EDUCATION

- RECEIVING AND STORING OF MEDICATION AND SUPPLIES
- MEDICATION STORAGE
- STORAGE OF SUPPLIES
- ROOM SETUP
- SAFE HANDLING / DISPOSAL OF BIOMEDICAL WASTE
- WHAT IS ASEPTIC (STERILE) TECHNIQUE?
- INFUSION CATHETERS
- SUPPLIES AND EQUIPMENT
- CATHETER SITE MANAGEMENT

- INJECTION CAP CHANGE INSTRUCTIONS
- IV TUBING CHANGE INSTRUCTIONS
- INFUSING YOUR MEDICATION
- TROUBLESHOOTING YOUR INFUSION
- GRAVITY INFUSION TROUBLESHOOTING
- PUMP INFUSION TROUBLESHOOTING
- CENTRAL CATHETERS
- MANAGEMENT OF PROBLEMS WITH CATHETERS

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RECEIVING AND STORING OF MEDICATION AND SUPPLIES

Your medication and other therapy related supplies are provided by At Home Infusion Services, LLC. A delivery schedule will be coordinated with you by the pharmacy staff. Please make sure to check all supplies against the delivery ticket included with each delivery.

CHECK THE MEDICATION LABEL FOR: YOUR NAME, PHYSICIANS NAME, PROPER DRUG, DOSAGE, AND “DISCARD AFTER” DATE.

DO NOT use any medication/solution after the “discard after” date printed on the label. Before each medication administration you should check all solutions for leaks, discolorations or particles. If you detect any of these, do not use the medication and call the pharmacy at (561) 353-4663 or (877)-309-2207.

Your home infusion therapy may require the use of multiple medical supplies. Your homecare nurse will train you, your family, or caregiver in the proper use of the supplies. If you are unsure about the supplies delivered, or think something is missing, call the pharmacy at (561) 353-4663 or (877)-309-2207.

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MEDICATION STORAGE

It is important that medications are stored correctly when delivered. Check the medication labels for proper storage instructions.
• If your medication is stored in the refrigerator, it should be removed 1-2 hours prior to usage and
  brought to room temperature.
• If your medication is stored in the freezer, remove the doses that will be used within the next 24 hours
  and place in the refrigerator. Once medication is thawed, remove from refrigerator 1-2 hours
  prior to usage and allow it warm to room temperature.

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STORAGE OF SUPPLIES

• Set aside a small workspace away from small children and pets.
• Supplies should never touch the floor.
• The red sharps container should only be used for blood soaked items, needles, syringes with attached needles and other sharp objects related to your therapy. The lid of the sharps container should never be removed.
• IV tubing and syringes without needles can be disposed of in your regular household trash.
• Store supplies in a dry place at room temperature and arrange in a neat and organized manner; this will help in keeping an accurate inventory of your supplies.
• Check each package for breakage and tears in the safety coating. If breaks or tears are found, contact the pharmacy or your homecare nurse immediately. Do not use as it is no longer sterile.
• Keep paper products dry. If they get wet, they are no longer sterile and should be thrown out immediately.
• Please keep an inventory of your supplies so that you always maintain an adequate supply. If you are using more than normal amount of supplies and are running low, please call the pharmacy before you run out. We will deliver the necessary supplies as quickly as possible.

Please keep track of your supplies. Contact the pharmacy before you run out to ensure that you can continue your scheduled therapy.

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ROOM SETUP

• The room should be neat and organized.
• Set aside a work area that is convenient and away from small children and pets.
• Designate a specific time for your therapy so that you are free from interruptions.
• The work area should have a smooth flat surface that can be cleaned with alcohol, soap and water or disinfectant wipes.
• The work area should be well lit at all times.
• Your sharps container should be accessible and within arm's reach.

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SAFE HANDLING / DISPOSAL OF BIOMEDICAL WASTE

• Place all blood soaked items, needles, syringes with attached needles, and other sharp objects into the red “sharps container” that was provided to you.
• If you have a mail back sharps container, do NOT remove the red container from the cardboard box that it came in. You will need this box to mail the container for destruction at the end of your therapy or when it is full.
• Place all used medical supplies into the sharps container if they are saturated with blood or body fluids.
• Any other used medical supplies including IV tubing, syringes without needles or empty bags can be thrown in the regular household trash.
• Never put your hand in the sharps container.
• Do not place the cap on the sharps container until it is ¾ full. Once the cap is placed on the container it cannot be reopened.
• Call At Home Infusion Services, LLC for a new sharps container when your container is ½ full.
• Do not throw full sharps containers into the trash. At Home Infusion Services, LLC will instruct you on proper disposal methods.

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WHAT IS ASEPTIC (STERILE) TECHNIQUE?

Sterile or Aseptic Technique is a special method of handling objects to keep them free of germs. If a sterile product is not handled properly, it becomes contaminated or “non-sterile” and should not be used. All products sent to you from the pharmacy are already sterile. If you have any question or doubt about any items sterility, PLAY IT SAFE.

WHEN IN DOUBT, THROW IT OUT!!!!

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PRINCIPLES OF STERILE TECHNIQUE FOR INFUSION THERAPY

• WASH YOUR HANDS before handling any products.
• DO NOT USE ANY EXPIRED SOLUTIONS OR MEDICATIONS!
• DO NOT let the outside of a package touch the item inside.
• DO NOT touch any sterile item with your fingers or let supplies touch any non-sterile surfaces.
• Use alcohol swabs or pads to disinfect injection caps or port sites where IV tubing is to be attached (NEVER RETOUCH THE DISINFECTED AREA).
• The sterile technique should be used when starting or stopping your infusion, changing your dressing, flushing your catheter, preparing your infusion, and changing your injection cap and/or tubing.

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INFUSION CATHETERS

Infusion catheters are hollow plastic tubes that are inserted into the vein and are used in the administration of intravenous (IV) medication. Catheters can remain in place for as little as a few hours to many months depending on the type of catheter inserted. You will be taught how to care for and maintain the catheter while receiving infusion therapy.

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SUPPLIES AND EQUIPMENT

While receiving infusion therapy from At Home Infusion Services, LLC, you may need special supplies and equipment. The homecare nurse will demonstrate to you and/or your caregiver how to use these specialized items. Common types of equipment used are as follows:
• Infusion Pump: This is a portable device that controls the flow of the infusion and is typically set on a table or carried in a fanny pack or back pack.
• IV Pole: This is used to hang the infusion bags above your head to allow it to infuse via gravity.
• Injection Cap: This is a screw on cap that is connected to the end of the catheter. You or your homecare nurse will connect the administration set of the IV tubing to it.
• Administration Set: This is the IV tubing or pump cassette that attaches to the medication container to connect to the catheter and is used to infuse your medication.
• Sharps Container: This is a specialized puncture proof container used for the disposal of sharp items, such as syringes and needles, or items contaminated with blood or body fluids.

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CATHETER SITE MANAGEMENT

While receiving infusion therapy from At Home Infusion Services, LLC, you may need special supplies and equipment. The homecare nurse will demonstrate to you and/or your caregiver how to use these specialized items. Common types of equipment used are as follows:
• Infusion Pump: This is a portable device that controls the flow of the infusion and is typically set on a table or carried in a fanny pack or back pack.
• IV Pole: This is used to hang the infusion bags above your head to allow it to infuse via gravity.
• Injection Cap: This is a screw on cap that is connected to the end of the catheter. You or your homecare nurse will connect the administration set of the IV tubing to it.
• Administration Set: This is the IV tubing or pump cassette that attaches to the medication container to connect to the catheter and is used to infuse your medication.
• Sharps Container: This is a specialized puncture proof container used for the disposal of sharp items, such as syringes and needles, or items contaminated with blood or body fluids.

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INJECTION CAP CHANGE INSTRUCTIONS

The injection cap on the end of your catheter needs to be changed every week. Your homecare nurse will provide instructions.

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IV TUBING CHANGE INSTRUCTIONS

IV or IV pump tubing should be changed every 24 hours if your infusion is intermittent and every 72 hours if it is continuous. Long-term infusions that are uninterrupted and have the tubing attached at the pharmacy should be changed only when the medication cassette is changed according to the expiration date of the medication in the cassette. Tubing should be changed immediately if contaminated. Note: TPN TUBING MUST BE CHANGED EVERY 24 HOURS.

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INFUSING YOUR MEDICATION

• Gather all supplies needed for therapy at least 1-2 hours ahead of time so that your medication can warm to room temperature.
• Wash hands thoroughly.
• Check medication bags for leaks, discolorations or particles.
• Connect IV or pump tubing (as applicable) to the medication bag.
• Make sure all clamps are closed.
• Hang the medication on the IV pole if applicable.
• Fill the air chamber below the spike point half to three quarters full if infusing by gravity.
• Unclamp the tubing and let the IV fluid run through the tubing to remove all the air before connecting to the catheter.
• Clean the injection cap attached to your catheter with an alcohol wipe.
• Connect the flush syringe to the injection cap and flush the catheter as instructed.
• Disconnect the flush syringe and connect the IV or pump tubing to the catheter and start the infusion process as directed.
• When the infusion is complete, disconnect the tubing. Place a sterile protective cap on the end of the IV tubing to maintain sterility if your infusion is more than one time per day. IV tubing should only be changed once per day so can be used multiple times as long as you put the sterile protective cap on the end of the IV tubing after each infusion.
• Clean the injection cap with an alcohol wipe and flush the catheter as instructed.
• When you are done using the IV tubing, you can discard it in the regular household trash.

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TROUBLESHOOTING YOUR INFUSION

If you experience any of the following during your infusion, immediately discontinue the therapy and call your homecare nurse or the pharmacy. You may be experiencing an allergic reaction. Symptoms are as follows:
• Chills
• Feeling of nausea or vomiting
• Shortness of breath
• Hives, rash, or itching
• Temperature above 99.1 degrees
• Or any other symptoms you have been informed about by your physician or homecare nurse
If the medication or solution is infusing, discontinue it immediately. If you are unable to determine the cause of the problem, call your homecare nurse for assistance.

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GRAVITY INFUSION TROUBLESHOOTING

• If your medication is not infusing properly, inspect the clamp on the catheter or tubing, if applicable. If clamp is closed, open it and attempt to continue with the therapy.
• Open the clamp wider to check for fluid flow into catheter. If it begins to drip again set it at the specific rate instructed to you by the homecare nurse.
• If the medication still does not drip, check for any kinks in the line. Straighten out the line and try again.
• If the medication still does not infuse, close the clamp on the line and disconnect. Make sure a sterile cap is placed on the end of the IV tubing before setting it aside.
• Make sure the injection cap at the catheter site is cleaned with an alcohol wipe and connect IV flush. Flush catheter with a syringe filled with flush solution.
• If there is any resistance in the catheter while trying to flush, stop and do not reconnect the medication. Close the clamp on the catheter and call the homecare nurse immediately.
• If the flush passes through line with no problem, re-wipe the injection cap, reconnect the line, and try to infuse again. For any further problems, call your homecare nurse or the pharmacy.

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PUMP INFUSION TROUBLESHOOTING

• If the pump alerts you of high pressure or occlusion, STOP the infusion and reference your pump manual for specific solutions.
• Check all clamps on the catheter and pump tubing, if any are closed open them and start again.
• If the clamps are open and the medication still does not infuse, check for any kinks in the line. Straighten out the line and try again.
• If medication still does not infuse, close the clamp on the lines and disconnect. Make sure sterile cap is placed end of the IV tubing before setting to the side.
• Make sure injection cap at the catheter site is cleaned with alcohol wipe and connect IV flush. Flush catheter with a syringe filled with flush solution.
• If there is any resistance in the catheter while trying to flush, STOP. Close the clamp on the catheter and call the homecare nurse immediately.
• If the flush passes through lines with no problem, re-wipe injection cap, reconnect lines, and try to infuse again. For any further problems, call your homecare nurse or the pharmacy.

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CENTRAL CATHETERS

Signs
Issues
Resolutions
Blood or fluid coming from the catheter.
Catheter breaks or leaks
Clamp catheter immediately between the leak and patient. Call the homecare nurse.
Pain in chest, arm, and shoulder, followed by swelling in the arm, face, and neck.
Catheter tip dislocation
Stop infusion, flush catheter, and call homecare nurse.
Chest pains, breathing difficulty, accelerated heart rate, fainting, or change in skin color.
Air Embolism
Clamp catheter, place patient on left
side of body and dial 911.

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MANAGEMENT OF PROBLEMS FOR ALL CATHETERS

Signs
Issue
Resolution
Redness, pain, swelling, drainage, heat at the catheter site or along the vein.
Possible infection or thrombophlebitis
Stop infusion, and call the homecare nurse.
Swelling, pain, leakage at catheter insertion site.
Catheter becomes displaced
Stop infusion, and call homecare nurse.
Catheter comes out.
Catheter dislodges
Apply pressure with sterile dressing until bleeding stops. DO NOT RUB!!! Place catheter in sterile gauze and apply band aid to site. Call homecare nurse.
Clear dressing becomes loose
Potential for infection or dislodgement
Apply tape to keep dressing in place. Call homecare nurse.
Fluid does not flow when trying to flush catheter, or medication will not infuse.
Obstructed Catheter
DO NOT force solution through. CALL THE HOMECARE NURSE.
Elevated temperature followed by normal temperature then followed by elevated temperature that stays, loss of appetite, chills, night sweats, redness, drainage at site, swelling.
Sepsis (Infection)
If infusing, STOP. Save all solution and tubing and call the homecare nurse.
Blood under the clear dressing.
Bleeding
If you notice more than a dime sized amount of blood, call your homecare nurse. Or if you notice a large amount of blood, apply pressure with sterile gauze and call your homecare nurse.

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