Soins complexes à domicile pour enfants
https://complexcareathomeforchildren.com

Intravenous antibiotic therapy

What is it? How does it work?

          

          
The pump works with non-rechargeable batteries or a rechargeable battery (depending on model) and is light enough to be worn all day by most children (usually in a small backpack).
It is programmed to automatically deliver the antibiotic into your child’s catheter at the times prescribed by the doctor.
Outside these periods, a very small amount of medication is administered by the pump to prevent the vein from blocking. Your child stays connected to the pump.
A CADD brand pump is commonly used in children, especially the Legacy®PLUS, Prizm ®VIP or ®Solis VIP models. The CADD-Legacy® PLUS pump was chosen to illustrate the steps of the care shown here.

Your child’s healthcare team will supervise the IV treatment and ensure that the equipment is functioning properly. Ask your healthcare team about specific recommendations for your child, including the procedure for changing the protective dressing which protects the insertion site of the catheter.

Refer to your healthcare team if the equipment used for your child is different from what is described in the care methods.



FAQ – Intravenous antibiotics

When to consult your healthcare team

Intravenous catheter

Equipment for administering the medication

Dressing

Health

Your child:

Your child’s healthcare team will use your child’s regular appointments to verify the proper functioning of the catheter and antibiotic delivery equipment and will make adjustments to the care as required.

Do not hesitate to contact your healthcare team with any specific questions concerning your child.

PLEASE NOTE: The information in this section is meant as a general guide to help parents and caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team. 

Discuss your child’s unique needs with your healthcare team, including WHO and WHEN to contact when problems arise.

 

Redness, heat, swelling, tenderness or pain at the catheter entry site

Possible cause(s)

  • Infection or inflammation at the catheter entry site
  • Phlebitis (irritated vein)

What do to?

  • If your child uses an elastomeric infusion pump:
    • stop the infusion by closing the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump to stop the infusion or shut the pump off as you have been shown by your healthcare team,
    • close the clamps of the catheter tubing and the tubing of the pump.
  • Contact your health care team quickly.

Extended redness or itching of the skin under dressing

Possible cause(s)

  • Contact dermatitis (ie, skin irritation due to the dressing)
  • Sensitivity to the adhesive of the dressing
  • Sensitivity to disinfectant solution
  • Reaction of the skin to the disinfection technique

What to do?

  • Contact your health care team who may suggest:
    • a change in dressing materials,
    • use of a topical corticosteroid,
    • a change in disinfection technique.

Cord-like sensation of the vein where the catheter is inserted (may be hard, red or tender to touch)

Possible cause(s)

Phlebitis (irritated vein)

What to do?

  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • Contact your health care team quickly.

One or more of these symptoms: burning or pain at the entrance site of the catheter, cold skin around the entrance site of the catheter, swelling of the arm (PICC line), swelling around the catheter catheter site, leakage at catheter entry site, change in skin color (whiteness or redness) around the catheter entry site

Possible cause(s)

  • Infiltration (medication is leaking out of the vein and into the skin)
  • Phlebitis of the vein (irritated vein)

What to do?

  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • Immediately contact your care team.
  • If your child’s arm with the catheter is swollen, elevate it as much as possible.

Child with an implantable chamber catheter (eg, Port-a-Cath®): pain or swelling at the site of insertion of the reservoir during the administration of the solution or irrigation

Possible cause(s)

  • Disconnection from the implantable chamber of the catheter
  • Displacement of the catheter
  • Displacement of the noncoring needle

What to do?

  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • If during irrgation:
    • close the clamp of the catheter tubing,
    • stop attempting to flush the line.
  • Immediately contact your care team.

Blood leaking at catheter insertion site

Possible cause(s)

  • Breakage or disconnection of the catheter or tubing
  • Recent catheter insertion
  • Child’s underlying health condition

What to do?

  • If there is continuous bleeding, put a compress over the dressing and apply firm pressure.
  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • Immediately contact your care team.

Protective dressing is wet or damp due to leakage of blood, pus or other discharge

Possible cause(s)

  • Breakage or disconnection of the catheter or tubing
  • Blockage of the catheter
  • Displacement of the catheter
  • Displacement of the needle if the child has an implantable chamber device
  • Infection
  • Contact dermatitis
  • Child’s underlying health condition

What to do?

  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP / START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • Immediately contact your care team.
  • If the dressing is falling off, put another dressing over it while waiting for the advice of your care team.
  • If the dressing is partially detached, do not remove it as you might remove the catheter by mistake.

Dressing is falling off, loose, punctured or torn

Possible cause(s)

  • Various causes

What to do?

  • If the dressing is falling off, tape the sides down.
  • If it is punctured or torn, install another clear adhesive dressing over the old one.
  • If the dressing is partially detached, do not remove it as you can remove the catheter by mistake.
  • Immediately contact your health care team.

Presence of blood in catheter tubing

Possible cause(s)

Return of blood (reflux)

What to do?

Medication administration time longer than usual

Possible cause(s)

  • Medication too cold
  • If using an elastomeric infusion pump and it is placed lower than the catheter insertion site
  • Malfunction of ambulatory infusion pump
  • Displacement of the catheter
  • Partial obstruction of the catheter

What to do?

  • A cold solution can also cause headaches or chills.
  • Irrigate the catheter with the saline solution. Refer to steps 5 and 8 to 12 of the “Catheter irrigation” care method.
  • If your child uses an elastomeric infusion pump:
    • make sure the medication is at room temperature. A solution that is too cold increases the time it takes for the drug to flow.
    • place the elastomeric infusion pump at the same height as the catheter insertion site.
  •  If the problem persists, contact your healthcare team promptly.

Leakage of the elastomeric infusion pump or bursting of the balloon

Possible cause(s)

  • Breakage of the portable infusion device
  • Technical defect of the device

What to do?

Presence of air bubbles or particles in the bag, cassette reservoir or elastomeric infusion pump

Possible cause(s)

  • Contamination of the solution
  • Problems in the preparation

What to do?

  • Do not administer the medication.
  • Contact your pharmacy or healthcare team quickly.

Ambulatory infusion pump alarms

Possible cause(s)

Various

What to do?

  • Close the clamp of the catheter tubing and the clamp of the pump tubing.
  • Press the “STOP/START” button to stop the alarm or as indicated.
  • Look at the message displayed on the screen.
  • Follow the instructions accordingly.
  • If necessary, consult the pump instructions you have been given.
  • If you still can not resolve the problem, contact your healthcare team.

Resistance or inability to irrigate (flush) the catheter

Possible cause(s)

  • Blockage or displacement of the catheter
  • Blockage of the tubing
  • Clamps are closed
  • Displacement of the needle in children with an implantable chamber device (PORT)

What to do?

  • Do not push the plunger of the syringe with saline solution or locking solution forcefully.
  • Make sure tubing clamps are fully open.
  • Check that the tubing is not pinched or bent.
  • Ask your child to:
    • move the arm on the side of the catheter,
    • turn on each side,
    • cough,
    • turn thir head towards the opposite side of the catheter or to bear down (as if they were going to have a bowel movement).
  • If your child has an implantable chamber catheter (eg, Port-a-Cath®): check if the needle has moved out of the correct position.
  • If the problem persists:
    • close the clamp of the catheter tubing,
    • stop attempting to flush the line,
    • contact your healthcare team immediately.

Inadvertent disconnection of the needleless connector or the pump tubing

Possible cause(s)

  • Accident
  • Mishandling

What to do?

  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • Immediately contact your care team.

Broken (leaking) catheter or malfunctioning equipment

Possible cause(s)

  • Mishandling
  • Catheter or other defective equipment
  • Blocked catheter

What to do?

  • You may notice leakage of blood or fluid at the point where the catheter or other piece of equipment is broken.
  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • If you can see where the equipment is broken or where the leakage is coming from: close the clamp between the catheter and the point of leakage. If there is no clamp, use the hemostat clamp, as your healthcare team has taught you, or bend the catheter in half and keep it folded in place with tape.
  • If you do not see where the leakage is coming from or where the equipment is broken: put a gauze compress on the dressing to absorb the leakage.
  • Immediately contact your care team.

External displacement of the catheter (part of the catheter outside the vein shorter or longer than usual or catheter completely removed from the vein) with or without: pain in the ear, neck or shoulder on the side of the catheter, swelling in the neck, unusual sound heard by your child on the catheter side during flushing of the catheter or administration of the medication

Possible cause(s)

  • Accidental displacement of the catheter
  • Mishandling of the catheter
  • Improperly adjusted dressing
  • Child has moved excessively and displaced the catheter

What to do?

  • Never push the catheter back into the vein.
  • If your child uses an elastomeric infusion pump:
    • close the catheter tubing clamp and the pump tubing clamp.
  • If your child uses an ambulatory infusion pump:
    • press the “STOP/START” button on the pump or close the pump as indicated,
    • close the clamp of the catheter tubing and the tubing of the pump.
  • If the catheter has been completely pulled out, put a clear dressing over the previous entrance site.
  • Immediately contact your healthcare team.

Unusual sound heard by your child on the catheter side during irrigation with or without: pain in the ear, throat pain

Possible cause(s)

Displacement of the internal (inside the body) portion of the catheter

What to do?

  • Close the clamp of the catheter tubing.
  • Stop attempting to flush the line.
  • Immediately contact your care team.

Particular odor or a strange taste reported by your child during irrigation

Possible cause(s)

Contact between the saline solution and the plastic of the syringe may activate your child’s sense of taste and smell

What to do?

  • This is commonly reported. There is no danger to your child’s health.
  • If the taste is very intense, contact your healthcare team.

One or more of these symptoms: swelling of the hand, arm or side where the catheter is located, underarm pain in the arm where the catheter is located, swelling of the neck and face

Possible cause(s)

  • Phlebitis of the vein (irritated vein)
  • Blood clot in the vein with the catheter

What to do?

Immediately contact your care team.

Fever with or without other symptoms: ≥ 38⁰C rectal or ≥ 37.5⁰C buccal or ≥ 37.5⁰C armpit

Possible cause(s)

  • Ongoing infection for which your child is being treated
  • Infection of the skin at the catheter entry site
  • Blood Infection
  • Other infection

What to do?

  • Note any other symptoms that your child may have including: pain, irritability, loss of appetite, drowsiness, etc.
  • Contact your health care team quickly.

 

For specific advice on your child or any other questions, do not hesitate to contact your child’s healthcare team.



Everyday tips

Clothing

  • As the tubing can easily wrap around your child’s neck or arm, keep the tubing underneath the child’s clothing.
  • If your child is wearing one-piece pajamas or a “onesie”, place the tubing inside the garment and pull it out through the bottom or the opening at the feet; this will prevent the tubing from wrapping around your baby’s neck.
  • If your child is older, keep the tubing underneath clothing; in young children, run the tubing underneath a snug-fitting undershirt so that the child is less likely to touch the tubing.

Bathing and swimming

  • Avoid getting the dressing wet because it may fall off. Bathing in shallow water is preferable to a shower.
  • To protect the dressing from splashing, cover it with waterproof plastic wrap (eg, saran-wrap ™) attached with tape so that the dressing stays dry.
  • Never put the catheter or dressing in the bath water, even if it has been covered in plastic.
  • Swimming is not permitted if your child has a short peripheral catheter, a central peripherally inserted catheter (“PICC Line”), a central tunnel catheter (eg, Broviac®) or an implantable chamber catheter with the needle in place; otherwise, the dressing may become wet and peel off. If the catheter is not protected, it may come out or become infected.
  • Your child can bathe and swim if he/she has an implantable chamber catheter (Port-a-Cath®) and the needle is not in place.

Sleeping

If your child uses an ambulatory infusion pump, place the pump beside your child in bed. Discuss the most appropriate place with your care team.

Nutrition and hydration

Talk to your healthcare team about your child’s diet and hydration recommendations, based on their health status.

Activities

  • Your child can continue his regular daily activities (eg, writing, brushing teeth, etc) but must avoid:
    • activities causing significant sweating; the dressing could fall off,
    • activities which may cause accidental displacement of the tubing and the catheter (eg, gymnastics, contact/competition sports),
    • the use of scissors near the catheter and tubing,
    • close contact with pets who may chew the tubing or the infusion pump,
    • lifting  heavy objects with the arm where catheter is placed,
    • bathing/swimming (unless your child has an implantable chamber catheter (eg, Port-a-Cath®) and the noncoring needle is not in place).
  • If your child’s healthcare team agrees, your child can return to school. Notify your school’s staff of your child’s treatment and care as needed.

Travel and transportation

  • Avoid exposing the pump and tubing to hot or cold temperatures. In cold weather, keep the pump and tubing under clothing and have your child wear a warm coat.
  • Use a cooler to store medication and a padded bag to store equipment, including the “troubleshooting kit” described below.
  • When traveling by plane, keep all medication and equipment with you in the cabin. Request a letter from your child’s healthcare team which explains your child’s healthcare condition and need for medications.
  • Healthcare travel insurance is recommended; check your existing policies or purchase insurance so your child is covered in the case that a medical issue comes up while traveling. Always have a “troubleshooting kit” on hand while your child is on IV treatment; take this on any trips away from home. The kit should contain the following items:
    • needleless connector
    • extension tubing
    • syringe pre-filled with saline solution and locking solution
    • disinfecting pads
    • transparent adhesive dressings
    • clean gauze compresses
    • adhesive tape to secure the dressing
    • hemostatic clamp

Others

If your child has a peripherally inserted central catheter (PICC line), the blood pressure should be not be measured in the arm with the catheter; this might damage the catheter or the vein.



Methods of care


Methods of care : Monitoring of the catheter site

Indications

Frequency

Required materials

If needed:

Refer to your healthcare team if the material used or the sequence of steps taught is different from what is described in the care method.


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Position your child

Position your child:

  • to easily reach the catheter entry site,
  • in one of the positions discussed with your healthcare team,
  • consider your child’s age and ability to collaborate.
Why ?

This step allows you to more easily view the catheter entry site and keeps your child comfortable.

Step 5: Check the catheter site

  • The catheter entry site should not change in appearance.
  • Do not give the antibiotic or press the “STOP / START” button on the pump (or close the pump as indicated) if:
    • you observe that the site is red, hot, swollen or sensitive to touch,
      345.Insertion site red and swollen
    • there is redness, sensitivity under the dressing or a cord-like feeling along the length of the vein where the catheter is inserted,
    • you notice that the skin is cold around the catheter, that the arm is swollen or if your child reports burning or pain at the entrance site of the catheter.
  • Close the clamps of the catheter tubing and the tubing of the pump.
  • Contact your health care team quickly.
Why ?

This step allows you to quickly detect problems.

Step 6: Check the dressing

  • The dressing should be kept clean and dry at all times.
  • If the dressing is wet or blood stained, do not remove the old dressing. The catheter site should always be protected.
  • If the dressing is falling off, tape the sides down.
  • If the dressing is punctured or torn, install another clear adhesive dressing over the old one.
  • Immediately contact your care team.
    317.Stained dressing
Why ?

This step helps you quickly identify complications.

Step 7: Check all tubing

  • Tubing should not be pinched or bent.
  • Make sure the extension tubing is securely fastened. If necessary, use adhesive tape to keep the tubing in place.
Why ?

This step helps to avoid complications.

Step 8: Check the outer length of the catheter, if applicable

  • The outer part of the catheter must remain the same length at all times; it should not move, neither inwards or outwards.
  • If you notice a change in length of the external portion of the catheter, DO NOT push the catheter back into the vein; contact your healthcare team immediately.
Why ?

This step will confirm the catheter has remained in the proper position. Allows quick action if the catheter has moved out of the proper position.

Step 9: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : Ross .Version : 1.0

Methods of care : Catheter irrigation

Indications

Frequency

Required materials

Refer to your healthcare team if the material used or the sequence of steps taught is different from what is described in the care method.


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the materials

  • Select and clean a workspace surface (eg, tabletop).
  • Gather the necessary equipment.
  • Check that the saline syringe is at room temperature.
Why ?

This step ensures safety and allows the subsequent procedure.

Step 5: Remove the air bubbles from the saline syringe

  • Hold the syringe vertically with the protective cap facing up.
  • Push the plunger of the syringe to release it.
  • Strike the syringe vigorously with your thumb and forefinger to raise the air bubbles.
  • Partially unscrew the protective cap.
  • Gently push the plunger until there is no more air in the syringe and a drop of liquid appears at the junction of the protective cap and the end of the syringe.
  • Screw the protective cap back onto the syringe tip.
  • Place the syringe on your table.

If necessary, refer to the technique taught by your healthcare team, pharmacy or manufacturer’s recommendations.

Why ?

This step is necessary for the security of the administration of the solution.

Step 6: Position your child

Position your child:

  • to securely reach the catheter entry site,
  • in one of the positions discussed with your healthcare team,
  • depending on comfort, age and ability to collaborate.
Why ?

This step facilitates the work.

Step 7: Monitor the catheter site

Refer to steps 5 through 8 of the Catheter site monitoring procedure.

Why ?

This step allows you to quickly detect problems.

Step 8: Disinfect the needleless catheter connector

  • Use a disinfectant swab to vigorously scrub the top and sides of the needleless connector.
  • Allow the connector to dry completely by holding it in one hand.
  • Do not blow on the connector.
  • Do not touch the connector between the time of disinfection and the syringe connection.
Why ?

This step is necessary to prevent contamination (transmission of bacteria).

Step 9: Remove the protective cap from the saline syringe

  • Take the saline syringe with one hand and remove the protective cap with the other.
  • Take care that nothing touches the tip of the syringe to avoid contaminating it.
Why ?

This step allows the procedure to continue safely.

Step 10: Screw the syringe onto the needleless connector of the catheter

  • Take the needleless connector of the catheter between the thumb and forefinger of one hand.
  • With the other hand, push the syringe into the connector.
  • Fasten the syringe by turning it about a quarter turn clockwise until the connection is solid.
  • Never use a needle to inject into the needleless connector of the catheter.
Why ?

This step allows the rest of the procedure.

Step 11: Irrigate the catheter with the saline solution

  • Open the clamp of the catheter tubing.
  • Press the plunger of the syringe to inject 1 ml at a time: using a brisk start-stop technique with each ml that is pushed (this helps keep the catheter from getting blocked).
  • When the entire solution is injected, close the clamp of the catheter tubing.
Why ?

This step removes deposits that accumulate in the catheter and prevents it from blocking.

Step 12: Disconnect the syringe from the needleless connector of the catheter

  • Hold the needleless connector of the catheter between the thumb and forefinger of one hand.
  • With the other hand, disconnect the syringe by turning it counterclockwise.
  • Dispose of the syringe in the trash.
Why ?

This step allows the rest of the procedure.

Using your two hands prevents the needleless connector from unscrewing instead of the syringe.

Step 13: Irrigate the catheter with the locking solution, if necessary

Why ?

This step prevents the formation of clots at the tip of the catheter when a prolonged delay is expected before its next use.

Step 14: Monitor the catheter site

Refer to steps 5 through 8 of the Catheter site monitoring procedure.

Why ?

This step allows you to verify that the catheter site is intact.

Step 15: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : Ross .Version : 1.0

Methods of care : Administration of intravenous antibiotics by elastomeric infusion pump

Indications

Frequency

The antibiotic doses are given at the frequency prescribed by the doctor.

Required materials

Refer to your healthcare team if the material used or the sequence of steps taught is different from what is described in the care method.


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the elastomeric infusion pump

  • Make sure that the infusion pump containing the medication is at room temperature.
  • Check the label to verify:
    • your child’s name,
    • the medication has not expired,
    • the drug name and dose are the same as those prescribed for your child.
  • Inspect the pump carefully. It must not contain air bubbles or particles. If this is the case, contact your pharmacy or healthcare team.
Why ?

This step ensures the safety of the procedure and helps to prevent medication errors.

Step 5: Prepare the materials

  • Select and clean a work surface (eg, tabletop).
  • Gather the necessary equipment.
  • Check that:
    • the balloon and the tubing of the perfusion pump are not broken or split,
    • the drug does not leak,
    • the cap located at the end of the tubing is present,
    • the filling site cap is in place.
Why ?

This step ensures the safety and allows the rest of the procedure.

Step 6: Position your child

Position your child:

  • to securely reach the catheter entry site,
  • in one of the positions discussed with your healthcare team,
  • depending on comfort, age and ability to collaborate.
Why ?

This step facilitates the work.

Step 7: Monitor the catheter site

Refer to steps 5 through 8 of the care method Monitoring of the catheter site.

Why ?

This step helps to quickly detect problems.

Step 8: Irrigate the catheter with the saline solution

Why ?

This step removes deposits that accumulate in the catheter and prevents it from blocking.

Step 9: Connect the pump tubing to the needleless connector of the catheter

  • Disinfect needleless catheter connector.
  • Take the tubing of the perfuser with one hand and remove its protective cap with the other.
  • Make sure that nothing touches the end of the tubing to avoid contaminating it.
  • Take the needleless connector of the catheter between the thumb and forefinger of one hand.
  • With the other hand, insert the end of the tubing of the infuser.
  • Turn clockwise about 1/4 turn until the connection is tight.
Why ?

This step allows the rest of the procedure and avoids contamination.

Step 10: Administer the drug

  • Open all clamps.
  • The drug enters the catheter very slowly. The duration of infusion varies according to the medical prescription.
  • During the drug administration, the balloon gradually decreases in volume.

Step 11: Secure the elastomeric infusion pump

  • Place the pump near your child’s body in a pocket of clothing, a waist pack or a backpack.
  • If possible, keep the elastomeric infusion pump at the same level as the catheter insertion site.
Why ?

This step helps protect the pump and ensure proper flow of the drug.

Step 12: Check the end of the infusion

Administration of the antibiotic dose is complete when the balloon is empty, flattened and small ridges are visible.

Why ?

This step verifies that the medication has been administered and that the balloon is empty.

Step 13: Disconnect the pump tubing from the needleless connector of the catheter

  • Wash your hands again.
  • Close all clamps.
  • Hold the needleless connector of the catheter between the thumb and forefinger of one hand.
  • With the other hand, disconnect the tubing from the perfuser by turning its end counterclockwise.
  • Put the empty perfusion pump and tubing in the trash.
Why ?

This step completes the medication administration and prepares for final flushing of the catheter.

The use of both your hands prevents the needleless connector from unscrewing instead of the tubing.

Step 14: Irrigate the catheter with the saline solution

Why ?

This step removes deposits that accumulate in the catheter and prevents it from blocking.

Step 15: Irrigate the catheter with the locking solution, if necessary

Instructions how to irrigate the catheter here.

Why ?

This step prevents the formation of clots at the tip of the catheter when a prolonged period is expected before its next use.

Step 16: Monitor the catheter site

Refer to steps 5 through 8 of the Catheter site monitoring procedure.

At the end, make sure that all the clamps are closed.

Why ?

This step allows you to verify that the catheter site is intact.

Step 17: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : Ross .Version : 1.0

Methods of care : Administration of intravenous antibiotics by ambulatory infusion pump

Indications

Frequency

Required materials

Refer to your health care team:

The steps outlined in the care method “Administration of intravenous antibiotic by ambulatory infusion pump” refer to the use of the CADD-Legacy® PLUS pump.

Change of bag or cassette reservoir


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the drug

  • Make sure the new bag or cassette is at room temperature.
  • Check on the label that:
    • your child’s name appears,
    • the date of the drug has not expired,
    • the drug name and dose are the same as those prescribed for your child.
  • Inspect the bag or cassette carefully. It must not contain air bubbles or particles. If this is the case, contact your pharmacy or healthcare team.
Why ?

This step ensures the safety of the procedure and helps prevent medication errors.

Step 5: Prepare the materials

  • Select and clean a work surface (eg, tabletop).
  • Gather the necessary equipment.
  • Check that the pump tubing is not broken or split and that there is no leakage coming from the medication bag or cassette.
Why ?

This step ensures safety and allows the subsequent procedure.

Step 6: Position your child

Position your child:

  • to securely reach the catheter entry site,
  • in one of the positions discussed with your healthcare team,
  • depending on comfort, age and ability to collaborate.
Why ?

This step facilitates the work.

Step 7: Stop the pump

Refers to the CADD-Legacy® PLUS pump

  • Push and hold the “STOP/START” button of the pump until 3 sets of dashes appear on the pump screen (or follow the instructions of your health care team for the special features of your child’s pump).
  • Close the clamps of all tubing.
  • Pump with bag: go to the next step.
  • Pump with cassette-reservoir: go to step 9.
Why ?

This step allows the rest of the procedure.

Step 8: Change the bag, if applicable

  • Disconnect the tubing of the empty bag from the tubing already in place on the pump.
  • Set aside the empty medication bag and old tubing.
  • Do not touch the end of the pump tubing to avoid contamination.
  • Holding the tubing of the pump with one hand, remove the protective cap from the tubing of the new bag.
  • Connect the tubing of the new bag to the tubing already in place on the pump.
  • Return the residual volume to the starting volume:
    • press the “NEXT” button on the pump to display the residual volume screen,
    • then press the “ENTER/CLEAR” button to restore the residual volume to the starting volume
      (or follow the instructions of your health care team for the special features of your child’s pump).
  • Dispose of the empty medication bag in the trash.
  • Go to step 11.
Why ?

This step allows the rest of the procedure.

Step 9: Remove the empty cassette reservoir, if applicable

  • Press the “ON/OFF” button on the pump to turn the pump off (or follow the instructions of your health care team for the special features of your child’s pump).
  • Unlock the cassette lock.
  • Remove the empty cassette reservoir from the pump.
  • Disconnect the empty cassette from the extension tube attached to the catheter already in place.
  • Do not touch the end of the tubing already in place to avoid contaminating it.
  • Dispose of the empty cassette in the trash.
Why ?

This step allows the rest of the procedure.

Step 10: Install the new cassette reservoir, if applicable

  • Remove the protective cap from the tubing of the new cassette-reservoir.
  • Connect the tubing of the new cassette to the extension tube attached to the catheter already in place.
  • Connect the new cassette to the pump.
  • Secure the cassette lock (at the side of the pump).
  • Place the reservoir cassette tubing into the pump air sensor.
  • Press the ON/OFF button on the pump to turn on the pump.
  • Return the residual volume to the starting volume.
Why ?

This step allows the rest of the procedure.

Step 11: Monitor the catheter site

Refer to steps 5 through 8 of the Catheter site monitoring procedure.

Why ?

This step allows you to quickly detect problems.

Step 12: Disconnect the pump tubing from the needleless connector

  • Hold the needleless connector of the catheter with one hand and the tubing of the pump with the other.
  • Disconnect the tubing by turning it counterclockwise.
Why ?

This step makes it possible to prepare for the irrigation of the catheter.

Use two hands to prevent the needleless connector from detaching from the catheter.

Step 13: Irrigate the catheter with the saline solution, if necessary

Why ?

This step removes deposits that accumulate in the catheter and prevents it from blocking.

Step 14: Reconnect the pump tubing to the needleless connector of the catheter

  • Disinfect the needleless connector of the catheter.
  • Take the needleless connector between your thumb and forefinger in one hand.
  • With the other hand, insert the end of the tubing of the pump.
  • Turn clockwise gently about a quarter turn, until the connection is tight.
Why ?

This step allows the rest of the procedure.

Step 15: Restart the pump

  • Open the clamps of all tubing.
  • Press and hold the “STOP/START” button of the pump and hold until the 3 sets of dashes disappear from the pump screen (or follow the instructions of your health care team for the special features of the pump used by your child).
Why ?

This step allows the administration of the antibiotic.

Step 16: Secure the pump and medication

  • Place the antibiotic bag near your child’s body in a waist pack or backpack.
  • Make sure that the pump is well positioned and the tubing is not bent or compressed.
Why ?

This step helps protect the pump and ensure proper flow of the medication from the pump into your child.

Step 17: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.

Change of bag or cassette reservoir AND tubing


Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the drug

  • Make sure the new bag or cassette is at room temperature.
  • Check on the label that:
    • your child’s name appears,
    • the date of the drug has not expired,
    • the drug name and dose are the same as those prescribed for your child.
  • Inspect the bag or cassette carefully. It must not contain air bubbles or particles. If this is the case, contact your pharmacy or healthcare team.
Why ?

This step ensures the safety of the procedure and reduces the risk of medication errors.

Step 5: Prepare the materials

  • Select and clean a work surface (eg, tabletop).
  • Gather the necessary equipment.
  • Check that the new tubing is not damaged.
Why ?

This step ensures the safety and allows the rest of the procedure.

Step 6: Position your child

Position your child:

  • to securely reach the catheter entry site,
  • in one of the positions discussed with your healthcare team,
  • depending on comfort, age and ability to collaborate.
Why ?

This step facilitates the work and optimizes your child’s comfort.

Step 7: Stop the pump

Refers to the CADD-Legacy® PLUS pump

  • Push and hold the “STOP/START” button of the pump until 3 sets of dashes appear on the pump screen (or follow the instructions of your health care team for the special features of your child’s pump).
  • Close the clamps of all tubing.
Why ?

This step allows the rest of the procedure.

Step 8: Remove the cassette or empty cassette reservoir from the pump

  • Press the “ON/OFF” button on the pump to turn the pump off (or follow the instructions of your health care team for the special features of your child’s pump).
  • Unlock the cassette lock.
  • Remove the old cassette or the empty cassette reservoir from the pump.
  • Set aside the old cassette and empty bag or empty cassette reservoir connected to the catheter extension tubing on the work table.
  • Pump with bag: go to the next step.
  • Pump with cassette réservoir: go to step 10.
Why ?

This step allows the rest of the procedure.

Step 9: Install a new bag and cassette tubing, if applicable

  • Insert the new cassette into the pump.
  • Secure the cassette lock.
  • Remove the protective cap from the tubing of the new bag.
  • Remove the protective cap from the cassette tubing.
  • Make sure that nothing touches the openings of the tubing to prevent contamination.
  • Connect the tubing of the cassette to the tubing of the new bag by turning a quarter turn clockwise until the connection is tight.
  • Press the ON/OFF button on the pump to turn on the pump.
  • Return the residual volume to the starting volume:
    • press the “NEXT” button on the pump to display the residual volume screen,
    • then press the ENTER/CLEAR button to restore the residual volume to the starting volume.
  • Go to step 11.
Why ?

This step allows the rest of the procedure.

Step 10: Install the new cassette reservoir and the new extension tubing, if applicable

  • Insert the new cassette reservoir into the pump.
  • Secure the cassette lock.
  • Remove the protective cap from the tubing of the cassette.
  • Remove the protective cap from the new extension tube.
  • Connect the tubing of the cassette reservoir to the new extension tube by turning clockwise about 1/4 turn until the connection is tight.
  • Press the ON/OFF button on the pump to turn the pump on.
  • Return the residual volume to the starting volume:
    • press the “NEXT” button on the pump to display the residual volume screen,
    • then press the ENTER/RESET button to restore the residual volume to the starting volume.
Why ?

This step allows the rest of the procedure.

Step 11: Remove the air from the new tubing

  • Open the tubing clamp of the new cassette reservoir or the clamp of the tubing of the new bag.
  • Keep the protective cap on at the end of the tubing to prevent contamination.
  • Prime the tubing:
    • press and hold down the “PRIME” button,
    • stop pressing down when “Prime” and 3 sets of dashes appear on the pump screen,
    • press again without releasing the button. “Priming…” will appear on the screen.
    • repeat until the solution reaches the end of the tubing.
  • Check that a drop appears at the end of the tubing and is visible through the transparent cap.
  • When the tubing is filled with solution (and no air), close the clamps.
  • Place the tubing in the pump air sensor.
Why ?

This step ensures the safety of the administration of the drug.

Step 12: Disconnect the old tubing from the needleless connector

  • Hold the needleless connector of the catheter with one hand and the tubing of the pump with the other.
  • Disconnect the tubing by turning it counterclockwise.
  • Discard the old tubing with the cassette and the empty bag or the empty cassette reservoir in the trash.
Why ?

This step completes the disconnection of the used tubing and the installation of the new tubing in preparation for flushing of the catheter, if required.

The use of both your hands prevents the needleless connector from unscrewing instead of the tubing.

Step 13: Monitor the catheter site

Refer to steps 5 through 8 of the Catheter site monitoring procedure.

Why ?

This step helps to quickly detect problems.

Step 14: Irrigate the catheter with the saline solution, if necessary

Why ?

This step removes deposits that accumulate in the catheter and prevents it from blocking.

Step 15: Connect the new tubing to the needleless connector of the catheter

  • Disinfect the needleless connector of the catheter.
  • Remove the protective cap from the new tubing.
  • Take the needleless connector between the thumb and forefinger of one hand.
  • With the other hand, insert the end of the new tubing into the needleless connector.
  • Turn clockwise about 1/4 turn until the connection is tight.
Why ?

This step allows the rest of the procedure.

Step 16: Restart the pump

  • Open the clamps of all tubing.
  • Press and hold the STOP/START button of the pump and hold until the 3 sets of dashes disappear from the pump screen.
Why ?

This step allows the medication delivery to be restarted.

Step 17: Secure the pump and medication

  • Place the antibiotic bag near your child’s body in a waist pack or backpack.
  • Make sure that the pump is well positioned and the tubing is not bent or compressed.
Why ?

This step helps protect the pump and ensure proper flow of the medication from the pump into your child.

Step 18: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : Ross .Version : 1.0

https://complexcareathomeforchildren.com/intravenous-antibiotic-therapy/

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