About

➀ Read and Learn

The following course content

Introduction   

In-home IV therapy is an emerging trend in healthcare delivery. It allows patients to receive care in the comfort of their own homes. Patients can enjoy more control over their schedules when undergoing treatment and can be less reliant on caregivers for transportation and healthcare support.  

Prior to at-home infusion therapy, patients relied on an acute care model requiring expensive and lengthy in-patient stays. As the at-home treatment model continues to grow, patients experience more autonomy and benefit from less exposure to hospital-acquired infections and less time away from their work, family, and lives. 

This is a comprehensive overview illustrating the indications, benefits, and necessary nurse teaching surrounding at-home IV therapy. 

Definition 

At-home intravenous therapy delivers intravenous medications, fluids, or nutrients to patients in the comfort of their homes or environments. The demand for at-home infusion therapy continues to expand as the landscape for healthcare delivery evolves. “The home and specialty infusion industry has experienced significant growth in the past decade, evident by a jump from 829,000 patients serviced in 2010 to 3.2 million in 2019” (1).   

This practice is facilitated by healthcare professionals who coordinate the necessary treatment plan while the home care nurse, patient, or caregiver administers the IV treatments. Before in-home IV therapy can proceed, the nurse ensures the patient and caregivers adhere to the protocols and instructions required for safe treatment outside a hospital or clinic setting (2).   

Numerous treatments, including antibiotics, chemotherapy, hydration, and parenteral nutrition, are suitable for at-home IV therapy. This approach aims to provide a patient-centered alternative to treatment, improving quality of life and allowing patients to maintain independence and comfort (2). 

Indications of Use 

At-home IV therapy can treat a wide variety of conditions and illnesses. If the patient doesn’t need acute care management, they can stay in the comfort of their own home to receive treatment.   

Chronic Infections 

Home IV therapy is highly effective for treating chronic infections requiring extensive antibiotic treatment. Conditions such as osteomyelitis, complex urinary tract infections, and endocarditis can significantly benefit from in-home IV antibiotic therapy (3). Antibiotic treatment accounts for almost half the patient population receiving at-home infusions (1). 

Cancer Treatment 

Patients undergoing cancer treatment often require IV infusions of chemotherapy, hydration, or supportive medications. Home IV therapy is an alternative to on-site infusions for those with stable cancer. However, patients in need of complex cancer treatment are not candidates for in-home infusions. Patients eligible for at-home treatment have a decreased risk of contracting hospital-acquired infections and can safely receive therapy in their environments (4).  

Nutrition Support 

Home IV therapy is essential for patients requiring parenteral nutrition due to conditions such as short bowel syndrome, inflammatory bowel disease, or severe malabsorption syndromes. There has been an increase in at-home IV support for patients with Colitis and Crohn’s disease. These patients experience an exceptionally heavy burden with frequent absences from work and school to receive biologic infusions. To minimize the hardship, biologics are now available for home infusion, greatly contributing to an increased quality of life for patients with Colitis and Crohn’s disease (5). 

Immune System Support 

Immunocompromised patients, such as those with primary immunodeficiencies or those undergoing immunosuppressive therapies, can significantly benefit from at-home IV therapy. Intravenous immunoglobulin (IVIG) therapy can be administered at home to improve immune function, prevent infections, decrease hospitalizations, and encourage better patient outcomes. “One study that compared rates of pneumonia and bronchitis in primary immunodeficiency patients receiving IVIG therapy in outpatient hospitals versus in the home demonstrated significantly lower rates of infection in patients receiving treatment at home” (6). 

Palliative Care  

Palliative care patients can utilize the at-home IV therapy approach to enhance comfort and allow patients to remain in their preferred home environment while receiving necessary symptom relief. Research shows that home palliative care, including IV therapy, improves patient comfort and quality of life (7). 

Benefits of At-home IV Therapy 

Enhanced Patient Comfort and Convenience 

One of the primary benefits of in-home IV treatment is that it offers patients with chronic conditions such as Crohn’s disease, cancer, or chronic infections an alternative to acute care. Reoccurring hospital stays for IV treatments can be physically, emotionally, and financially demanding. These visits can incur transportation costs and expensive hospital bills, becoming burdensome for patients and caregivers.  

At-home therapy reduces time away from one’s everyday activities, and studies show a decrease in anxiety-related treatment (8). 

Cost Reduction 

Home-based IV therapy can be more cost-effective than acute care and clinic fees. Costs are significantly reduced because facility fees and the cost of on-site healthcare professionals are eliminated. Ongoing studies indicate that IV home infusion therapy will decrease patient care costs. Patients receiving IV treatment at home forgo hospital and healthcare provider fees, offering a less expensive alternative to therapy in the healthcare setting. This is a promising trend for patients needing continued IV therapy (8).  

Improved Clinical Outcomes 

Home-based IV therapy has proven to be a safe and effective alternative to on-site care. “Patients receiving home infusions were no more likely to experience adverse drug events or side effects and had as good or better clinical outcomes” (8). 

Patient Satisfaction 

Patient satisfaction is often higher when there is an option for a home-based alternative. Patients feel they have more autonomy (9) and appreciate the flexible scheduling. It also reduces stress on caregivers and family members responsible for patient transportation and support. Infusion therapies require frequent absences from work, school, and family, and the option to undergo care at home reduces time away from the patient’s family and responsibilities (5). 

Reduction in Nosocomial Infection 

Patients receiving treatment at home experience less exposure to hospital-acquired infections, an unfortunate and common cause of hospital readmission. At-home IV therapy can reduce the risk of infections, including central line-associated bloodstream infections (CLABSIs), which are prevalent in hospital settings (10). Patients in the home setting have fewer hospital staff handling the catheter and aren’t subject to other sick patients in the hospital setting. 

Nursing Care Protocols 

The role of nurses in the monitoring and management of IV home infusion therapy is crucial for ensuring patient safety and procedural success. Key responsibilities of nursing care will include the following. 

Initial Assessment and Care Planning 

Nurses play a critical role in determining whether a patient is a good candidate for home infusion therapy. The nurse must evaluate the patient’s medical condition and determine whether the home environment is safe and fit for at-home therapy. Nurses should also be aware of the cleanliness of the environment and ensure there is a suitable and safe location for therapy administration. 

If the nurse deems the home environment suitable, they must assess the level of the patient’s support system to develop a strong care plan that will address the patient’s needs and ensure appropriate therapy administration (2).  

Patient and Caregiver Education 

Education is a fundamental piece of nursing care that helps fortify successful at-home IV therapy. Nurses must provide a detailed protocol for administering IV infusions, educating their learners on the signs of complications, and performing routine maintenance tasks, including sterile dressing changes and effectively flushing lines. Thorough education instills those patients and caregivers with confidence and competence in managing IV therapy independently. Caregivers and patients report in-depth education to be the cornerstone of successful at-home treatment (1). 

Ongoing Monitoring and Support 

Continuous patient monitoring and support is critical to identify potential issues that can arise, including catheter complications, infection, adverse medication reactions, or addressing missed doses of medications. Nurses can utilize telehealth options, in addition to regular home visits, for patient monitoring to provide timely interventions when needed. Regular follow-up visits and patient communication are critical. Nurses can use the visits to adjust the care plan as needed and respond to patient needs and questions (11). 

Troubleshooting and Problem-Solving 

Nurses are adept at troubleshooting, and using these skills for their home infusion patients will be important when common problems such as catheter blockages, leakage, or infection occur. They can guide the management of these issues and when to seek additional help. When nurses can successfully troubleshoot the problems that arise with at-home IV therapy, patients can avoid hospital visits or readmission (11). 

Psychosocial Support 

Patients and families faced with the prospect of home IV treatment after in-hospital care may feel unequipped or intimidated to meet the challenges that lie ahead. Fortunately, nurses are uniquely positioned to offer the necessary psychosocial support and care for a positive at-home treatment experience. This support can range from addressing anxiety associated with IV therapy, offering tools for stress management, providing various resources, and offering encouragement (1). 

Patient Safety Considerations 

At-home IV therapy is not without its risks, and negative patient outcomes can still occur. However, top-notch nursing care can help reduce infection and emergency events through appropriate education and follow-up. Key patient safety considerations include the following. 

Infection Prevention and Control 

Preventing infection is a top priority and one of the most critical considerations while managing at-home IV therapy. The nurse, patient, and caregiver should make painstaking efforts to ensure the patient remains infection-free. All individuals involved in hands-on care must adhere to strict hand hygiene protocols and always use the appropriate sterile supplies to mitigate infection risk. Careful and consistent monitoring of the catheter site is necessary to identify signs of infection, including redness and swelling. Patients should also monitor themselves for fever or other symptoms denoting infection (12). 

Proper Catheter Management and Maintenance 

Regular catheter maintenance is essential to prevent occlusions or blockages that may occur. Nurses should ensure their patients understand the critical nature of flushing the catheter with heparin or saline and keeping the site clean and dry. Clear instructions should be provided to patients and caregivers on how to flush the catheter with the prescribed solution and what to do if they encounter any issues (12).  

Patient and Caregiver Education 

Comprehensive education establishes a foundation for patients and caregivers to manage home IV therapy effectively (2). Education should be unique to the patient and should cover proper catheter care. Particular attention should be given to discussing the prevention of catheter-related bloodstream infection and recognizing and responding to potential complications. Well-taught patients are more likely to feel confident managing their care, adopting treatment protocols, and promptly reporting issues, reducing the risk of adverse events. Ongoing education should be dynamic and flexible to meet individual patient and caregiver needs (12). 

Monitoring and Follow-Up 

Regular monitoring and follow-up are critical to maintaining safety for in-home IV therapy. This includes scheduled healthcare provider visits, remote telehealth monitoring, and regular evaluations to assess catheter function and the patient’s health. Effective follow-up detects and addresses issues before conditions deteriorate into more serious problems (11). 

Emergency Planning 

Patients receiving home IV therapy should have a clear plan for handling emergencies should they arise. Their nurse will have properly educated patients and caregivers to recognize symptoms of potential complications, such as infection, allergic reactions, or catheter malfunctions. A concise, clear protocol for seeking medical assistance should be established, including emergency contact numbers and the patient’s specific healthcare resources. The nurse should regularly review emergency protocols so patients are well prepared (11). 

Patient and Family Education 

Proper education and tools are imperative for patients to have successful and positive health outcomes while undergoing IV therapy at home. The nurses who educate them should provide comprehensive instruction to achieve the best outcomes (11).  

First and foremost, nurses must tailor their teaching to meet each patient’s and their caregiver’s unique and specific needs. Educating them in a manner that is cohesive with their learning style will increase understanding and compliance and reduce the need for extensive follow-up care (13). Despite learning styles, nurses should employ the teach-back method so they can identify any areas of catheter maintenance where the patient needs additional instruction. 

Personalized education plans will vary significantly from patient to patient. There are so many different types of IV treatments that can now be administered at home, each therapy will come with different protocols as well as challenges. Key components of at-home IV therapy education should include the following. 

Catheter Care and Maintenance 

• Site Care: Patients and caregivers should be thoroughly instructed to properly manage, clean, secure, and remove their catheters if necessary. Maintaining clean and dry catheter insertion sites is imperative for patient safety and to reduce the risk of infection or potential sepsis. Patient and caregiver education must include proper sterile cleaning techniques, sterile dressing changes, and continuous monitoring for infection (2). 

Infection Prevention and Control 

• Hand Hygiene: Nurses must emphasize the crucial role of hand washing when handling IV mechanisms, such as PICC lines, ports, and venous catheters. Hand washing before handling IV equipment is essential for preventing infections, and patients need to be able to convey to their nurses that they fully understand this concept. Education should emphasize the use of hand sanitizers and proper hand-washing techniques (14). 

• Aseptic Technique: Nurses should teach patients and caregivers aseptic techniques for handling IV supplies and medications. They should ensure the patient can use the teach-back method to demonstrate donning sterile gloves, avoiding touching sterile components, and properly disposing of used materials to prevent contamination (15). 

Medication Administration 

• Preparation and Administration: Simple, detailed instructions on preparing and administering medications through the IV system should be explained and provided in a written or recorded format for patient and caregiver ease. This includes measuring proper doses, formulating solutions, and administering drugs exactly as prescribed to ensure therapeutic efficacy. Learners should also be instructed on missed or late doses (16).  

• Storage and Handling: Education should include proper medication storage, including temperature requirements and shelf life, to maintain drug efficacy and safety. Nurses should advise patients to be aware of medication expiration dates and how the medication should look (e.g., cloudy, clear, etc.) (16).  

Emergency Procedures 

• Responding to Complications: Nurses should anticipate complications with at-home intravenous therapy and educate their patients and caregivers accordingly. Responses will depend on the specific medication being administered and the different types of catheters utilized. Learners should know what to do if they suspect an infection, have pain at the insertion site, have issues with catheter function, or have an adverse medication reaction (12). 

• Emergency Contacts: Clear instructions on when and how to contact healthcare professionals in emergencies ensure timely intervention. Emergency contact numbers and procedures should be readily available (11). 

Self-Monitoring and Documentation 

• Daily Monitoring: Learners should be instructed to be aware of and monitor their health regularly. This includes inspecting their IV site, observing any symptoms during ongoing therapy, and noting any changes in their condition. Nurses should also educate their learners to monitor symptoms, including feeling improvement (2). 

• Record Keeping: Patient record-keeping education should include guidelines for maintaining accurate notes of at-home IV infusions. This includes, but is not limited to, medication administration, site care, and any adverse effects or reactions to medications. Documentation encourages effective communication with healthcare providers and ensures patients and caregivers report the most accurate information to influence their course of treatment appropriately. This also allows healthcare providers to address concerns in real time. Patients should also be directed to write down any questions that arise so they can address them during follow-up visits with their nurse or other provider (2). 

Conclusion

Nurses have the unique role of offering the necessary education, monitoring, and emotional support to in-home IV therapy patients, enabling them to avoid unnecessary in-hospital acute care stays.  

In-home IV therapy is gaining momentum as an advantageous alternative to treatment in traditional hospitals and clinics. It provides necessary care for patients with a broad array of illnesses and conditions. It allows the patient to maintain control over their environment, can decrease the risk of nosocomial infection, reduces healthcare costs, and increases patient satisfaction and comfort.  

➁ Complete Survey

Give us your thoughts and feedback

➂ Click Complete

To receive your certificate