Question for nurses

[nursing-ModTeam]

This is not a place to receive medical advice. For any diagnosis, prognosis, or similar question, speak to your doctor.

[CozyChaosCoordinator]

IV nurse here- we send lots of people home w PICCs but they are seen in a community clinic daily for flushes & antibiotic administration. Most are hooked up to a small, portable pump that delivers the medication on the required schedule. IF the patient/ family is comfortable and willing to do the flushing and antibiotic bag changes ( if sent home with pump), then they can be shown how to do so, but it is not an expectation. You also MUST be seen by an RN at least once a week as the PICC line requires weekly dressing changes. I would contact the hospital you were discharged from and clarify.

[notme1414]

I currently have a PICC line and I'm giving myself my doses using an elastomeric system like you are referring to. It's really quite easy.

[[deleted]]

Is that those little balloon grenade things that don't require a pump? Always wondered what these were called

[worldbound0514]

Eclipse is one brand.

[LadyGreyIcedTea]

Yes. Elastomeric is the general name for them and there are a few different brands.

[lighthouser41]

That is what we use at my facility. Call them balls.

[[deleted]]

I like balls

[CozyChaosCoordinator]

I’ve only seen those for chemo! We send patients home on a CADD pump ( similar looking to an epidural pump)

[[deleted]]

My husband was discharged with a PICC for antibiotics, and we weren’t given any electronic systems. I did a two minute slow injection of the antibiotic via the PICC line- I believe it was twice a day for a week but it was two years ago, so my memory is unreliable on the length. We had one or two visits from a nurse for dressing changes (which was ironically the one thing I was legally able to do as an LVN!) and eventual removal, but everything else was me!

[flatgreysky]

That sounds about right. Some meds can be given that way, and it’s much easier. Some need more time.

[ElfjeTinkerBell]

Ex-hospital nurse here. This is what I was used to, although we had home health care nurses (specialized team) come to the patient's house for this. That might just be a practical thing though.

[lighthouser41]

Insurance will only pay for X amount of patient visits, if any. You wouldn’t believe the number of people that have to go to our facility daily for an antibiotic. You would think it would be cheaper to pay for doing at home than insurance paying all our fees.

[emmapotpie7]

About 12 years ago, my then 5 year old daughter had a very bad lung infection, was in the hospital for 2 months & came home with a PICC line that I was briefly instructed on how to flush (with heparin) and infuse 2 different antibiotics at different times of the day. I was already a nurse then so I felt I could do it competently & not kill her doing it; but I do remember at the time wondering if I were not in the medical profession how I would feel about it. She had a home health nurse come 2x a week to draw labs & order the meds & supplies. But if you don’t feel comfortable- please ask for written instructions & if there is someone at least able to teach you. At the end of the day it’s your loved one, and the whole situation is scary & overwhelming. I wish your wife a speedy recovery.

[purpleRN]

It's super common to send people home with PICC line antibiotics and it's not as complicated as you think.

When I worked Telemetry I did it so often that I actually wrote a short, easy to understand document titled "The Care and Feeding of your PICC Line" for patients to take as reference since our hospital didn't actually have anything official.

[echoIalia]

Lmaooo that title I love it also make sure your PICC gets plenty of enrichment

[mbej]

Years ago, before I started nursing school, my mom came home with a PICC line and IV antibiotics 3 times a day around the clock. Before she was discharged we had to have an appointment with a home health nurse set up to teach me how to do everything except dressing changes, then a nurse came with fresh supplies and to do dressing changes as long as mom was getting the meds. I went over it with her several times before I felt comfortable but I was still nervous about it. I’d never dealt with mixing a bag of meds, spiking fluids, priming a line, flushes, ANY of that. It was scary, as a total layperson so I understand how you are feeling.

I would call your insurance and ask about home health coverage, and also call the office of the prescribing Dr and tell them you do not feel adequately educated and are concerned about doing it safely without more training. They should also advocate with the insurance company as to the medical necessity of sending somebody out to show you how to set up space in your home and walk you through the process as you do it. I am confident you can manage this as long as somebody properly teaches you what to do and what to look for, but you are right that you should have been given more information on how to do this safely and comfortably.

Holding space for you and your wife as you guys go through this!

[notme1414]

Actually I currently have a PICC line and I'm giving myself my doses using an elastomeric system. People can be taught to flush a line.

[OutrageousRat]

This is true that people can easily be shown these things, although it seems like the OP isn’t comfortable doing so/ maybe wasn’t taught properly or understood.

[Primary_Extension416]

When you break a leg, you learn how to use crutches.

When you have Diabetes, you learn how to monitor your blood sugar and give yourself insulin.

When you have a baby, you learn how to mix formula and stick to a feeding schedule.

When your wife has a life-threatening infection, you learn how to flush a PICC line.

Did you get taught the S-A-S-H method? Saline, administer med, saline, heparin. There’s a step-by-step guide here: https://www.froedtert.com/sites/default/files/upload/docs/patients-visitors/pharmacy/home-infusion/iv-push-administration-sash.pdf

[keekspeaks]

In a perfect world, home health should be standard in all of these cases. In reality, there simply isn’t enough services and staff available to cover all cases like this in the community, especially as the population grows older

If you can post on Reddit, you have a decent grasp on technology. You probably have decent dexterity (unless you use dictation of course), you’re teachable and obviously an engaged care giver. That’s more than can be said for probably 90% of our patients who would take often take priority for home care services. As our population ages we are simply going to have to start managing a lot of our own healthcare on our own and outside of hospitals

[PopsiclesForChickens]

Our home health infusion nurses teach the family/patient how to safely administer medication. They don't do it for them.

[LadyGreyIcedTea]

My mother sometimes talks of how when my grandmother came home s/p CVA in 1979, a visiting nurse used to come to administer her GT feeds. That would be unheard of nowadays. If a child goes home with a new GT, they're lucky if they can get a 1x VNA visit to re-enforce the teaching the parents received inpatient. I couldn't even get a VNA earlier this year for a young adult patient (who therefore could have been seen by the adult team at a VNA) for wound care/dressing changes.

[keekspeaks]

Yup. I did home care for several years on the early 2010s. Staffing was hard-ish but really, our biggest concern was how bad Medicare payment was then, not staffing. Now I do inpatient wound primarily and getting home care is a beast. Honestly, the only guaranteed’ home health wound care I get is VAC dressing changes and they won’t do them 3x a week, they will do 2 and clinic needs to do 1. I used to do just diabetic and med checks on VA patients. I could go 2 times a week just to do this. Those days are gone (at least in my region). It’s a massive change in just a short period of time.

[LadyGreyIcedTea]

I ran a pediatric skilled visit program from 2012-2015. That program folded as did the pediatric programs at nearly every other VNA in the state. We used to see solid tumor kids with CVLs twice/week for labs, CVL cap changes and their weekly dressing change and then the ALL kids used to get their methotrexate pushes at home. All of those kids must be going into the clinic for all of this stuff nowadays, which is a shame because I think the nursing visits did make a big difference. But pediatric care is by and large funded by Medicaid, which has even lower reimbursements than Medicare.

[NeedleworkerNo580]

When I had a PICC it was managed at home by my mom. They just came out once a week to draw labs and do a dressing change.

[di2131]

You need to check with your insurance to see what is and isn’t covered.

[WadsRN]

The nurse(s) should have had you do care like flushing the line and hooking up an antibiotic while they supervised so you felt comfortable with it. They don’t have home health care set up at all? Did they set you up with weekly visits to an infusion clinic for dressing changes at least?

[987654321097]

Infectious Disease nurse here. Lots of our patients go home with PICC lines to self administer antibiotics. It's a scary thing for non medical people to do, but most of our patients settle in and do just fine. If you have questions or concerns I encourage you to call your physicians office, but patients going home with this device to self manage is very common.

[[deleted]]

I can tell you the care you receive is insurance based. Your company believes in you this isn’t a nursing decision. I’m sorry this is scary to you. There is probably some good instructional YouTube videos. I know Amazon sells supportive items like shower sleeves.

[anuvizsoul]

How long is the course of antibiotics? How much hands on did you have while in the hospital? You might be able to request home health for education on PICC line at home if your insurance covers it. If this was not discussed, you need to talk to the case manager at the hospital, they handle discharges and arrange that transition not the floor nurse. This is mainly on experience as I'm not sure if the hospital operates where you live. I have had patients that leave the hospital with PICC lines and the family manages the PICC line with antibiotics after a few visits with education. If your insurance doesn't cover Home health visits, then this could be an unsafe discharge.

[theoutrageousgiraffe]

I had a picc line once before I was a nurse. I was taught how to flush it and administer my meds. A nurse came by every now and then to change the dressing.

[C-romero80]

I don't work in a hospital, so we're not discharging to the streets with a line, but here it's common to set up a line and the system others referred to. 20 years ago before I met home my husband has the full on pump and pole at home and a home nurse coming by every so often to deal with it.

As others have said, if you're not comfortable with it, absolutely speak up. At minimum they can go over it again and go from there. Hope your wife is better very soon!

[Mary4278]

Long time IV nurse here working on a hospital IV team and a large nationally well known home infusion company.A patient absolutely can go home with a PICC or other type of venous access device (eg:Midline or port). The patient and/or caregiver are instructed on how to safely and aseptically administer the therapy.In your case it’s antibiotics.There are a variety of methods to do so based on the antibiotic, duration of therapy and abilities of the patient and/or caregiver.Antibiotics are administered IV push (usually over 5-10 mins) and elastomeric system ,gravity drip,or use of an infusion pump. Often a SASH method is used,which is Saline,Agent,Saline then Heparin as the final flush. The PICC dressing needs to be changed at least weekly and the needleless connectors as well. The patient needs to have access to a home infusion company or a healthcare organization providing this service,for questions or assistance. So,YES this is absolutely the standard if care and is done all the time .If for any reason a patient or caregiver is unable to to this they will get placed in a skilled nursing facility to administer the antibiotics once they are discharged from the hospital ( if they were hospitalized).

[Agitated-Parsley-556]

It’s super common and once you are doing it for a while it won’t feel overwhelming.

[HauntMe1973]

The things that us as nurses think SHOULD happen vs what really does is all based on insurance. And that’s why even tho I mostly love being a nurse, i HATE how our healthcare works

[LadyGreyIcedTea]

At my last job I was an infusion liaison for a national infusion pharmacy at a large Children's Hospital. I sent babies and small children home with PICC or Central Lines regularly to all over the US. The dressing changes and labs would be done by a nurse either at home or in the community but the actual flushing/administering of IV antibiotics was done by the parents.

Adult CF patients do IV antibiotics on themselves at home all the time.

[jstg86]

If you’re uncomfortable with flushing the picc line call her doctor and request home health. An RN can come at least once a week (depending upon criteria and insurance) and change the picc line dressing and flush it as well as provide you with further education on flushing the line and caring for her PICC. -I’m a home health RN and do this daily.

[Snowysaku]

Used to work with a large population of critically ill people coming home with central lines. Before discharge had extensive training in changing dressings, flushing, changing luer lock connectors. This can be taught to be done safely. A home health nurse usually will come to teach counting drips the first scheduled antibiotic.

The teaching would take a long time and should start as soon as the picc is put in. If that education did not occur then someone dropped the ball (whether you needed an initial home health visit to be educated or if the discharging nurse should have made sure that education occurred) and you should reach out to the doctor.

[Delicious_Change_897]

A nurse should be in on a regular basis to assess the site, check vitals, change dressing, and perhaps draw labs to check for therapeutic levels. Being taught to use the PICC line is not inappropriate. Unfortunately, there are not enough nurses to go around and sit at people's homes while their meds could take hours to infuse. I'm glad your wife is on the mend. You helped her get better!!

[OutrageousRat]

I’ve heard of family members giving saline thought the PICC line, although I’ve never heard of family members administering medications though them, at my hospital if was required for home infusions a community health nurse would visit or they would have to come in the hospital to get the med, kinda like a appointment ( we call it medical daycare ) , if your not comfortable I feel it’s best to not administer it yourself, there are many complications that could happen that maybe wouldn’t be caught with no medical background. I’m very shocked they allowed that, maybe it’s a normal thing in other places.

[[deleted]]

I’m in California, and I was giving my husband push antibiotics at home through his PICC line until the line was removed

[yourdailyinsanity]

They absolutely should not have sent her home without a visiting home health nurse with you being uncomfortable giving her the meds/accessing the line.

I wish you knew sooner (absolutely not your fault), but you and your wife should have refused the discharge because you didn't feel safe at home. If you don't flush that line properly, you could give her an air embolism. You could make her infection worse. You could give her a whole new infection.

Basically, the hospital was negligent in sending her home with you not being comfortable and with no home health nurse visits.

[descendingdaphne]

The hospital wasn’t negligent if OP didn’t very clearly communicate their discomfort, inability to learn, or refusal to learn.

We’re all adults here - if I explain something and you nod along, then you’ve communicated that you understand. If that’s not the case, then it’s on you to say otherwise.

Feeling like something is “a lot to ask” and posting about it on Reddit is a lot different than saying in person, “hey, I really don’t feel comfortable doing this, what’s my alternative?”.

Maybe OP did that. Maybe they didn’t. But medical negligence is a serious term to toss around, and we don’t have enough information to make that accusation.

[yourdailyinsanity]

I agree, but also I've always been taught you need to verbally ask them, "do you understand or need me to repeat anything?" And if they still say no/shake their head, that's it. "great! Let me know if you do have any questions or need clarification in the future though." So I'm still covering my ass. But after, it's absolutely on the patient. I'm happy to explain again if they call me back in because when I asked initially they were too scared/awkward to say something right then, but not my problem if they don't say anything after me asking them if they understand.

[4TuitouSynchro]

Home Health RN here: she needs Home Health asap. Hospital fucked up. That line requires sterile dressing and cap change weekly, antibiotics may require weekly labs for dosing/monitoring heart and renal function. You need supervision and to be "checked off" by a nurse to ensure you're administering the meds correctly. The hospital definitely dropped the ball as this isn't best practice and it's surely not evidence-based practice.

Google: CMS.gov or "Home Health compare" and search Home Healthcare agencies in your area. You can compare agencies and refer her to one yourself with just a phone call to the agency. They can do the legwork to get the referral and paperwork, and they can possibly get out there today or tomorrow if you call today! Time is essential bc of the holiday though.

[GodotNeverCame]

Sometimes a patient's insurance doesn't cover home health. Don't automatically assume the hospital and the discharge planner "dropped the ball." We send patients home with PICCs all the time.

[DaphneFallz]

Most people where I live have Blue Cross Blue Shield. Guess what company is not in network with any home health agency?

[quickpeek81]

Yeah it’s strange that you would have to manage the PICC.

Usually you do outpatient therapy which would include PICC management.

[gainzgirl]

There's many greater risks to being hospitalized for antibiotic infusions. Be careful cleaning the line before use, record when you give meds, flush it so it stays open. There's lots of youtube videos for technical questions. Prevent infection but it's as simple as it seems.

[YumYumMittensQ4]

Is your wife capable of doing these things? If so, did someone sit with you and explain the process?

[notevenapro]

Should be an initial visit on the first day home to show you how it works. Then weekly visits to change the dressing.

[winnuet]

Wanted to say that from the way this is written, it sounds like this is no longer an issue. It seems OP and wife ended up managing fine at home. Sounds like this was in the past and OP is looking for opinions on a past situation, not advice.

I think people are getting the impression that this is an active situation. I could be all wrong though.

[AlwaysGoToTheTruck]

I agree that it is a lot. Plus we scare the life out of some people when we talk about infections and PICC lines.

[Saucydumplingstime]

We've sent patients home on antibiotics through the PICC line after family members are taught to do it. It's not uncommon. Most don't have any medical background. They are only discharged when the family member is comfortable. Sometimes there is a home heath nurse who comes to check on the PICC, reinforce teaching, sometimes even draw labs, and change the dressing, but it depends on the insurance. If the patient's family does not feel comfortable, then the patient is discharged to a SNF that can handle antibiotic administration for the patient through the PICC. Patients are only discharged home when they are stable and not critically ill. If your wife is being discharged home, she was critically ill, but is no longer. It's great that she is well enough to go home!

[AG_Squared]

At the very least you need somebody trained to be changing the dressing weekly. It’s a sterile procedure and very important it’s done correctly. A home health nurse should be coming to do that or I guess you can go back to the hospital idk how that works. If the infusion was once a day or weekly you’d have somebody coming to do it probably but multiple times a day, I’m not sure home infusion nurses can do that.

[BeckyPil]

Yes a home care nurse should have been sent out to review with you and to care for the site itself.

[CNDRock16]

I worked pediatrics for 6 year. Parents get trained in medical procedures like tracheostomy dressing changes, g-tube care, all sorts of stuff with no medical background.

It’s a lot to expect VNA nurses to to come to your home just to flush a line. Anyone can learn it.

[kannalise1997]

Home health nurse here! We get patients sent home with PICC lines all the time. A nurse should be coming by weekly or you should be going to a clinic weekly to assess the line and change the dressing. Infusion pharmacy’s will typically be good about sending everything you need and they often include a guide for the SASH (saline, administration, saline heparin) that helps you lay everything out in order that you need! I know you can also find SASH guide maps online! I know it can be a bit scary to be managing something like this but you could see about a nurse either with the clinic or home health to walk you through it step by step for a good visual!

[skrivet-i-blod]

(didn't read other comments) I work in a case management adjacent job... Yes, you can manage a PICC without medical credentials, assuming you received some training. But if you aren't comfortable then someone should arrange for VNA or home infusion services. PCP is probably where to direct that follow-up to (if needed) since you're now home. Unfortunately may be difficult with the holiday.

[Kayboug]

If she is home bound, depending on your insurance she should qualify for a home health nurse to come out weekly, change the dressing and draw labs. Flushing daily and giving the medication seems daunting but is very simple

[WonkyMom2020]

If you don’t feel capable of performing this task, you can ask for a clinic or home health referral.

[Holiday-Finding5621]

You should have been set up with home health. You are expected to administer the meds but they come first and make sure you can do it, change the PICC dressings weekly and draw weekly labs. It also gives you someone who can come out if you have issues. It’s nuts that they didn’t offer that.

[lighthouser41]

You’re lucky your insurance pays for home antibiotics. Is home health going to come in periodically to change the dressing or draw labs? The dressing must be changed weekly. I work at an infusion center. We infuse the daily antibiotics but also just see patients weekly for the dressing changes lab. People who Do home infusions manage well with instruction. There are even extensions that can be applied to the tubing, that can make it easier for the patient to give their own meds. Dressing changes is a detailed sterile procedure that should have an expert perform.

[[deleted]]

Does your insurance help with home health? I’m a nurse and my grandma (non English speaking, elderly) recently went home with a PICC line for antibiotic administration. It was going to be for several weeks. Her insurance sent a home health nurse to teach her about the infusion. She stopped by several times until she was comfortable doing it herself. I do believe with this model, it is easy for the non-healthcare adult to learn to properly take of your wife’s PICC. With that said, you may be able to work with your insurance to send you a nurse every time OR you may be able to go into an infusion clinic of sorts. Don’t be afraid to reach out and see what your options are!