Home Infusion Therapy Part 3: Infusion Administration Basics

1. Infusion Administration: Medication Safety

Medication safety is paramount when administering home infusions. This includes medication reconciliation and verification, and ongoing monitoring for response to the infusion therapy and potential adverse reactions. A patient case study is used to explain and apply safety issues and recommendations.

2. Key Aspects of Infusion Administration

A variety of infusion delivery methods may be used in the home setting. Whether an infusion is administered via a simple method, such as gravity infusion, or via an infusion pump, it is imperative to follow proper procedures to reduce the risk for VAD-related occlusion and infection prevention methods to reduce the risk for a bloodstream infection. This chapter focuses on the SASH technique and aseptic technique, which are critical, as failure to follow them places the patient at risk for a bloodstream infection. Frequency of administration sets and use of any add-on devices is also included, based on evidence-based recommendations.

3. Non-Infusion-Pump Methods: IV Push and Gravity Drip

Direct injection of an intravenous medication, usually called “IV push,” is indicated for certain antimicrobial drugs or other medications, such as furosemide or antiemetics. Gravity drip infusion is more commonly used for a variety of intermittently delivered medications and, in some cases, hydration fluids. Patient characteristics may also be a factor in choice of methods, as exhibited in the patient case example. Demonstration of the gravity drip method is highlighted, with attention to use of a manual flow regulator, calculation of drop rates, use of aseptic technique, and patient education.

4. Mechanical (Nonelectric) Infusion Devices

Mechanical infusion pumps use various types of technology, such as stretched elastomers or compressed springs, to create the force required to infuse. Mechanical infusion devices most commonly used in the home setting include the elastomeric (“balloon”) pump and mechanical syringe pumps. Indications for their use are discussed in the context of patient examples.

5. Electronic Infusion Devices

The most common type of electronic infusion device (EID) used in home care is the ambulatory EID. These compact infusion pumps are capable of delivering infusion therapies, including continuous infusions, intermittent antimicrobial infusions, analgesic infusions with patient-controlled analgesia, and parenteral nutrition allowing tapering of the infusion. Features include programmable memory, lock-out ability for safety, and alarms. There are now “smart pumps” available for use as well that include drug libraries. Safe practices when programming or resetting the program on the pump are demonstrated. Strategies for safe home electronic infusion device use as recommended by the FDA are highlighted in this section.

6. Patient Education and Synopsis of Key Points

General guidelines and key points to address in the patient education process are summarized in this section.