Home intravenous antibiotics for Bronchiectasis Service. Information for patients Chronic Obstructive Pulmonary Disease Service

Transcription

1 Home intravenous antibiotics for Bronchiectasis Service Information for patients Chronic Obstructive Pulmonary Disease Service

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3 What is the home intravenous antibiotics service? Patients with bronchiectasis sometimes require treatment with intravenous (IV) antibiotics (antibiotics delivered through the vein) which are usually given in hospital. Many patients have said they would prefer treatment at home and, taking on patients' views, we have developed a home IV treatment service. This leaflet describes an option for patients with a Sheffield GP, who have bronchiectasis, to complete longer courses of intravenous (IV) antibiotic treatment at home, rather than having to stay in hospital for days. Patients may instead prefer to be treated in hospital and are of course welcome. For the home IV service, you would usually be admitted to hospital for 1-2 days, to ensure the most appropriate antibiotic is started, and to make sure you are alright on the treatment. It also allows for routine tests including sputum culture, blood tests, chest x-ray and chest physiotherapy to be completed. You will be reviewed by the COPD nurse specialists to discuss your preferences. If you are happy to proceed with the service at home they will contact the specialist community Active Recovery IV nursing team to check they have available capacity, and to confirm a start date and time at home. The IV nursing team will visit and administer the antibiotics and check on your improving condition, for the course of your treatment at home. If there is no capacity or a delay in the service, we would still provide and continue treatment in hospital. Not all patients are suitable for home IV treatment, for example if you were very poorly, we would advise you remain in hospital for closer observation and monitoring as the best standard of care. We can only accept patients who have bronchiectasis. This is usually confirmed by a CT scan you will have had done in the past and a sputum test showing infection is present. page 3 of 12

4 The information in this leaflet is not exhaustive but may help you come to an informed decision. Please feel free to ask if anything is unclear or you need further information. This can be done in outpatients before any treatment starts or when you see the COPD nurse specialist or doctor. What are the advantages? The main advantage of finishing your treatment at home is that it is more convenient for you. It allows you to lead a normal life and recover at home, whilst receiving your treatment and a review each day from the Active Recovery IV team. Home chest physiotherapy can also be made available if necessary. As well as being more convenient, some of the risks of coming into hospital, such as hospital-acquired infections, are also reduced. Are there any risks in finishing my treatment at home? There is always a risk you could develop an unforeseen problem at home which may not be picked up as quickly as it would if you were in hospital. Potential problems may include development of side effects or an allergy relating to treatment. This may require a change of antibiotic, allergy therapy or, very rarely (1 in 100,000 patients) it can be life-threatening and require emergency treatment. This is very unlikely, but an important consideration. You will also be discharged home with an intravenous line inserted into a vein in your arm or hand. This will be a flexible tube that is secured with a dressing that allows your antibiotics to be given directly into your bloodstream. People can have problems once the line has been put in. Complications are rare and usually easily dealt with and most people do not have any serious problems with their line. page 4 of 12

5 What happens if I do decide to finish treatment at home? We would discuss the options with you first. You would then have time to think about your preference. Your treatment would start in hospital while you make your decision. One of the COPD specialist nurses would come to the ward and talk through your wishes with you, and collect some information relating to your individual bronchiectasis management and details of your home address and contact numbers. This assessment will only take place once you are well enough for discharge home and you are no longer receiving any additional hospital treatments or investigations. The COPD nurses will liaise with the Community IV team regarding a start date and time for the service to begin at your home. At busy times this could be delayed, or the service may not have any capacity at all, due to increased demands. You will be discharged with IV medications and the appropriate mixing solutions, a medication card, copies of your observation chart and IV peripheral cannula chart (if you are being discharged with this particular IV line). The Community IV team will provide all the necessary equipment for your treatment when they visit you at home. You will need to have your own transport home. The IV nurse would visit you at home each day, check your vital signs, look for signs of allergy, review your intravenous line and administer your treatment. Your condition will be checked at each visit to ensure you are continuing to improve. How long would treatment last? Usually days in total, from the date started in hospital. page 5 of 12

6 How will the treatment be given? Intravenous antibiotics will be given using a selection of IV flexible tubes that will be inserted into a vein in your hand or arm. Selection of the best IV line for you will be made by your doctor or COPD nurse specialist depending upon your previous history and treatment with IV antibiotics. Selections include: 1. Intravenous cannula is a small flexible tube inserted into a vein, which can be done on any ward or at home. You may feel a small amount of pain or discomfort, like a pin prick, at the time the cannula is inserted. A dressing will secure the cannula in place and keep the site clean. Cannulas usually only last 3-5 days at most and may need to be replaced a number of times during an antibiotic course at home. IV cannulas have an injection port to administer your medicine; it is important that this remains clean and closed at all times when not being used. 2. PICC line (peripherally inserted central catheter) is a longer, soft flexible tube which is put into a vein in your arm. This is inserted in hospital, under x-ray, until the tubing tip reaches a large vein in your chest. This will be done after putting on some local anaesthetic cream. An x-ray will be taken after insertion to check it is in the correct position, and a secure dressing will keep it in place and clean. Insertion usually takes about 30 minutes. Your dressing will need to be changed the day after insertion and weekly. PICC lines can only be inserted in hospital and can be left in place for the full duration of your IV antibiotic treatment. 3. Midlines are long thin flexible tubes, which are inserted either into one of the large veins in the upper arm, or a vein in the lower arm. These lines are thought of as long cannulas. They are put in using a portable ultrasound machine and using a needle and short wire, which are removed once the line is in position. This line will be secured with a dressing. A Midline will initially be inserted in hospital and can stay in place for the full course of page 6 of 12

7 your antibiotic treatment. However it can be replaced at home by the IV nurses if required. What problems might I have with my line? Bleeding - It is normal to experience a small amount of bleeding where the line enters the skin within the first 24 hours. However, if the bleeding leaks through the dressing, apply firm pressure over the area for 10 minutes. If the bleeding continues you will need to contact the IV nurses for advice. Infection - This can develop into a serious problem. It is important that you recognise the signs of infection including; pain, redness or swelling around the line and feeling hot, cold and shivery, or feeling generally unwell and you may have a temperature above 37.5 C. Your IV nurse will monitor your line at each visit. Inflammation - Lines can irritate the lining of the vein and cause inflammation (mechanical phlebitis). You may have redness and swelling around the line but will not feel unwell or have a temperature. It may help by applying a heat pack to your arm. Line blockage - Your line will need to be flushed regularly and after every antibiotic has been administered. Sometimes your line may block and the nurse will experience difficulty flushing the line. It may be possible to unblock your line, but if this is not possible it will need to be removed. Splitting of the line - It is rare for the line to split or break, and this is most likely to happen at the end near the cap, caused by the line being twisted too much or by the dressing. You may notice that your dressing is wet and the line will leak as it is being flushed. If you have a PICC line this could be repaired. Formation of a clot - On rare occasions it is possible for a blood clot to develop in your vein. Although this may sound alarming, if this is suspected it is not likely to cause a problem. However, you will have to attend A&E for a scan and it may result in additional page 7 of 12

8 medical treatment if a clot is present. If you notice that your arm, fingers or neck appear swollen, discoloured or are painful or any lumps on your arms, please contact the IV nurses. Line is moving, becoming dislodged or falling out - If your line appears longer than usual it may have become dislodged. Although the dressing secures the line, it is still possible for it to move. If you think the line has moved please inform your IV nurse. If your line falls out, inform the Community IV nurses, press firmly on the hole in the skin for a few minutes, then apply a sterile dressing or plaster. Please keep the line for the nurses to inspect. What happens after the IV antibiotics are completed? Your IV line will be removed and all equipment taken away. You will be asked to provide a sputum sample at least 48 hours after completion of the intravenous antibiotic course via your GP surgery. You would return to outpatients for a check-up after finishing treatment. Is there anything I should or should not do? There isn t anything in particular that you should avoid. Just be sensible. Eat healthily. Exercise in general is good, but start slowly and build up a little each day. There is no reason why you should not continue with normal activities such as work, exercise and sex. However, because of the risks of infection, inflammation and dislodging the line it is important to be careful when you are getting dressed or doing things at home that you do not bump or pull the intravenous line. This can be painful and the line could be accidentally knocked out. Please also avoid: swimming. playing sports like golf or tennis, where you use your arm repeatedly. page 8 of 12

9 lifting weights. doing heavy manual lifting. Regular physiotherapy exercises for your chest are advised and may need to be increased whilst you are ill. Home chest physiotherapy may be arranged. Frequently asked questions Can I get my IV line wet? It is important that the IV line stays dry; please attempt to keep the IV line out of direct water. You could use cling film temporarily to cover the line, to help keep this dry in a shower or bath. What if a new IV cannula can't be put in at home? If there are any difficulties putting in an intravenous cannula once at home, you will need to have transport available to bring you back to Brearley 3 for a member of hospital staff or a doctor to replace this. Is there anything to look out for with the IV line? Please inform your nurses immediately if you notice any of the following: You feel pain in the hand or arm that the IV line is in You feel the area around the IV site is very hot You see redness, a change in colour or swelling around the IV site. You see bleeding or leakage where the tube is inserted into your skin Your dressing is dirty, wet or loose page 9 of 12

10 How does the IV line get removed at the end of treatment? All Community nurses can remove IV cannulas and the IV nursing team are specially trained in removing both PICC and midlines. They will arrange a follow up appointment to remove this and apply a dressing which can be removed after 24 hours, once your antibiotic course has been completed. Is there anything else to watch out for? You will be familiar with your chest symptoms, usually breathlessness, cough and phlegm production. If these worsen rather than improve, please let us know by speaking to either your IV nurses or the hospital COPD nurse specialist. Please contact us or another health professional immediately if you notice signs of a rash or reaction to antibiotics. page 10 of 12

11 Contact numbers for advice Your Community IV Nursing team can be contacted for advice as below: Active recovery Mon - Sun, 8.00am pm Active Recovery Co-ordinator Mon - Sun, 6.00pm pm Evening and Nights Nursing Mon - Sun, 10.00pm am Alternatively contact your GP or NHS 111, or in an emergency, you can call the ambulance service on 999. COPD nurse Mon - Sun, 8.30am pm or via switchboard and ask for bleep 2526 Clinical lead for the service: Dr Omar Pirzada page 11 of 12

12 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD5601-PIL1987 v6 Issue Date: May Review Date: May 2021