Who Uses Iv Fluids At Home?

[thejohnsongang]

One thing I did want to ask everyone is about IV fluids. I see that some people are on IV fluids at home and I am very curious. When I do end up in the ER or hospital I know that IV fluids make me feel wonderful and whole again for a day or two. No pots symptoms at all. I push fluids like crazy as well as salt load, but not the same. How did you end up on IV fluids at home? How hard is it to deal with? Do you have a central line or port? Who monitors your treatment at home? Who prescribed it? How much does it help? Will insurance pay for it? And anything else you can tell me about it. I am thinking of talking to my doctor about it and see if we can try it for a little while (maybe at the office or lab) and see if it helps. If it does then I will talk with her about doing it home. Any input anyone has to offer would be appreciated.

Nolie

[AJVDK]

Hello,

I been on IV fluids and ABX. for over the last eight months. I can say IV fluids do help, But I would like to say, from my own experince is that only do them when nothing else works. I been sick for over 10 years, I have NCS, POTS, and Lyme. I tried so many treatment, and am having to use fliuds to help with my blood prussure, after my last heart abltion, and pacer place I begain to have a hard time keeping my blood prussure up, so going to Mayo, Cleveland, and seeing many doctors in the area, trying everything from loading salt, to meds, to compression stockings........ After trying all these things then I was left with trying fliuds. I also have a alot of problems with nause..... so I have a hard time keeping fliuds to begain with.

That being said if you need them,I would first try the ER, or in a doctor office, or infustion center. I would try to adviod a PICC, central line, port if you can. If you can stay with a PeripherallyIV line and have no problems getting an vein. I would go for that. Also one thing to think about is IV fluids cost alot, and you need alot of follow up care. For me I have a nurse come on to my house three time a week (when I first started it was just once a week, I begain to have problems with my PICC, for the ABX, plus I can not handle tapes..... so I had to go to a clothe dressing.

Also I am not trying to scare you but I want you to have the hole picture. PICC, cost alot, Mine have been $3,500- 4,000 each. You then have the follow up care to think about, supplies ( like pump, pole, tubing, ect.). You need to make sure your insuracne company will cover it. Mine did as I tired verything else, and been to so many doctors. Plus my cardio was the DR. to order my first PICC, after that is been up to my lyme doctor, and my PCP for the orders. But all the doctor know whats going on with the care.

They next thing is saftey. There is a high risk of infection. You need to think about your quality of life, and weight out the risk of infection, sepsis, Bleeding.

I am not trying to scare you, I just want you to see the whole picture. Do you have an ANS doctor to talk it over with? I hope others can give there imput. I turly beleive fliuds work, but i think if you can get away with just using them on a as needed bases at an ER, or infusion center, I think it would be better, but that just my option after going though it.

Here's a little info on lines:

(http://en.wikipedia.org/wiki/Intravenous)

Peripheral IV lines

This is the most common intravenous access method in both hospitals and paramedic services. A peripheral IV line consists of a short catheter (a few centimeters long) inserted through the skin into a peripheral vein, any vein that is not in the chest or abdomen. Arm and hand veins are typically used although leg and foot veins are occasionally used. On infants the scalp veins are sometimes used. Part of the catheter remains outside the skin, with a hub that can be connected to a syringe or an intravenous infusion line, or capped with a bung between treatments. The caliber of cannulae is commonly indicated in gauge, with 14 being a very large cannula (used in resuscitation settings) and 24-26 the smallest. The most common sizes are 16-gauge (midsize line used for blood donation and transfusion), 18- and 20-gauge (all-purpose line for infusions and blood draws), and 22-gauge (all-purpose pediatric line). 12 and 14-gauge peripheral lines actually deliver equivalent volumes of fluid faster than central lines, accounting for their popularity in emergency medicine; these lines are frequently called "widebores" or "trauma lines."

Blood can be drawn from a peripheral IV if necessary, but only if it is in a relatively large vein and only if the IV is newly inserted. Blood draws are typically taken with specialized IV access sets known as phlebotomy kits, and once the draw is complete, the needle is removed and the site is not used again. If a patient needs frequent venous access, the veins may scar and narrow, making any future access extremely difficult or impossible; this situation is known as a "blown vein," and the person attempting to obtain the access must find a new access site proximal to the "blown" area.

Originally, a peripheral IV was simply a needle that was taped in place and connected to tubing rather than to a syringe; this system is still used for blood donation sets, as the IV access will only be needed for a few minutes and the donor may not move while the needle is in place. Today, hospitals use a safer system in which the catheter is a flexible plastic tube that originally contains a needle to allow it to pierce the skin; the needle is then removed and discarded, while the soft catheter stays in the vein. The external portion of the catheter, which is usually taped in place or secured with a self-adhesive dressing, consists of an inch or so of flexible tubing and a locking hub. For centrally placed IV lines sets and flushes contain a small amount of the anticoagulant heparin to keep the line from clotting off, and frequently are called "heparin locks" or "hep-locks." Heparin is no longer recommended as a locking solution for peripheral IVs however. Saline is the solution of choice for a "vac lock."

A peripheral IV cannot be left in the vein indefinitely, because of the risk of insertion-site infection leading to phlebitis, cellulitis and bacteremia. Hospital policies usually dictate that every peripheral IV be replaced (at a different location) every three to four days to avoid this complication.

[edit] Central IV lines

Central IV lines flow through a catheter with its tip within a large vein, usually the superior vena cava or inferior vena cava, or within the right atrium of the heart. This has several advantages over a peripheral IV:

It can deliver fluids and medications that would be overly irritating to peripheral veins because of their concentration or chemical composition. These include some chemotherapy drugs and total parenteral nutrition.

Medications reach the heart immediately, and are quickly distributed to the rest of the body.

There is room for multiple parallel compartments (lumens) within the catheter, so that multiple medications can be delivered at once even if they would not be chemically compatible within a single tube.

Caregivers can measure central venous pressure and other physiological variables through the line.

Central IV lines carry risks of bleeding, bacteremia, and gas embolism (see Risks below).

There are several types of central IVs, depending on the route that the catheter takes from the outside of the body to the vein.

[edit] Peripherally inserted central catheter

PICC lines are used when intravenous access is required over a prolonged period of time, as in the case of long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition.

The PICC line is inserted into a peripheral vein under ultrasound guidance, usually in the arm, and then carefully advanced upward until the catheter is in the superior vena cava or the right atrium. This is usually done by feel and estimation; an X-ray then verifies that the tip is in the right place.

A PICC may have two parallel compartments, each with its own external connector (double-lumen), or a single tube and connector (single-lumen). From the outside, a single-lumen PICC resembles a peripheral IV, except that the tubing is slightly wider.

The insertion site must be covered by a larger sterile dressing than would be required for a peripheral IV, due to the higher risk of infection if bacteria travel up the catheter. However, a PICC poses less of a systemic infection risk than other central IVs, because bacteria would have to travel up the entire length of the narrow catheter before spreading through the bloodstream.

The chief advantage of a PICC over other types of central lines is that it is easy to insert, poses a relatively low risk of bleeding, is externally unobtrusive, and can be left in place for months to years for patients who require extended treatment. The chief disadvantage is that it must travel through a relatively small peripheral vein and is therefore limited in diameter, and also somewhat vulnerable to occlusion or damage from movement or squeezing of the arm.

[edit] Central venous lines

There are several types of catheters that take a more direct route into central veins. These are collectively called central venous lines.

In the simplest type of central venous access, a catheter is inserted into a subclavian, internal jugular, or (less commonly) a femoral vein and advanced toward the heart until it reaches the superior vena cava or right atrium. Because all of these veins are larger than peripheral veins, central lines can deliver a higher volume of fluid and can have multiple lumens.

Another type of central line, called a Hickman line or Broviac catheter, is inserted into the target vein and then "tunneled" under the skin to emerge a short distance away. This reduces the risk of infection, since bacteria from the skin surface are not able to travel directly into the vein; these catheters are also made of materials that resist infection and clotting.

[edit] Implantable ports

A port (often referred to by brand names such as Port-a-Cath or MediPort) is a central venous line that does not have an external connector; instead, it has a small reservoir implanted under the skin. Medication is administered intermittently by placing a small needle through the skin into the reservoir. Ports cause less inconvenience and have a lower risk of infection than PICCs, and are therefore commonly used for patients on long-term intermittent treatment.

Edited June 19, 2007 by AJVDK

[taylortotmom]

I was on iv fluids at home for 18 months via a port-a-cath. I loved the freedom of having my fluids as I needed as often as I wanted. BUT, I acquired sepsis and my line became infected and I almost died- seriously. I have done surprisingly well without the iv's (the line was removed in October) by using other pharmacological therapies and a gallon of gatorade a day. And I am really loving not being tied down to a line for 8-16 hours a day! I loved the iv's when I had them and I was terrified when they removed my line that my quality of life would spiral downwards. Initially, it did but now I am actually doing better than I was BEFORE I went on the iv's. Granted, this could change at any time but right now I am enjoying the luxury of being to swim, shower, and travel without a suitcase dedictate to iv paraphanelia- lol. But seriously, as Amy stated- it can be a wonderful option but it can also be a dangerous option so discuss it thoroughly with your doctor. Good luck.

Carmen

[Kitsakatsa]

Like the two previous respondents have said, it is a big decision. You have to decide which line you will have and then have to have the finances and the clinical things worked out to support it. I started with a picc line and moved to a port a cath. I am one who has deep and small veins. After being on 3% sodium for two years, the fluid had "burned" my veins out and the IV would blow out after a few minutes of the fluid. In one day at the IV center I had 14 sticks, and blew 4 IVs. The picc line disappeared because the adhesives gave me deep flesh burns. So, that's when I adopted the port a cath. I'm one who has to have regular access to 3% because I have to work and 3% keeps me upright. After this drama, the fluid part has come rather easily.

I get these delivered through home health. It is expensive, but not as expensive as an ER visit or the IV center visits. I inject Zofran in them and get high. It is simply much better to be home and in your own recliner for fluid. There are some very regimented steps that you have to take so that you don't infect or hurt yourself, but they are easy and your home health RX comes with patient education and usually someone that you can call.

For me, at least, it has been beneficial. It is a decision that you have to go into realizing that its not the cure, but a pathway that has benefits and risks.

Kits

[goldicedance]

Please be very careful when making your decision. I had had a medaport put in for chemotherapy. I used it for IV fluids during chemotherapy and afterwards. I, who live in Maryland, was told by a doctor in Ohio to get it out immediately if not sooner. This doctor basically said it was not a question of if but when. The situation is extremely dangerous given the strains of bacteria that are resistant to antibiotics. My veins stink. It takes nurses many attempts to get an IV in. My veins are smart--they collapse when the see an IV coming.

Now when I need an IV for hydration I have an arrangement at an infusion center to come in and get a liter. It takes about 2 hours.

Infusion centers are extremely careful about maintaining sterile sights. I would think that the risk doing it yourself at home is more elevated.

Don't make your decision hastily.

[Lukkychrm42]

Hi there. I've never done saline regularly. My understanding is that continual IV saline is pretty controversial as a treatment not because of those doctors who think that you should be able to get the same benefit from drinking water and eating salt, but because the risk of infection with the invasive PICC, port, or central line. I do know of some POTS patients for whom daily saline therapy is indispensible. While I know that I, too, retain IV saline better than drinking, I haven't felt desperate enough yet to seriously consider this option, which I'm sure is a good thing. On the other hand, if you discuss it with a doctor to have IV saline available to you on an as-needed basis, so that you can go to the ER, doctor's office, or patientfirst-type place every week or every few days for a few hours, this might be an option to, IF you have the time (though, hey, if you can work via the internet and have wireless access with a laptop, or just a computer available there to you, it might be great!).

Let us know what you decide and how it works for you!

[cardiactec]

As already stated, this is a HUGE risk take......

I have seen TOO MANY TIMES working in the hospital setting patients that have almost died or HAVE DIED from lengthy IV port a cath, PICC, and central line use. It isnt worth it in my book no matter how sick you are with your pots. Unless it is life or death situation, I would do everything possible to avoid long term usage of IV line. It is not very safe and i'm sure if someone pulled some statistical data on long term IV use and sepsis, the results would be overwhelming frightening.

hope you can find some alternative treatments that better your symptoms...

cardiactec.

[thejohnsongang]

Thanks everybody. After reading all the post and doing some research I have decided that I am just going to talk to my PCP about getting some iv fluids while in her office on an as needed basis and see if it helps as much as it does in the ER. I am trying to keep my symptoms down as much as possible. Even though I always have a water bottle and salt shaker with me, I still have symptoms. But if for any reason i get IV fluids then i feel great for a couple of days with no symptoms at all. Worth a try that way and less risk. My PCP is great about trying things to see if they help. She has several other POTS patients and understands. Her physician's attending is a great guy and I love to see him more than her. He has pots and really understands. He just doesn't have symptoms like most of us do.

Thanks for helping me make this decision.

Nolie