Home Intravenous Therapy HOPT (Home / Outpatient Parenteral Therapy)

This booklet has been given to you because your doctor has started you on intravenous (IV) treatment in hospital or you have seen a doctor who feels you need IV treatment. The terms intravenous, IV or parenteral are used when medication is given into a vein. Contents Page Introduction 1 Frequently asked 4 questions How will I know if 12 something is wrong? Introduction If you do not need to be in hospital for any other reason it may be possible for you to have your IV therapy at home or in the community. There are many conditions that can be treated with IV therapy out of hospital, including some types of infection and some inflammatory conditions. Depending on circumstances, some patients do not need to be admitted to hospital before starting their IV therapy at home. Home / Outpatient Parenteral Therapy (HOPT) is the official name given to the Home IV Therapy service. The HOPT Team consists of doctors, nurses and a pharmacist. The advantages and disadvantages of both hospital and home IV therapy are detailed next. In hospital Advantages It allows you to be constantly assessed The effects of your treatment can be easily monitored Disadvantages You will have to stay in hospital for the time you need treatment Possible loss of independence Unable to attend work Separation from family and friends Travelling expenses for visitors At home / in the community Nurse administration This involves a nurse visiting your accomodation to give the IV medication you require. The nurse will try to visit you at a time that is suitable to you both. However, it is difficult to guarantee times so please bear this in mind. Written and verbal information will be given to you and 24 hour help is always available (contact numbers are on page 15). Advantages You will not have to stay in hospital Independence is maintained and you may be able to return to work 24 hour help is available A nurse will review you at the time of treatment You only need to be reviewed at clinic every 2-4 weeks depending on your condition and progress Disadvantages You will have to learn about your IV line You will have to learn about your medication and its possible side effects The time the nurse visits may vary slightly on a daily basis so a degree of flexibility is required on both sides Weekends and bank holidays may be less easy to arrange treatment times Compared to being in hospital you will see medical staff less often 1 2

Self administration Occasionally a patient may be able to give their own medication at home. This is usually only suitable when more than two weeks of treatment is required, and involves you or your carer being taught how to look after your IV line, prepare and administer your treatment. You must always have another person with you when having your medicine, in case of side effects. If this is the best way for you to get your medication, you will be taught either in hospital or at home and supervised until both you and the HOPT Nurse are happy for you to continue on your own. Once you are trained a nurse will visit weekly to change the dressing over your line and take blood samples from you. Advantages You will not have to stay in hospital after you are trained Independence is maintained and you may be able to return to work 24 hour help is available There is no waiting for a nurse to administer the medication You only need to be reviewed at clinic every 2-4 weeks depending on your condition and progress You will be visited by a nurse weekly Disdvantages You will have to learn about your IV line You will have to learn about your medication and its possible side effects Training you can be time consuming and may result in a delay in your going home Compared to being in hospital you will see medical staff less often What happens now? You should have time to look at the information you have been given before you decide whether you would like to have your IV medication at home. The HOPT Nurses (who arrange IV therapy in the community) will visit you to complete your assessment. The HOPT nurses will discuss your health needs, support available and home circumstances with you and your doctors to decide if home IV therapy is suitable for you. The HOPT Team will discuss available options with you to develop a plan that fits your needs. You will be able to ask the HOPT Team any questions about the service. You may wish to make notes of questions as you think of them. Frequently asked questions Do I have to go home? No. It is up to you to decide if you would like to have your treatment at home. If at any time you change your mind or become unwell, you can discuss with the HOPT nurse whether it is appropriate to return to hospital to complete the course of treatment. If you decide not to go home with your IV therapy you will stay in hospital and finish your treatment. Not every patient will be able to have IV therapy at home and the team will discuss options with you to find the most suitable and convenient way of giving your treatment. continued page 5 3 4

When can I go home? You will have to be assessed by the HOPT Team before you can go home and will also require a special line to be put into your arm (see page 6). Your discharge date also depends on your medical condition being stable and needs to be agreed with the hospital team involved in your care e.g. doctors, physiotherapists, dieticians. The HOPT Nurses will discuss this with you. Do I have to tell my GP? No. Your GP (General Practitioner) will be made aware that you are having your IV therapy at home. How will I get my medication? All IV medication will be prescribed from the hospital and either: Delivered directly to your home Given to you on discharge or Given to you at the hospital clinic Brought to your home by the nurses attending you. Are there any risks of having IV therapy at home? To have IV therapy at home you will need to have a special line put into your arm (see page 6). This is because we need to guarantee we can give your medication each time it is required. The line will either be put in while you are in hospital or put in when you are at home. There are some risks associated with having an IV line but they are minimal after the line has been put in (these are detailed on page 7). An allergy (reaction to a drug) can sometimes happen when new drugs are given. You will also be given written advice about reactions and what to do if one occurs. When will a doctor see me? Most people who are having home IV therapy are seen at the hospital clinic every 2-4 weeks. This is usually with a member of the medical or surgical team who has been caring for you throughout your current illness along with a member of the HOPT Team. Before you leave hospital you will be given a set of notes that everyone involved in your home IV therapy will update. You will be asked to keep these notes and bring them to the clinic. If you cannot come to the clinic please contact the clinic to arrange a new time. If you require hospital transport to the clinic please try to arrange this at least 48 hours before your appointment. The Receptionist at your GP s surgery can arrange this. How does the medication get into my vein? There are various types of IV lines that are suitable for use at home, but the two main types are called midlines and PICC s. The type of line you have will depend on the treatment you need and the estimated length of time it is required for. The HOPT Nurse will discuss your treatment with you. Before the line is put in, the procedure will be explained and you can see one first if you want. Having a line in means you do not have to have lots of needles put in to give the medication. Consent After you have read this booklet, discussed options with the HOPT team and have had time to ask questions, the HOPT team will ask you if you have understood the information given and are in agreement to have a line inserted. You will be informed how the medication will get to you 5 6

What is a midline? A midline is a short fine hollow tube that is inserted into the small veins in your arm with the tip lying in your upper arm. It can stay there for a few months. What is a PICC? A PICC (Peripherally Inserted Central Catheter) is a long fine hollow tube similar to a midline but longer. It is inserted into the small veins in your arm with the tip lying in the large vein in your chest (superior vena cava), which leads to your heart. Because the tip lies in a large central vein a PICC is a type of central line. A PICC can stay in place for up to a year. Patients who have a different type of line (tunnelled line or port) will have separate information given about how it will be put in. Are there any likely side effects of having an IV line? Midline The main risks with a midline are: 7 Infections - but by following basic training given and ensuring prompt action is taken if a problem occurs, most lines are complication free. The nurses will always wear gloves when caring for your line Thrombosis (a clot) - insertion of any needle into the vein causes damage to the vein wall. The trauma can occasionally cause a clot that can block a vein Mechanical phlebitis - is redness or a slight swelling in the arm which may occur within seven days of the line being inserted. It is caused by the vein being sensitive to the movement of the line. The line is slightly smaller than the size of the vein, so the vein can take a little time to get used to it. This usually settles down and gives no further problems. To try to prevent this happening, apply a warm compress to the upper arm at least 4 times a day for 20 minutes for the first three days to help the line settle in. This helps the vein dilate and lets the blood flow around the line and can help ease any discomfort PICCs (Peripherally Inserted Central Catheters) Everyone having a PICC inserted will have a chest x-ray to check that none of the following have happened: Malposition (line is not in the correct place). If the line is in the correct position you will only need one chest x-ray. If it needs to be re-positioned, you will require another x-ray. There are a few symptoms of malposition, which is why you will have a chest x-ray. If you notice discomfort in your neck or chest when having your drugs, unusual breathing difficulties or your heart beating irregularly you should report them to the HOPT Nurse or the hospital nurse as these may be signs that the line is not in the correct place Palpitations can result if the tip of the PICC lies beyond the superior vena cava (the large vein where the tip should be). This can cause the heart to beat faster or irregularly. A chest x-ray will show if the position of the line is correct and prevent this from happening Although a PICC is a central line going into your arm and the tip ends in the veins near the heart, the risks associated with the insertion for a PICC are less than those for central lines going into a vein in your chest or neck. How is a midline or PICC put in? You will be given a local anaesthetic (a small injection under the skin on your arm) and positioned on your bed or chair with your arm out to the side. A nurse (or sometimes a doctor) will put your line in by inserting a needle into your arm just above where it bends. An ultrasound machine will be used to take a picture of your vein. You may feel some pressure when the needle goes in. If it is painful, let the nurse or doctor know. The midline or PICC will be passed into your vein. The whole procedure takes approximately 30-45 minutes. Can I eat or drink before my line is inserted? Yes. 8

How is the IV line kept in place? It is kept in place with a Statlock (a special securing device which sticks to your arm) and a clear dressing where it comes out of your arm. The dressing helps prevent infection getting into the vein where the line enters. To help prevent infection entering the line, there is a plastic cap attached to the end of the line. The cap, the clear dressing and usually the Statlock are changed weekly by the nurse. Will I be able to move my arm? You will be aware that the line is in your arm, but it should not stop you carrying out basic activities. Excessive exercise should always be avoided as there is a risk your line may become dislodged. Who will care for my IV line? While in hospital your line will be looked after by the hospital IV team or the nursing staff. This includes: Cleaning the exit site (where the line comes out) on your arm 24 hours after it is put in Cleaning the exit site and applying new dressings weekly until your treatment ends Giving your IV medication through the line Flushing the line before and after giving your medication Observation of your line and exit site to detect problems When at home a nurse will take over this care, unless you are giving your own medication as mentioned earlier. Can I help care for my IV line? To help prevent infection you should keep your line clean and dry at the exit site on your arm and also at the end where the plastic cap is attached. Strict hygiene is important. Do not touch your line or the exit site unnecessarily. Do not allow anyone else to touch your line apart from the nurse who is trained to care for and manage your line. A clear dressing will cover the exit site. If the area appears clean and dry your nurse will change this dressing each week. If you notice any redness or pus around the exit site that is new to you, then you should contact the helpline number (on page 15) and arrangements will be made for you to be reviewed. You will be given tubegauze to cover your arm, which will minimise contact with dirt and prevent pulling of the line. You should avoid heavy lifting and excessive movement of your arm. Some people may return to work with a midline or PICC, but it must be light duties. Will I need to stay in hospital after my IV line has been inserted? No. To ensure that there are no problems following insertion of your line, it will need to be checked the day after it is put in. Often patients are in hospital so during this time we will discuss and arrange your medications for discharge. Some patients will have their line inserted at home. The HOPT Team will arrange for the nurse to check the line and change the dressing the following day. How is the IV line removed when it is no longer needed? A nurse removes the midline or PICC. No anaesthetic is required and the line should come out easily. Can I have a bath or shower? Yes. You can still bath or shower as long as the line is kept clean and dry. You will be supplied with a long plastic arm glove to protect the line and exit site while you bath / shower. Do not immerse your arm in the water. If the dressing does become wet underneath, contact the helpline as the dressing will need to be changed promptly. It is useful to bath or shower before the nurse visits you so if your dressing does become wet it can be changed during your visit. Can I lead a normal social life? Having a midline or PICC in place should not interfere with your social life unless you require your medication frequently each day. 9 10

Can I play sports? Sports which involve vigorous exercise are discouraged if you have a midline or PICC in your arm. Can I go swimming? Swimming is not advised with midline or PICC line as there is a high risk of infection and excessive movement may make the line come out. How is the equipment and medication stored and disposed of? Medication Sometimes medication is sent to you in ready-made syringes and sometimes it is not. When it is not ready-made, it should be left in the box it is supplied in. Keep the box at room temperature and not beside a radiator. If your medication is already made up you will be supplied with a small fridge to store it in. The medication will be delivered in a separate box with an ice pack. If you have a fridge delivered you will need to plug it in and look in the supplies box for the fridge thermometer. Place the thermometer in the fridge and when and when it is at the correct temperature (between 2 C and 8 C) you can take the medication out of the ice pack and place them both in the fridge. These will be collected at the end of your treatment. The nurse will check the fridge temperature daily and document this (if you are self administering you will need to do this yourself). Sharps boxes Sharps boxes are for the disposal of used sharp equipment including needles, glass etc. They should be kept out of the reach of children and animals. DO NOT put your hand into a sharps box for any reason as this may cause serious injury. The company who deliver the boxes will collect them during and at the end of your treatment with any left over medication and equipment. Waste and rubbish Apart from sharps boxes, all other waste generated can go with your normal rubbish. How will I know if something is wrong? There are many symptoms that can indicate something is wrong. If in any doubt, do not hesitate to contact the helpline (see page 15). If a problem occurs, we will aim for you to remain at home, but if it cannot be resolved, you may have to go back into hospital until the problem is sorted. Some common problems: If someone is pricked by a needle Encourage the area to bleed by squeezing it and running it under cold water for at least five minutes Pain, inflammation, redness or heat at the exit site. Chills, sweats, rasied temperature or feeling generally unwell These can all be signs of infection If your IV line seems longer This could mean the IV line has moved and needs examining If the line is a PICC you may need an x-ray to check the position IV line fallen out completely If your line comes out completely: Elevate your arm Apply pressure on the entry site for 5 minutes using a clean swab or tissue When the bleeding has stopped, apply a plaster or similar dressing as soon as possible as the line will most likely need to be replaced 11 12

Inflammation of the upper arm Elevate your arm on a pillow Apply a warm compress at least 4 times daily for 20 minutes Leakage from connectors Put on a pair of gloves Tighten the connections Cracks in the IV line or in the plastic ends of the IV line Apply gloves and wrap a piece of gauze around the crack to prevent infection. If possible cover with the clear dressing the nurses use on your exit site immediately Wet or loose dressing Do not attempt to remove the waterproof dressing - it may pull the IV line and make it fall out Hard to flush or blocked IV line (for patients who selfadminister) If it becomes difficult or impossible to push the contents of the syringe into the IV line do not force the plunger of the syringe Pain or swelling in the arm or neck or shortness of breath immediately Your line may have moved and may need to be repositioned or You may have a clot The line should not be used until it has been reviewed in the hospital Reaction to medication Reactions to medication are rare and are usually related to the first few doses given. Reactions can be classed into three main groups: A) Mild reactions May include: headaches, chills, fevers, nausea, vomiting, joint or back pain and light headedness or dizziness Stop giving the medication (see page 15) B) Moderate reactions May include: wheezing, itching or a rash. Other mild symptoms (as above) rapidly getting worse or recurring Stop giving the medication and call your GP or contact the helpline (see page 15) C) Severe reactions May include: tightness of the throat, severe headaches or shaking, severe dizziness or fainting, severe breathlessness or wheezing, collapse, any kind of chest pain or other moderate symptoms persisting or rapidly getting worse Stop giving the medication Call 999 and wait until an ambulance arrives Lie down If you have collapsed your nurse or carer should place you on your side in the recovery position and check your airway and breathing 13 14

Helpline If you have an issue specifically linked to your intravenous therapy, please contact one of the numbers below: Notes 9am to 5pm After 5pm Monday to Friday Weekends & Bank Holidays Pager: 07623 971 090 Telephone: 08457 573 100 When you page the helpline you will be asked to; enter your numeric message followed by the hash key Please enter the phone number you are calling from into your keypad. This can be your home or mobile phone. The paging service will then tell you your message has been accepted Replace your handset. A nurse will call you back on the number you typed into the phone. You will speak to a trained person who will ask for your details. These will be passed onto a nurse who will call you back. HOPT Team Intermediate Care, 1st Floor, Sandringham House, Windsor Street, Salford, M5 4DG 0161 206 7017 15 16

G17072601W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: MED41(17) Review Date: August 2019 For further information on this leaflet, it s references and sources used, please contact 0161 206 7017 Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients