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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
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
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