regularly

Need to evaluate if importance of time schedule is known

Need to evaluate patients’ competence with every iv treatment

Need to evaluate patients’ motivation for home iv

How to teach the patient/ relatives

Hospitalisation 3 days

Preparing discharge: medication & material

Support home – care organisation

Reinbursement for medication and material

Outpatient clinic after 10 days

How we do it

Hospital pharmacy : medication

Home – care company: material, home – visit blooddrawn tobramycine bloodlevel, vital signs, iv access controle, pulmonary function test.

After home visit : report to CF nurse

CF nurse: report, tobramycine bloodlevel, follow up problems

How we do it

That’s all folks !