O= Patient Patient Information information Home parenteral nutrition and intravenous fluid advice sheet This information sheet has been designed to help should you have problems relating to your parenteral nutrition or home intravenous fluids. It is vital that you inform someone if you are having difficulties. For pump problems, contact your homecare provider helpline or homecare nurse. For all other problems, please contact the Nutrition Support Team during office hours or the Sidmouth Ward nursing team if it is outside normal working hours (contact information can be found at the end of this document). If you are unable to contact the relevant team, and have on-going concerns please attend the Emergency (A&E) either at the Royal Berkshire Hospital or at your local hospital. If you attend hospital please take your last clinic letter and a copy of this information leaflet with you wherever possible. The flow charts attached provide a guide to managing complications you may experience whilst using home parenteral nutrition or intravenous fluids. If at any stage you are uncertain of which steps to take then please contact your healthcare team on the numbers below or attend the Emergency. Included in this leaflet are flow charts for the management of the following complications: Fever Problems with PICC or Hickman exit sites Suspected broken PICC or Hickman line Slow or blocked line Missed feed Swollen ankles / Weight changes Other symptoms, November 2017 1
Management of fever FEVER 38.3⁰C or more 1. STOP Infusion 2. Switch off pump 3. Disconnect infusion 4. If cannot disconnect, clamp using blue crocodile clamp. 5. Do not recommence feed until advised by Nutrition Support Team Recheck temperature at 30 minutes. Fever over 38.3⁰C or feel unwell? Is it longer than 48 hours to the next Do you have daily parenteral nutrition or intravenous fluid? Attend local Emergency (A&E) for medical assessment Attend local Emergency Support Team next, November 2017 2
Problems with PICC or Hickman exit sites Problem with PICC / Hickman exit site Whether or not you are currently infusing: Pain at exit site or surrounding area Redness at exit site or surrounding area Ooze at exit site Dirty dressing Dressing coming off Pain, shivers or fevers? If infusing: follow advice for FEVER. If not infusing: attend local Emergency (A&E) If you develop fevers Support Team next, November 2017 3
Suspected broken PICC or Hickman line Suspected broken line e.g. visible crack, leaking, broken connector DO T USE THE LINE Do you have daily parenteral nutrition / Intravenous fluid? Can you clamp ABOVE THE DAMAGE POINT AS CLOSE TO SKIN AS POSSIBLE using blue crocodile clamp? Attend local Emergency (A&E) Is it longer than 48 hours to the next Support Team next, November 2017 4
Slow or blocked line Slow or blocked line? Do not put pressure on syringe Do not use syringes smaller than 10ml Check line for external kinking Massage the section of line using thumb and finger Change the needleless connector (Bionector/ Microclave) if able Cough moving the shoulders up and down Resolved? Do you have daily parenteral nutrition? Inform Nutrition Support Team next Is it longer than 48 hours to the next Attend local Emergency Support Team next, November 2017 5
Missed feed Missed feed eg due to delivery problem or burst bag 1. Hang spare bag if available and signed off for connection by your homecare company. 2. Do not give extra sodium chloride unless advised by Nutrition Support Team 3. Inform Nutrition Support Team next Do you have daily parenteral nutrition? Is it longer than 48 hours to the next Attend local Emergency Support Team next, November 2017 6
Swollen ankles Swollen ankles Weight increase or decrease Inform Nutrition Support Team next Other symptoms If you experience any of the following: Swelling of arm, neck, shoulder or face Noticeable veins on chest Discolouration of skin Pain during infusion Attend local Emergency (A&E) This information leaflet is to provide a guide only to managing common problems associated with using parenteral nutrition and intravenous fluids at home. If you have symptoms that are not covered in this leaflet and are concerned then it is important that you inform someone using the contact details provided. Contact information Nutrition Support team Monday to Friday 8am-4pm: Mobile: 07748 631985 Email: RBFT.nutritionsupport@nhs.net Outside the hours above, including weekends and bank holidays: Sidmouth Ward 0118 322 7468 For pump problems please contact your homecare company: Calea 0800 1218300 Lloyds Homecare 0845 7573100 Baxter 0800 0288966 B Braun 0800 8405503 Further information Patients on Intravenous and Nasogastric Nutrition Therapy (PINNT) www.pint.com More information is available on the Trust website: www.royalberkshire.nhs.uk This document can be made available in other languages and formats upon request. Imogen Steed / Nutrition Support Team Written: November 2017. Review due: November 2019, November 2017 7