Home intravenous therapy training

Information for patients

Introduction

The Nutrition Team that have been looking after you, while you have been in hospital, have decided that you need to have intravenous (IV) fluids or IV nutrition (known as Parenteral Nutrition – PN) when you go home.

We have designed this booklet as a training guide for you. This booklet belongs to you, and when you have completed your training, you can take it home with you. Please use this in conjunction with the other information booklets provided for you, as well as your patient passport.

We hope that this booklet will answer most of your questions, but let us know if you want more information.

Why do you need home intravenous nutrition?

IV nutrition is needed when you cannot manage to eat enough food to maintain your ideal body weight. This happens when long sections of your bowel are removed and may also be due to the large losses of fluid from a stoma.  The bowel may be too short to give nutrients time to be properly absorbed, leaving you malnourished.

In some cases, the bowel that is left may be long enough to absorb the food that you eat but cannot absorb the fluids and some of the essential minerals and salts that your body needs to work properly. In these cases, you will only need IV fluids, not IV nutrition. Sometimes, we use a combination of IV fluids and nutrition.

There are many reasons why patients need home IV fluids or nutrition. The length of time that you need IV therapy can also vary. The members of the Nutrition Team will talk with the Consultant looking after you to decide how long you may require treatment. In some cases, we may not know how long you will continue IV therapy but will be reviewing your progress regularly, in our nutrition clinic.

How do we give home intravenous therapy?

Whilst you are in hospital, the lines team will insert a PICC/Hickman line. This is a tube that enters your body on the chest wall or in your arm and leads directly into one of the large veins next to your heart.

Whilst you are an inpatient, the IV nutrition or fluids will be started and will run over 24 hours. Over several days, we will reduce the duration of the infusion to 12 hours (overnight). We cannot start with a 12 hour infusion, because the body has to get used to the large volume of fluid or sugar-rich solution that is in the feed. During this time we will closely monitor your bloods and glucose levels. This is to make sure that your body is coping with the infusion, and that the sugar levels in your blood are okay.

PICC – Peripherally Inserted Central Catheter

PICC
(Peripherally Inserted Central Catheter)

Diagram of Peripherally Inserted Central Catheter

Hickman Line

Diagram of Hickman Line

Practical Guidelines for Looking After Your PN/Fluid Therapy

The following guidelines will help you learn the practical skills needed to give yourself IV therapy at home. These guidelines can act as a reminder when you have gone home if you are unsure about your home therapy.

The guidelines will help you with:

  1. Hand Hygiene
  2. Connection of the infusion to your PICC/Hickman line.
  3. Disconnection of the infusion from your PICC/Hickman line.
  4. Changing the dressing and bionector on your PICC/Hickman line.     
  5. How to change the biopatch (Hickman lines only)       

Staff will train you on the procedures relevant to you during your inpatient stay. This may be all procedures or just some of the procedures. The Clinical Nurse Specialists on the Nutrition Team are responsible for your training and will assess your competency when you are ready.

We will help you work through these skills at your own pace. If you have any questions, please ask as we go along.

Aseptic Non-Touch Technique – ANTT

We will teach you a technique called the Aseptic Non-Touch Technique, or ANTT

This has four elements which can then be applied to anything you do related to the PICC/Hickman line and the IV fluids.

1. Always wash hands effectively.
2. Identify the key parts and protect them at all times.
3. Never contaminate the key parts.  For example, never let go of a needle free device that you have just decontaminated.
4. The ONLY thing that can touch a key part is ANOTHER KEY PART.

Hand Hygiene

Hand washing is one of the most important but simplest procedures for the prevention of infection.
Good hand washing technique is easy to learn and effective.
Using the following 6 steps under running water will ensure no areas will be missed.

Palm to palm

Palm to palm

Right palm over back of left, fingers interlaced, and then vice versa

Palm to palm, fingers interlaced

Palm to palm, fingers interlaced

Back of fingers opposing palms with fingers interlaced

Back of fingers opposing palms with fingers interlaced

Rotational rubbing of thumbs enclosed by palm

Rotational rubbing backwards and forwards with fingertips of right hand
in palm of left, and vice

Connecting the PN/Fluids

  • Trolley
  • Detergent wipes
  • Apron (only if carrying out procedure on someone other than yourself)
  • Alcohol gel
  • 2 x pair of gloves
  • Drip stand if you have Bodyguard pump / if you have a Micrel pump you will need your rucksack. Sapphire pump will be either drip stand or rucksack.
  • 1 x prefilled 10mL saline syringe (Posiflush)
  • 2 x IV wipe (2% chlorhexidine in 70% alcohol)
  • Giving set
  • Feed/fluids
  • Dressing towel

1.       If PN is stored in the fridge, take bag of PN out of the fridge around 30 minutes before connection to ensure the PN is not cold administration. If appropriate.

2.       Check: name, date of birth, PAS number and NHS number, batch number, expiry date and contents of the bag against the prescription chart. 

3.       Wash your hands with soap and water using the 6 step hand wash technique

4.       Decontaminate hands with alcohol gel. 

5.       Clean trolley with detergent wipes.

6.       Gather all equipment needed and place on the bottom of the trolley.

7.       Decontaminate hands with alcohol gel

8.       Put on apron

9.       Open the dressing towel and place on top of the trolley. Open the flush syringe, the giving set and IV wipe and place them on to the dressing towel.

10.     Hang PN bag onto drip stand or place in rucksack,

11.     Alcohol gel hands

12.     Put on pair of gloves

13.     Break off the port cover on the bag of PN.

14.     Insert the pointed end of the giving set into the PN bag.

15.     Insert giving set into pump and programme pump.

16.     Prime the PN through giving set to the end using appropriate pump, making sure that all air bubbles are expelled.  Ensure covered end of giving set remains on dressing towel.

17.     Alcohol gel hands and put on a pair of gloves.

18.     Take the IV wipe and hold it in one hand

19.     Firmly hold the CVAD with the other hand

20.     Disinfect needle free device for 30 seconds with IV wipe (2% chlorhexidine in 70% alcohol)

21.     Wait 30 seconds for the alcohol to dry. DO NOT PUT THE LINE DOWN

22.     Take the prefilled syringe (Posiflush) and remove the cap, break the seal and expel the air bubble

23.     Carefully attach the syringe to the needle free device

24.     Unclamp the CVAD and flush using a push/pause technique

25.     Disconnect the syringe. DO NOT PUT THE LINE DOWN.

26.     Disinfect needle free device for 30 seconds with IV wipe (2% chlorhexidine in 70% alcohol)

27.     Remove the cover from the end of the giving set and then attach the giving set to the needle free device. Remove gloves.

28.     Dispose of all wrappings, clean trolley then wash your hands using the 6 step hand wash technique

Disconnecting the PN/Fluids

•         Trolley

•         Detergent Wipes

•         Apron

•         Sterile Dressing towel

•         1 x prefilled 10mL syringe ( 0.9% sodium chloride – Posiflush) per lumen

•         2 x IV wipes (2% chlorhexidine in 70% alcohol) per lumen

•         Alcohol ge

•         One pair of gloves

•         Curos Cap (one per lumen)

  1. Turn the pump off and clamp the line and giving set
  2. Clean hands with soap and water using the 6 step technique
  3. Decontaminate hands with alcohol gel
  4. Clean trolley with detergent wipes
  5. Gather all equipment needed and place on the bottom of trolley. Decontaminate hands with alcohol gel
  6. Put on apron – gel hands with alcohol gel
  7. Open the dressing towel and place on top of the dressing trolley. Open the flush and IV wipes from the packet and place on to the top of the trolley aseptically. Place Curos Cap on side of trolley, opened ready
  8. Gel hands with alcohol gel.
  9. Put on a pair of gloves
  10. Firmly hold the end of the line with one hand.
  11. Disconnect the giving set and hang it on the drip stand.
  12. Take the IV wipe to disinfect the needle free device by rubbing vigorously for 30 seconds.    DO NOT PUT THE LINE DOWN
  13. Wait 30 seconds for the alcohol to dry.
  14. Take the prefilled syringe (Posiflush) remove the cap, break the seal and expel the air bubble
  15. Carefully attach the syringe to the needle free device
  16. Flush using a push/pause technique. CLAMP THE LINE BEFORE THE FLUSH IS FINISHED
  17. Disconnect the syringe. DO NOT PUT THE LINE DOWN
  18. Take an IV wipe and clean the needle free device for 30 seconds
  19. Place Curos Cap on the end of each lumen.
  20. Dispose of all wrappings and clean trolley

Changing the Needle Free Device

The needle free device placed at the end of your Hickman line should be changed every seven days unless damaged, in which case it should be changed immediately.

We recommend that this be done on the same day that you renew the dressing to the PICC/Hickman line. It should be changed when you are not connected to fluids.

To change the needle-free device:

  • Trolley
  • Detergent wipes
  • Apron (only if carrying out procedure on someone other than yourself)
  • Alcohol gel
  • 1 x IV wipe (2% chlorhexidine in 70% alcohol)
  • One pair of gloves
  • New Bionector
  • 1 x green curos cap
  • 1 x prefilled 10mL saline syringe (Posiflush)
  1. Wash hands thoroughly with soap and water.
  2. Make sure the PICC/Hickman line is clamped.
  3. Clean the trolley with a detergent wipe.
  4. Place the items you need onto the bottom of the trolley.
  5. Open the packet containing the needle-free device, Posiflush and alcohol wipe and tip on to the top of the trolley.
  6. Decontaminate hands with alcohol gel.
  7. Put on new gloves.
  8. Attach the Posiflush to the needle free device and flush some saline through it.
  9. Detach and discard the Posiflush
  10. Firmly hold the line with one hand
  11. LOOK AT THE CLAMP AND MAKE SURE IT IS CLOSED.
  12. Remove the existing needle-free device and dispose of it. 
  13. DO NOT LET GO OF THE LINE.
  14. Take the IV wipe  and clean around the end of the catheter with the chlorhexidine wipe for 30 seconds and allow to dry
  15. Attach new needle-free device.
  16. Peel Curos cap off its backing and screw onto needle-free device
  17. Remove gloves and put all the waste in the bin
  18. Give the trolley a wipe down with a detergent wipe.

Changing the Hickman/PICC Line Dressing & needle free device

  • Trolley
  • Detergent wipes
  • 2 x pair of gloves
  • Occlusive dressing eg: Tegaderm
  • Chlorhexidine applicator
  • Alcohol hand rub
  • 1x Biopatch
  • 1X skin fix for Hickman line
  • Tubigrip for PICC line    
  • 1 x needle free device
  • 1 x Biopatch
  1. Clean hands with soap and water.
  2. Decontaminate hands with alcohol gel.
  3. Clean trolley with detergent wipes.
  4. Gather all equipment needed and place on the bottom of the trolley.
  5. Open the new dressing and chlorhexidine applicator from their pack and tip on to the top of trolley.
  6. Decontaminate hands with alcohol gel and put on gloves.
  7. Carefully loosen the exiting dressing on your Hickman / PICC line, remove the dressing.
  8. Remove gloves.
  9. Decontaminate hands with alcohol gel and put on new gloves.
  10. Using chlorhexidine applicator, clean around the Hickman line/PICC line insertion site and allow drying for 30 seconds. Wipe from inner to outer of Hickman/PICC line
  11. Apply BIOPATCH Disk printed side up with edges of radial slit approximated and aligned with catheter tubing. Do not peel printed side from BIOPATCH Disk. (For Hickman line only)
  12. Apply the new dressing to the Hickman/PICC line.
  13. Remove needle free device, clean end of line with IV wipe (2% chlorhexidine in 70% alcohol)
  14. Apply new needle free device
  15. Apply skin fix to your skin secure the Hickman line with skin fixed and covers the end of lumens with tegaderm semi permeable adhesive film dressing in your preferred way.
  16. If you have PICC line use tubigrip to secure the line.
  17.  Dispose of all wrappings and clean trolley.

Contact Numbers

We are here to help you! Please get in touch if you have any problems, or if you need a chat about anything to do with home therapy. Keep these numbers handy in case of emergencies.

St James’s University Hospital
Switchboard
0113 2433144

Nutrition office
Monday – Friday 8am- 4pm
0113 2068649

REMEMBER: IF YOU HAVE A PROBLEM/QUERY OUT OF HOURS, CONTACT J91 AND MAKE THEM AWARE YOU ARE A PN PATIENT. J91: 01132069191 (4pm-8am) and weekends

Support Groups

PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy)

PINNT is a support organisation for people who are tube-fed. It aims to promote greater understanding of the therapies amongst patients, potential patients and the medical profession. It also aims to provide contact between patients, to try and eliminate some of the problems that come with treatment (particularly when it is carried out at home). Over the years it has not only brought together patients from all over the UK, but also doctors, nurses and other health professionals working in the field of artificial nutrition worldwide.

PINNT have information sheets available on all types of tube feeding; provide help and advice about going on holiday for those who are tube-fed, including travel and insurance. There is a small membership fee.

In addition, PINNT have a website which is intended for all nutrition patients and their carers as well as healthcare professionals and the general public.

PINNT assists its members with anything the patient feels is important. A lot of time is spent helping with benefit claims and fighting appeals. Many members will need frequent help for the rest of their lives, and PINNT provides practical assistance for their needs.  This can be a great help in times of stress.

You can write for further information to:
Carolyn Wheatley,
PINNT,
P.O. Box 3126,
Christchurch,
Dorset,
BH23 2X

Tel: 01202 481 625
Fax: 01202 481 625

Or contact them via the website www.pinnt.com   
Best time to telephone: 9.30am – 4.30pm (Answer phone at other times)



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