One of the growing areas of healthcare is home infusion therapy (HIT). It is estimated that HIT will have an annual growth rate of 7.5% through 2028. This modality helps reduce costs and increases patient convenience; however, a gap exists between HIT and clinician knowledge, which can lead to suboptimal outcomes. To help address this concern, the Infectious Diseases Society of America in conjunction with the HIV Medicine Association published a primer on home infusion administration methods.
The primer explains the differences between the various types of vascular access devices (VADs), which include peripheral venous catheters (PVCs), midlines, and central venous catheters (CVCs), such as peripherally inserted central catheters (PICCs) and ports.
Among the elements that factor into a decision regarding the type of VAD that a patient should receive at home include duration of therapy, osmolarity and medication pH, and the ability of a patient to shower. A PVC can be left in for 1 to 5 days, a midline for up to 4 weeks, and a CVC for months to years depending on patency. Drugs that are likely to result in extravasation (i.e., vesicant drugs) should be administered via a CVC, and medications that are only irritants may be given via a midline. The risk of contamination exists during showering for VADs, especially for those that utilize tubing. Disposable arm sleeves or PICC line shower covers are available for those receiving their medication through a PICC.
Another important aspect of HIT is compliance with USP <797>, which involves sterile compounding. Compounded sterile products must be made in an International Organization for Standardization (ISO) 5 environment or better to help ensure the acceptable particle number per cubic measure of air. ISO standards range from an ISO 1, which is the highest, to an IOS 9, which is the lowest in terms of cleanliness. USP <797> also mandates beyond-use dates (BUDs), which are dependent upon the number of manipulations a sterile product undergoes. The risk of contamination is ranked as low, medium, or high, with low-risk compounds receiving a BUD of 14 days if refrigerated, a medium-risk drug having a BUD of 9 days, and a high-risk drug for 3 days.
The primer describes the pros and cons of various administration methods utilized in the home environment. These include IV push (IVP), the use of elastomeric devices or “infusion balls,” gravity infusion pumps, ambulatory pumps, and stationary pumps. Selection of an infusion device depends upon four factors, which include medication stability, dosing frequency and duration, cost, and patient preferences.
The primer provides a summary of preferred methods of administration as well as alternative methods of administration for commonly used antibiotics. IVP is the recommended route of administration for ceftriaxone and cefazolin. Antibiotics that should be administered via an elastomeric pumps include vancomycin, ertapenem, daptomycin, cefepime, meropenem, and piperacillin/tazobactam. Ambulatory pumps are the preferred route of administration for penicillin and ampicillin.
This primer is a valuable resource for both the novice pharmacist who is becoming involved with HIT as well as for those actively engaged in this area of practice area.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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Published February 7, 2023