Home IV infusion therapy (HIT) allows patients to receive necessary medications, fluids, or nutrition intravenously at home. This treatment is commonly used for long-term antibiotics, hydration, pain management, and specialized nutrition. A home IV regimen is only initiated under a physician’s prescription and requires comprehensive training from a licensed healthcare provider (HCP). Patients or their caregivers must be educated on proper technique and complication management before self-administration. This article provides general information and is not a substitute for the specific, hands-on instructions and continuous medical oversight provided by a trained nurse or pharmacist.
Essential Preparation and Sterility Management
Preparing the workspace and materials correctly prevents potential infection. Select a clean, well-lit, and distraction-free surface, such as a kitchen table, away from pets or excessive foot traffic. Wipe the area thoroughly with an antibacterial sanitizer or cleaner, then lay out a clean, disposable cloth or sterile drape to create a dedicated working field.
Before touching any supplies or the vascular access device (VAD), perform hand hygiene using antiseptic liquid soap and warm water. Lather your hands, wrists, between your fingers, and under your nails for a minimum of 20 seconds. Rinse your hands with fingers pointed downward, and use a clean paper towel to dry your hands and turn off the faucet.
After washing, gather all necessary supplies, including the medication, IV tubing, pre-filled syringes for flushing, alcohol wipes, gloves, and a sharps container. Check the medication label against the prescription to verify the patient’s name, drug name, dose, and concentration. Inspect the medication bag or vial for signs of cloudiness, discoloration, or particulate matter, and confirm the expiration date has not passed.
Step-by-Step Infusion Administration
The first step is to prepare the IV line by “priming” the tubing, which removes all air before connecting it to the VAD. After spiking the IV bag, hold the tubing end over a waste receptacle and slowly open the flow control clamp to let the fluid run through the line. This fluid flow forces air bubbles out of the tubing, preventing a dangerous air embolism.
Once the tubing is free of air and the drip chamber is partially filled, close the flow control clamp and prepare the injection port, or hub. The hub must be vigorously cleaned with an alcohol or antiseptic wipe, often for 15 seconds, using friction (“scrubbing the hub”). This cleaning disrupts and removes bacteria from the access port surface.
After the hub has dried completely, connect the primed IV tubing to the VAD hub using a firm push and twist motion, ensuring a secure connection. If using an infusion pump, program the device with the prescribed flow rate and volume, then open the clamp on the catheter line. If administering without a pump, set the drip rate manually using the roller clamp to achieve the desired drops per minute.
Monitor the drip chamber or pump throughout the procedure to confirm consistent fluid flow and patient comfort. When the prescribed volume has been infused, or the pump alarms, close the clamp on the catheter line before disconnecting the tubing. Carefully disconnect the IV tubing and immediately follow the prescribed flushing procedure.
Catheter Site Care and Maintenance
Maintaining the patency and cleanliness of the vascular access device (VAD) is a continuous process between infusions. The catheter lumen must be flushed regularly, usually with pre-filled syringes of normal saline, and sometimes followed by a heparin solution, as directed by the healthcare provider. Flushing prevents the buildup of blood or medication residue that could lead to a blockage or occlusion of the line.
The correct flushing technique is often a “push-and-pause” motion, where the plunger is briefly pushed, paused, and then pushed again. This turbulent flow effectively cleans the inner walls of the catheter. Always scrub the hub before attaching the flush syringe, and never force the fluid if resistance is met, as this could damage the VAD.
The dressing covering the catheter insertion site must be kept clean, dry, and intact. Dressings are typically changed once per week, or immediately if they become wet, soiled, or start to lift around the edges, requiring sterile technique. During the dressing change, inspect the skin around the insertion site for signs of irritation, redness, or drainage.
To prevent accidental displacement, the catheter line should be securely anchored to the skin using the provided securement device or medical tape. Avoid placing tension on the line, and do not rub or snag the device on clothing or bedding. Daily inspection of the entire catheter path and surrounding skin is important for catching problems early.
Recognizing and Managing Adverse Events
Home infusion patients and caregivers must be trained to recognize and respond immediately to common complications. One frequent issue is infiltration, which occurs when infusion fluid leaks out of the vein into the surrounding tissue. Signs include swelling, coolness, pain, or blanching (paleness) at the insertion site. If infiltration is suspected, stop the infusion immediately, remove the catheter line, and apply gentle pressure until bleeding ceases.
Another complication is phlebitis, an inflammation of the vein wall, or a localized infection at the site. This may present as redness, warmth, tenderness, or a firm, painful cord along the vein path. Systemic infection symptoms, such as fever, chills, or drainage from the site, demand immediate attention. If signs of phlebitis or infection appear, stop the infusion, notify the home health nurse or physician, and follow their instructions.
A blockage, or occlusion, is indicated by an inability to infuse fluid or flush the line, or by resistance when pushing the syringe plunger. If the line is resistant, first check that all clamps are open. If the blockage persists, do not attempt to force the flush, as this can damage the catheter. Stop the procedure and contact the health team immediately for guidance on clot-dissolving protocols.
The most severe, though rare, complication is a venous air embolism, caused by air entering the bloodstream, usually due to failure to prime the tubing or an open connection. Symptoms include sudden shortness of breath, chest pain, confusion, or a rapid drop in blood pressure. This is a medical emergency; immediately clamp the VAD, call 911, and position the patient on their left side with the head lower than the feet to prevent the air from entering the lungs.
Step-by-Step Infusion Administration
After the hub has dried completely, connect the primed IV tubing to the VAD hub using a firm push and twist motion, ensuring the connection is secure. If using an infusion pump, program the device with the prescribed flow rate and volume, then open the clamp on the catheter line. If administering without a pump, you will set the drip rate manually using the roller clamp to achieve the desired drops per minute.
Monitor the drip chamber or the pump throughout the procedure to confirm the fluid is flowing consistently and that the patient is not experiencing any discomfort. When the prescribed volume has been infused, or the pump alarms, close the clamp on the catheter line before disconnecting the tubing. Carefully disconnect the IV tubing and immediately follow the prescribed flushing procedure.
Catheter Site Care and Maintenance
Maintaining the patency and cleanliness of the vascular access device (VAD) is a continuous process that occurs between infusions. The catheter lumen must be flushed regularly, usually with pre-filled syringes of normal saline, and sometimes followed by a heparin solution, as directed by the healthcare provider. Flushing prevents the buildup of blood or medication residue that could lead to a blockage, or occlusion, of the line.
The correct technique for flushing is often a “push-and-pause” motion, where the plunger is briefly pushed, paused for a moment, and then pushed again. This turbulent flow helps to effectively clean the inner walls of the catheter. Always scrub the hub before attaching the flush syringe, and never force the fluid if resistance is met, as this can damage the VAD.
The dressing covering the catheter insertion site must be kept clean, dry, and intact at all times. Dressings are typically changed once per week, or immediately if they become wet, soiled, or start to lift around the edges, requiring a sterile technique. During the dressing change, the skin around the insertion site should be inspected for any signs of irritation, redness, or drainage.
To prevent accidental displacement, the catheter line should be securely anchored to the skin using the provided securement device or medical tape. Avoid placing tension on the line, and take care not to rub or snag the device on clothing or bedding. Daily inspection of the entire catheter path and the surrounding skin is highly important for catching problems early.
Recognizing and Managing Adverse Events
Home infusion patients and caregivers must be trained to recognize the signs of common complications and respond immediately. One frequent issue is infiltration, which occurs when the infusion fluid leaks out of the vein and into the surrounding tissue. Signs include swelling, coolness, pain, or blanching (paleness) at the insertion site. If infiltration is suspected, stop the infusion immediately, remove the catheter line, and apply gentle pressure until any bleeding ceases.
Another complication is phlebitis, an inflammation of the vein wall, or a localized infection at the site. This may present as redness, warmth, tenderness, or a firm, painful cord felt along the vein path. Systemic infection symptoms, like fever, chills, or drainage from the site, demand immediate attention. If signs of phlebitis or infection appear, stop the infusion, notify the home health nurse or physician, and follow their instructions for care or accessing a new site.
A blockage, or occlusion, is indicated by an inability to infuse fluid or flush the line, or by a resistance when attempting to push the syringe plunger. If the line is resistant, first check to ensure all clamps are open, and if the blockage persists, do not attempt to force the flush, as this can damage the catheter. Stop the procedure and contact the health team immediately for guidance on clot-dissolving protocols.
The most severe, though rare, complication is a venous air embolism, caused by air entering the bloodstream, usually due to failure to prime the tubing correctly or an open connection. Symptoms include sudden shortness of breath, chest pain, confusion, or a rapid drop in blood pressure. This is a medical emergency; immediately clamp the VAD, call 911, and position the patient on their left side with the head lower than the feet to prevent the air from entering the lungs.