- Reference Number: HEY-756/2019
- Departments: Nutrition Support
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This leaflet has been produced to give you general information about your treatment. It will help you understand how home intravenous fluids (IVI) works. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team or nutrition specialist nurse, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the Hospital Nutrition Team.
What are Home Intravenous Fluids?
If you are already on Intravenous fluids, you will have some idea of what is involved whilst you have been in hospital. Intravenous fluids are a way of replacing your high fluid losses in the body by giving them directly into the bloodstream. The fluids contain water and electrolytes (sometimes called salts). These are given to stop you becoming dehydrated and to make sure they have the right amount of fluid and salts that the body needs.
Some bags of fluid may contain a mineral called magnesium, which assists to replace your levels when your levels become low due to high fluid losses.
The fluids are usually given through a long term central venous catheter tunnelled under the skin. Patients usually have their fluids over 10 to 12 hours at night but this can vary depending on the volume of fluid to be administered. Feeds and equipment are supplied by a commercial homecare company, but all other aspects of IVI are managed by the Hospital Nutrition Team
Can there be any Complications or risks?
Whilst you are having your IVI fluids at home you will be monitored regularly by the Hospital Nutrition Team in clinic, this is to ensure that you only receive the necessary amount and type of IVI fluid.
If you receive too much IVI fluids, this can cause you to have symptoms such as swollen ankles, passing a lot of urine and feeling breathless. Serious problems are rare if the procedures and advice provided by the Hospital Nutrition Team are followed.
Infection of the central line can occur but this will depend on how well you care for your central line. This problem requires admission to hospital for treatment.
What are the benefits?
Receiving home IVI fluids ensures you do not become dehydrated. The main symptom of dehydration can be feeling thirsty. If you do not have enough fluids you may experience other symptoms such as not passing very much urine, having dark or strong smelling urine, having a dry or sticky mouth, a coated or furry tongue and cracked lips.
You may also feel dizzy, especially when you stand up. The aim of home IVI is to allow people to go home and to live as normal a life as possible. Many people on home IVI go out to work, look after a family, go on holiday and take part in sport and social activities like anyone else.
Are there any alternatives?
Home IVI is not usually considered if there is another way of keeping a person well. Medication advice and maximisation of medication is attempted as the first line of treatment alongside dietary and fluid intake advice. A member of the Hospital Nutrition Team will look at this with you. If you wish to discuss possible alternatives in your case, please ask a member of the Hospital Nutrition Team.
How are Home Intravenous fluids given at home?
The Hospital Nutrition Team normally uses tunnelled central venous catheters for home intravenous fluids. A tunnelled central venous catheter is a tube which is inserted into a large vein in the neck or shoulder. It is usually placed in theatre or the X-ray department using a local anaesthetic. The catheter is tunnelled under your skin for 2 – 4 inches and has a section outside the body with a small plastic clamp and a hub where feeds can be connected. Tunnelled catheters can have one external section (single lumen tubing) or two (double lumen tubing) depending if you are receiving any additional treatment.
When can I go home?
To organise home IVI can take between 7 – 10 days to arrange with a homecare company for requesting a final fluid prescription and ordering the equipment required for your use. The Hospital Nutrition Team applies for funding which can cause a delay in obtaining agreement from your local commissioning group. The nutrition specialist nurse will discuss this further with you. During this time, the nutrition specialist nurse will commence training either you or someone close to you to look after your tunnelled line. You should be able to go home when this has all been done and anything else you need has been arranged.
What support will there be for me at home?
The Hospital Nutrition Team will provide the following just before you go home:
- Details of your homecare company.
- Details of your fluid regime.
- How to contact the Hospital Nutrition Team.
- Follow up arrangements.
A nurse from the homecare company will visit you in hospital prior to discharge. The Hospital Nutrition Team will also arrange a home access visit if required, this can take place with your carer and the homecare nurse, before you are discharged home.
The homecare company will give you a 24 hour helpline telephone number for use if you have problems with any of the equipment or deliveries. Members of the Hospital Nutrition Team will also be contactable through the hospital switchboard. Your doctor will have details of your treatment but should not be the first person to call about any problems with your IVI.
What information will people have about me?
A brief letter explaining the situation is sent to the Clinical Commissioning Group to gain their agreement to pay for your IVI. The homecare company that the Hospital Nutrition Team choose for you will usually receive a similar amount of information about your case but they will also need to know your name, address, telephone numbers and your doctor’s contact details.
The Hospital Nutrition Team registers all patients on IVI with the British Artificial Nutrition Survey but the information they require does not allow individuals to be identified.
Members of the Hospital Nutrition Team also hold their own records to enable them to look after you
What if I have problems?
Most problems can be resolved over the telephone – either by the homecare company or a member of the Hospital Nutrition Team. However, before you go home your nutrition specialist nurse will go through potential problems that may arise and will discuss arrangements with you and to prevent, where possible, going through your local Emergency Department.
What happens if / when I do not need home intravenous fluids any longer?
The Hospital Nutrition Team usually leaves the tunnelled line in for a few weeks after someone stops IVI, just in case there is a need to restart it. The hospital will arrange removal of the tunnelled line and equipment when it is certain that you no longer need IVI.
Where can I find out more about home IVI?
A copy of the ‘IVI Handbook for Patients,’ will be given to you within the next few days. This will provide you with more information. Members of the Hospital Nutrition Team will try to answer any other questions you have if they can. There is a patients’ organisation called ‘PINNT’ (Patients on Intravenous and Nasogastric Nutrition Therapy) which publishes a newsletter and other useful information. They can be contacted on:
PINNT, PO Box 3126, Christchurch, Dorset, BH23 2XS