Challenges with Home IV Antibiotic Therapy
**Patient Profile** - **Gender:** Male - **Age:** 37 - **Possible Diagnoses:** Ocular and neurosyphilis, secondary syphilis presenting with rash, Kaposi's Sarcoma, bilateral tree-in-bud nodularity of unclear origin, oral HSV-1, recurring thrush, painful swallowing, post-dural puncture headache, hypertension, HIV/AIDS, and ADHD. **Current Medications:** - Biktarvy - Bactrim - Norvasc - Vyvanse - Protonix - Roxicodone - Lidex **OPAT Treatment:** Continuous infusion of penicillin G potassium at 24 million units via IV at a rate of 1 million units per hour. After being hospitalized for seven days and receiving OPAT, I was discharged yesterday. I meticulously followed the protocol for the Alaris infusion pump and PICC line as described by both my nurse and the accompanying instructions. I paused and clamped the pump, disconnected the line, cleaned the connector, re-clamped the PICC line, and then pushed saline through before attaching the elastomeric pump to deliver my antibiotics. After opening the IV clamp, I believed I was set, designedly following all advised steps, even reviewing a tutorial video to ensure accuracy. Upon returning home, I went to sleep, but when I checked this morning, the elastomeric bag was still full—indicating that for the past 12 hours, my medication had not been administered. I carefully disconnected it, retrieved a new bag from refrigeration, and repeated the procedure, although I noted that the PICC line felt cold during this process. Now, I am left with a significant concern: how can I confirm that the new bag is functioning as intended after the first one failed? I observed the liquid movement upon connecting the new bag, but considering it has a volume of 240ml administered at a rate of 10ml/hr, this uncertainty lingers. I have reached out to both the pharmacy and the on-call team from my doctor's office for assistance but have not yet received a response.
Answers (1)
7/4/2025, 8:31:04 PM
OpenHealth AI
It sounds like you're experiencing a challenging situation with your home IV antibiotic therapy, especially with the concerns about the malfunctioning elastomeric pump. It’s great that you’re being proactive by following the procedures carefully. Here’s a structured approach to address your concerns.
Key Points:
- Potential Issues with Infusion: The elastomeric bag not delivering medication could be due to a kink in the tubing, an issue with the bag itself, or the state of the PICC line.
- Next Steps: Prioritize confirming that the new bag is functioning correctly and ensuring the PICC line is patent (open and unobstructed).
Explanation:
Your observation of the elastomeric bag remaining full indicates that the medication wasn’t delivered as expected. Given your post-care setup, it’s important to ensure the infusion is functioning properly to maintain your treatment plan. A cold PICC line could suggest that the line is not patent, which could interfere with drug delivery.
Actionable Steps:
-
Check for Kinks or Obstructions:
- Carefully inspect the entire length of the tubing from the elastomeric bag to the PICC line for any kinks or blockages. Ensure that the tubing is straight and not pinched.
-
Clamp Removal:
- Double-check that the clamps are completely removed to allow gravity and pressure to help the fluid move if that is part of the setup.
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Monitor Flow:
- After connecting the new elastomeric bag, ensure that you see a drip of medication in the drip chamber (if applicable) or any movement in the tubing. You should observe the fluid level in the bag drop consistently.
-
Flush the PICC Line:
- If you have already flushed the line with saline, monitor how the line responds. If you notice resistance or if the cold feeling persists, there may be a blockage.
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Immediate Communication:
- Continue to reach out to your healthcare provider or pharmacy for urgent assistance. If you do not receive timely help, consider contacting the on-call nurse service or go to an urgent care facility where they can check the PICC line and ensure everything is functioning correctly.
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Observe Symptoms:
- Keep an eye on your symptoms. Look out for signs of infection at the PICC insertion site (redness, swelling, heat) or systemic symptoms like fevers, chills, or unusual pain.
Reassurance:
You're doing everything right by following the care instructions and reaching out for help. It's understandable to feel anxious about the situation, but addressing these steps should help ensure effective delivery of your medication. Don’t hesitate to seek immediate help if anything feels off. Your health is the priority. Let me know if you need further assistance or clarification!
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