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Intravenous antibiotic treatment outside the hospital

Intravenous antibiotic treatment outside the hospital

Important facts on the safety of the I.V. antibiotic treatment that you should know:

There are some risks related to the use of VADs (Vascular Access Devices) that you should be aware of:

  • Local pain, edema, tenderness, striated erythema, inflammation at the injection-site 10. May be signs of phlebitis or thrombophlebitis 5 due to chemical or mechanical irritation 10.
  • Pain, swelling, venous congestion and/or limitation of movement of the limb, shoulder or neck 10. These may be signs of venous thrombosis associated with the catheter 5,10. Depending on the medical condition, additional medical interventions may be required to treat thrombosis 5.
  • Induration, redness, pain and/or pus drainage 10. Local induration, erythema, tenderness and/or purulent discharge plus fever may be signs of more severe catheter-related infection 5, 10.
  • Persistent pain, burning, edema, coldness or pallor of the local tissue, leakage at the insertion site and paresthesia 10. These may be infiltration signs or extravasation of the solution. Instead of entering the veins it is passing into the subcutaneous tissue 10.

How does home intravenous drug administration work?1

  • After the venous access device is placed, a sterile drape will be applied to protect the injection-site 1.
  • As part of venous access care, periodic draping changes may be required. Avoid shocks and heavy lifting to the limb 1.
  • After an initial training visit, the patient, family members or caregivers will be ready to administer the antibiotics at home 1.
  • Between one and three doses may be required over a period of days or weeks, depending on the physician’s prescription 1.
  • Always notify your doctor or nurse on new or alarming symptoms, you may or if you detect 1.
  • Once the treatment is completed, the venous access can be removed at home or in the hospital 1.

Important safety aspects of the I.V. antibiotic treatment that you should know about:

What is intravenous (IV) infusion therapy?

It is the administration of a drug through a catheter that is used when the disease or its severity does not allow it to be effectively treated with oral medications3.

Many acute and chronic medical conditions can be treated with home infusion therapies: infections, dehydration, heart failure, multiple sclerosis, and rheumatoid arthritis, to name a few3.

What types of infusion devices are there?

Elastomeric pumps: Elastomeric pumps are lightweight devices composed of a plastic container and a balloon inside where its content is inserted8. Estas bombas presionan de forma continua y constante el globo e impulsan el medicamento a través del tubo de venoclisis hasta un catéter8.

Electronic infusion pumps: These are devices used for the injection of fluids, drugs or nutrients into the patient’s circulatory system4. They can be electronically programmed to administer small, intermittent or continuous doses throughout the day4.

Syringes or syringe pumps: Tubes with an inner plunger and a small opening through which the content is expelled when the plunger is pressed9. Allows the introduction of small amounts of medication or fluids into the venous access system by injection9.

The antibiotic administration to the outpatient may be done at home by a nurse, by the patient (or a family member) or in a specialized center.

The required devices work together to get the right dose of the antibiotics into the bloodstream at the right speed4.

At the patient’s home:
After basic training, a family member or caregiver can administer the antibiotic at home1.

At the patient’s home:
After basic training, a family member or caregiver can administer the antibiotic at home1.

In an infusion center or specialized nursing facility:
The patient comes to the site each day for antibiotic and catheter care1.

How does home intravenous drug administration work? 1

When intravenous antibiotic treatment is required, but there is no other reason to stay in the hospital, the person could receive this therapy as it’s out-of-hospital setting1.

The following settings may be conducive to receiving therapy outside the hospital:

Vascular access device (VAD):

The VAD is a catheter inserted into the veins or ports that can be implanted under the skin, to allow fluids and medication to go into the veins5.
Depending on the type of access (VAD), it can remain implanted from a few days to weeks or months5.

Infusion devices:

The infusion pump is a medical device that delivers fluids or medications to the body in controlled amounts, through the VAD 4. These devices have an interface that allows programming the amount and duration of the infusion to be administered accurately and automatically 4.

What are the benefits of the IV antibiotic treatment in the outpatient? 2,3

Helps reduce health care costs (general expenses and length of hospitalization)2.

It’s proven to be a safe way to receive treatment and causes less disruption to daily life3.

ABC of venous access devices6

The choice and placement of the catheter would be made by a trained health professional6.

Peripheral venous access devices:

  • This is placed in the arm or back of the hand’s veins6.
  • This is used for short injections and short-term treatments (3-5 days approximately)6.

Central venous catheter6,7:

  • It is usually inserted into a large vein in the neck or upper chest (jugular or subclavian)6,7.
  • These are long, flexible devices that reach close to the heart veins7.
  • A central venous line can last weeks or months and is very useful for patients who receive medication several times a day7.

Other access devices6:
There are other types of devices that can be used for administration of drugs or fluids by other routes, for example:

  • Arterial catheters6.
  • Subcutaneous accesses6.

The prescribing information for this drug, which includes indications, contraindications, precautions, warnings, adverse reactions, etc., is available to the medical staff in the following QR code

Before prescribing INVANZ® please consult the complete Product Circular in force in your country. MSD does not recommend the use of any product, in a way other than that described in the current Product Circular.

Referencias:

  1. Grennan D, Gottsch M. Home Intravenous Antibiotic Therapy. JAMA 2019; 322(1):90.
  2. Candel FJ, Julián-Jiménez A, González-Del Castillo J. Current status in outpatient parenteral antimicrobial therapy: a practical view. Rev Esp Quimioter. 2016 Apr;29(2):55-68.
  3. National Home Infusion Association. About home and specialty infusion. Disponible en: https://www.nhia.org/about-infusion-therapy/ [Consultado el 15 de junio de 2021].
  4. U.S Food and Drug Administration (FDA). Medical Devices: Infusion Pumps. Disponible en: https://www.fda.gov/medical-devices/general-hospital-devices-and-supplies/infusion-pumps [Consultado el 15 de junio de 2021].
  5. Carr PJ, Higgins NS, Cooke ML, Mihala G, Rickard CM. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD011429.
  6. Royal College of Nursing. Standards for Infusion Therapy. Publicado 12/12/2016. Disponible en: https://www.rcn.org.uk/professional-development/publications/pub-005704 [Consultado el 15 de junio de 2021].
  7. Centers of disease control and prevention (CDC). Healthcare-associated Infections (HAI). Frequently Asked Questions about Catheters. Disponible en: https://www.cdc.gov/hai/bsi/catheter_faqs.html#:~:text=A%20central%20venous%20catheter%20can,intens ve%20care%20units%20(ICUs) [Consultado el 15 de junio de 2021].
  8. Ramírez-Latorre JL, Patiño-Arias A, López-Hernandez CA, Giraldo-Salazar O, Yepes-Tejada DA, Erazo-Posada SE. Analgesia intravenosa ambulatoria con bombas elastoméricas en pacientes sometidos a cirugía plástica: serie prospectiva de casos. Rev Colomb Anestesiol 2018; 46: 3–8.
  9. Wikipedia. Disponible en: https://es.wikipedia.org/wiki/Jeringa [Consultado el15 de junio de 2021].
  10. Mattox EA. Complications of Peripheral Venous Access Devices: Prevention, Detection, and Recovery Strategies. Crit Care Nurse 2017; 37 (2): e1–e14.

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