INFUSION NURSING AT HOME Yrd.Doç.Dr.Nurgül GÜNGÖR TAVŞANLI

HEALTH SCHOOL OF CELAL BAYAR UNIVERSITY

Intravenous infusion means intravenous application of exceeding amounts of drugs or solutions by injection

or catheter. It is used if the patient does not have the possibility to be treated orally. When the drug is

applied in form of infusion it is given to the patient by a certain period (short or long) and speed. In the

methods of intravenous treatment, the drug can be injected directly into the vein or by Bolus technology

putting the drugs in 500-1000 ml. serums.

Nowadays especially the patients having chronic diseases want to be treated at home. To meet the patients’ complex health requirements, curing at home services by maintaining

infusion reatments is done.

The areas where infusion treatment

usually applied are;

• It is anticipated that infusion treatment at home will decrease the time of staying in hospital

•decrease the risk of infection,

•decrease the treatment costs of chronic diseases by preventive health services,

•decrease the invisible costs (companion, transportation expenses, labor costs, etc.)

by incorporation of patient relatives,

•remove the costs that arise from the problems of relatives,

•decrease the return to the hospital,

•emergency department or intensive care services.

The role of the home-care nurse is being a

coordinator and support person for the patients. She is

responsible for briefing the essential staff for providing

high technological services. Nurses at home must have

the goods and be well-quipped to take care of catheters

and maintenance of treatment. Period of home caring

visits must be organized according to patient needs.

Other than home visits, home caring services must go

on 24 hours for emergency conditions.

The role of the home-care nurse

These days of becoming widespread of home caring services in our

country, a certification programme must be prepared to standardise the

applications, post-graduate programmes must be opened to raise

experts of at home caring services, guides must be prepared. Infusion

Nurses Society (INS) established at 1973, Infusion Nursing Certification

Corporation (INCC) established at 1983, are the foundations that serve

internationally in this area of work.

KAYNAKLAR

•Ay Akça F, Ertem Turan Ü, Özcan Keser N, Güneş B, Işık Demir R., Savran S (2007). “Temel Hemşirelik Kavramlar, İlkeler, Uygulamalar” , İstanbul Medikal Yayıncılık, 1.Baskı, s: 348-350.

•Cox ve ark. (2007). Home Intravenous Antimicrobial Infusion Therapy: Aviable Option in Older Adults, J Am Geriatr Soc 55:645–650.

•Duke M., Street A (2003). Hospital in the home: constructions of the nursing role – a literature review, Journal of Clinical Nursing, 12: 852–859.

•Ertem G (2010). Jinekolojik kanserlerde evde bakım, Türk Onkoloji Dergisi, 25(3):124-132.

•Ewers M. (2002). The Advent of High-Tech Home Care in Germany, Public Health Nursing Volume 19 Number 4 July/August, pp. 309–317.

•Graves D B (1995). Home Infusion Therapy, Nursing Management / Vol 26 No. 8, August, pp:32j-32p.

•Gugerty B (2006). The Holy Grail:Cost-Effective Healthcare Evidence Transparently and Consistently Used by CliniciansJournal of Healthcare Information Management, Volume 20, Number 3, pp:21-24.

•Infusion Nurses Soceity – INS (2011). 22 Temmuz 2011 'de http://www.ins1.org adresinden indirildi.

•Infusion Nursing Certification Corporation - INCC (2011). 22 Temmuz 2011 'de http://www.incc1.org/i4a/pages/index.cfm?pageid=3321 adresinden indirildi.

•Madeline M., Lorentz B A (2008). Home Healthcare Nurse April, vol. 26, no. 4, pp 237-243.

•Milli Eğitim Bakanlığı [MEB] (2011). Ortaöğretim Projesi, Anestezi ve Reanimasyon, İntravenöz sıvı infüzyonu, Ankara, s:15-37.

•National Home Infusion Assocation [NHIA] (2011), About Infusion Therapy, 22 Temmuz 2011 'de http://www.nhia.org/about-home-infusion.cfm adresinden indirildi.

•NHE - The National Health Expenditures (2009). National Health Expenditure Projections 2009-2019 (September 2010). 20Ağustos 2011'de

https://www.cms.gov/NationalHealthExpendData/downloads/NHEProjections2009to2019.pdf adresinden indirildi.

•Oran T N (2006). Evde İnfüzyon Tedavisi, Evde Bakım, İzmir, Meta Basım Matbaacılık Hizmetleri, s: 95-110.

•Özsarı H (2011). “Evde Sağlık Hizmetlerinde Maliyet Etkililik”, 1.Uluslararası Evde Sağlık Kongresi 8-9 Nisan, Maritim Pine Beach Hotel, Belek-Antalya.

•Rice R (2006 ). The Patient Receiving Home Infusion Therapies, Home Care Nursing Practice: Concepts and Application, Fourth Edition, Mosby Elsevier, USA, pp: 381-402.

•Royal college of nursing, Standards for infusion therapy, The RCN IV Therapy Forum, Third edition, January 2010.

STANDARDS FOR İNFUSİON THERAPY

1. Education and training

1.1 Staff education

1.2 Patient and caregiver education

2. Infection control and safety compliance

2.1 Infection control

2.2 Hand-washing 1

2.3 Personal protective equipment (PPE)

2.4 Reconstitution

2.5 Compatibility

2.6 Expiry dates

2.7 Safe use and disposal of sharps and

hazardous material

2.8 Cleaning and sterilising reusable

equipment

3. Products and documentation

3.1 Product requirements

3.2 Product defect reporting

3.3 Labelling 15

3.4 Patient safety incidents

3.5 Research, audit and benchmarking

3.6 Documentation

4. Infusion equipment

4.1 Add-on devices

4.2 Splints

4.3 Filters

4.4 Flow control devices

4.5 Blood/fluid warmers

4.6 Injection and access caps/ports

4.7 Tourniquets

4.8 Administration sets

5. Site selection and placement

5.1 Site selection

5.2 Device selection

5.3 Hair removal

5.4 Local anaesthesia

5.5 Insertion site preparation

5.6 Device placement

5.7 Device stabilisation

5.8 Dressings

6. Site care and maintenance

6.1 Site care

6.2 Maintaining patency

6.3 Catheter clearance

6.4 Vascular access device

removal

6.5 Catheter malposition

6.6 Catheter exchange

6.7 Catheter repair

7. Specific devices

7.1 Intrapleural catheters

7.2 Arteriovenous fistulae, shunts

and haemodialysis catheters

7.3 Cutdown surgical sites

7.4 Intraosseous access

7.5 Subcutaneous

injection/infusion

(hypodermoclysis)

7.6 The Ommaya reservoir (an

intraventricular access device)

Kaynak: Royal college of nursing, Standards for

infusion therapy, The RCN IV Therapy Forum, Third

edition, January 2010.

8. Infusion therapies

8.1 Medication and solution

administration

8.2 Intrathecal chemotherapy

administration

8.3 Oncology and chemotherapy

8.4 Patient-controlled analgesia

8.5 Parenteral nutrition

8.6 Transfusion therapy

8.7 Intravenous conscious

sedation

8.8 Epidural analgesia infusion

8.9 Intravenous immunoglobulin

therapy

8.10 Apheresis procedures

(donor/therapeutic)

8.11 Blood sampling

9. Infusion-related complications

9.1 Phlebitis

9.2 Infiltration

9.3 Extravasation

9.4 Haematoma

9.5 Haemorrhage

9.6 Pneumothorax and

haemothorax

9.7 Cardiac tamponade

9.8 Air embolism

9.9 Speedshock/fluid overload

9.10 Infusion-related

bloodstream infections

9.11 Thrombosis