A discussion regarding IV access for therapyA discussion regarding IV access for therapy – Big Fat Reference Guide, AlphaNet
Augmentation therapy requires the placement of an intravenous catheter or needle at the time of each infusion. Weekly infusion times are relatively brief and range from 15 to 40 minutes, depending on the product and the individual’s tolerance of the infusion, as infusions should be slowed if side effects become a problem. A small IV catheter or needle usually is used for infusions. There are a variety of devices available which provide for ease of placement and patient comfort. However, the ease of placement is directly dependent on the level of skill and experience of the person placing the IV, as well as the condition of the individual’s veins. For some Alphas, having an IV placed may be an uncomfortable and traumatic experience — especially if they have had previous difficulty with IV therapy. For those people for whom the discomfort of IV placement is problematic, a local topical anesthetic such as lidocaine/prilocaine cream, can be applied to the intended IV site prior to catheter placement.
The overwhelming majority of patients choose to have a simple peripheral IV catheter or needle placed at the time of each infusion. Peripheral IVs are placed in the hand or forearm, are well-tolerated, remain in place for a brief period of time, and complications are minimal. Experience with all of the augmentation therapies has shown that augmentation therapy is very easy on peripheral veins, and many Alphas have therapy infused into the same vein each week over the course of many years without problems. Still other patients, for various reasons, choose a more central and longer use IV access device. These devices include the Implanted Vascular Access Device (IVAD), also called a port, and various types of tunneled and peripheral central catheters. (See Comparison Table Of Intravenous Devices.)
The decision to choose one method of IV access over another should be a well-researched and informed decision. Many Alphas have shared that they chose to have an implanted device or central catheter placed to avoid multiple and traumatic IV attempts from unskilled nurses, and poor peripheral venous access. Others have these devices placed in order to allow for self-infusion or infusion by a spouse or significant other. Still others share that they were instructed to have the device placed prior to beginning therapy without an assessment of their overall venous access status, or without being fully informed of the risks and benefits. Having such a device in place may make obtaining IV access easier, but they may pose some additional risk to you.
What to consider when choosing an Implanted Vascular Access Device (IVAD) or Central Catheter
What is the general condition of your peripheral veins? Are they visible on the back of the hands and forearms?
Are they accessible?
What is your infusion schedule?
Have you had previous difficulties with peripheral IV insertions?
Have you had a good experience with certain nurses and bad experiences with others?
Have you been informed of the risks and benefits of the particular device and do the benefits outweigh the risks?
Do you understand the procedures for insertion?
Have you talked with others who have had an implanted device?
Do you plan on doing your own infusions, or having a spouse or significant other do them for you?
Whose need is being met? The doctor, nurse, or yours?
Do you understand the special care and maintenance required of the device?
The placement and use of an IV catheter for therapy, whether a short-term peripheral catheter or an implanted or indwelling central device, pose some specific risks. These include but are not limited to infection, bleeding, blood clots, thrombosis of the veins, phlebitis, and embolism.
[Comparison Table of Intravenous Devices]
Port and Central Catheter Infections
Although we have outlined the potential complications of ports and central catheters, it is an infection that can pose an important challenge for healthcare providers and individuals receiving augmentation therapy. The signs and symptoms of an infection can mimic the signs and symptoms of a reaction to augmentation therapy.
Infection can be external, located at the site where the port or central catheter is implanted, under the skin in the “pouch,” or along the tunneled area of the catheter. One usually sees redness, swelling, pain and tenderness at the site, a low-grade fever may be present, and drainage may be seen. These are classic signs and symptoms of a local infection.
However, an infection also can occur within the reservoir of a port, or along the walls of the central catheter in the vein. Bacteria can be inadvertently introduced into the device through lapses in sterile technique, inadequate skin preparation, or contaminated equipment. Also, the device may attract bacteria from other infectious processes in the body and flourish in the port or central catheter.
When the device is accessed and flushed, a shower of bacteria can be sent into the bloodstream and can cause: Body aches
Shaking, chills, and/or fever over 101° F
Nausea and vomiting
Increased difficulty breathing
These symptoms may represent a systemic infection, or an infection in the bloodstream called bacteremia that can be life threatening.
Many individuals mistakenly presume these symptoms are related to their augmentation therapy infusion and report a reaction to their medication. Both situations have similar symptoms, and one can mimic the other. Though some patients do have side effects from their therapy, a patient with an indwelling port or a central catheter must first consider an infection, and this should be ruled out before assuming that a medication reaction has occurred.
What to do if you have symptoms related to an infusion and have a port or central catheter
If you have an implanted device and you experience problems during or shortly after your infusion, report this immediately to your nurse and physician. Note what the symptoms were, when they began, how long they lasted and what made them better, if anything. If you experience shaking or chills, check your temperature. Call your healthcare provider promptly if you have a fever over 101°. If symptoms are severe, seek immediate medical attention.
One helpful technique for differentiating an infection from medication side effects is to infuse saline through the device instead of augmentation therapy. If the same symptoms occur, this strongly suggests an infection.
The diagnosis of an infection is based on results from blood cultures often drawn from a vein in your arm, as well as from the device. If there is an infection these cultures will grow the offending bacteria, although the results may not be available for up to 48 hours. If you are due for an infusion while undergoing a work-up for infection, you still may receive your infusion. It is recommended; however, you DO NOT USE the device. The infusion should be administered through an IV catheter placed in your hand or arm. Your healthcare provider will need to approve this plan. Receiving the infusion peripherally and observing for the absence or presence of symptoms will help to determine if the medication is the source of the problems, or if the symptoms are related to the port or central catheter.
If an infection has been confirmed, depending on the severity or the bacteria involved, IV antibiotics may be required to treat the infection. In most instances, the device will need to be removed.
If all blood cultures are negative, further monitoring is required, and investigation into a reaction to the medication should be pursued.
The best intervention is prevention
The best intervention for a port or other central catheter infection is prevention. Preventing infection should be the priority of all individuals who have a port or other central device, as well as a top priority for those care providers who access these devices. Excellent hand washing and maintaining strict sterile technique while performing all access and flushing procedures is the standard of care. These devices provide a direct connection from the outside environment into the large blood vessels of the body. Great respect and care need to be exercised whenever handling these devices. Any procedure for accessing, administering medication, flushing, or de-accessing requires sterile technique. Specific skin care and site preparation needs to be completed prior to accessing the device. Procedures vary from institution to institution, and individual agency/institutional policy should be followed.
Limiting the number of individuals who handle the port or central line also is important in maintaining these devices. The old maxim “too many cooks spoil the soup,” holds true here. Make sure those individuals who do handle it use impeccable technique and follow the established protocol. Avoid allowing anyone who is ill, coughing, or sneezing, to handle the device, or insist a mask be worn. It is recommended anyone caring for these devices should wear a mask. A mask is provided in most central device access kits for just this purpose.
The decision to choose a port or central catheter should be made with the input of your physician, and should include a realistic evaluation of the condition of your veins, as well as a discussion of the potential risks and benefits of such a device versus that of peripheral IV therapy. Additionally, be sure that you clearly understand the procedures involved in the insertion of each of these devices.
Remember that the success of your IV therapy also is dependent upon the level of skill of the person preparing and administering your augmentation therapy. You have choices when it comes to those who provide your care. If you have not had a good experience with a particular individual, you have every right to request a different care provider.