Home Infusion Therapy

Las Vegas, Nevada

HOME INFUSION THERAPY

FOR GI PATIENTS

Biologics, Parenteral Nutrition, and Specialty Medications

A Comprehensive Guide for Home Infusion and GI Nurses

Target Audience: Registered Nurses, Home Infusion Nurses, GI Nurses

Level: Intermediate

Release Date: February 2026 | Expiration Date: February 2029

Nevada State Board of Nursing Approved CE Provider

Author Disclosure

The author and planning committee have no relevant financial relationships to disclose.

Evidence-Based Guidelines Referenced

• Infusion Nurses Society (INS) Standards of Practice, 2024 • ASPEN Guidelines for Parenteral Nutrition • AGA Guidelines for Biologic Therapy in IBD • CDC Guidelines for Prevention of Intravascular Catheter-Related Infections

LEARNING OBJECTIVES

Upon completion, the participant will be able to:

Describe the scope of home infusion therapy for GI patients including biologics, parenteral nutrition, hydration, and antimicrobials

Compare vascular access devices used in home infusion and apply appropriate care and maintenance protocols

Implement safe administration practices for home biologic infusions including infliximab, vedolizumab, and ustekinumab

Develop patient education plans for self-administration of subcutaneous biologics

Apply ASPEN guidelines for home parenteral nutrition management and monitoring

Recognize and respond to complications of home infusion therapy including catheter-related infections and infusion reactions

Integrate telehealth monitoring strategies into home infusion nursing practice

SECTION 1: OVERVIEW OF HOME INFUSION THERAPY

1.1 The Growing Role of Home Infusion

Home infusion therapy has expanded significantly, driven by patient preference, cost considerations, and the development of stable, safe-to-administer medications. For GI patients, home infusion offers the opportunity to receive complex therapies in the comfort of home while maintaining quality of life.

GI-RELATED HOME INFUSION THERAPIES: • Biologic therapy for IBD (infliximab, vedolizumab, ustekinumab) • Home parenteral nutrition (HPN) for short bowel syndrome, intestinal failure • IV hydration for chronic dehydration, gastroparesis • IV iron infusions for iron deficiency anemia • Antimicrobial therapy for GI infections (C. diff, intra-abdominal abscesses) • Octreotide infusions for neuroendocrine tumors, dumping syndrome

1.2 Patient Selection Criteria

Not all patients are candidates for home infusion. Assessment includes:

SECTION 2: VASCULAR ACCESS DEVICES

Reliable vascular access is the foundation of home infusion therapy. Device selection depends on therapy duration, infusion frequency, and patient factors.

2.1 Device Types and Selection

2.2 Catheter Care and Maintenance

INS STANDARDS FOR CENTRAL LINE CARE: • DRESSING CHANGES: Transparent dressings changed every 7 days or gauze every 2 days. Change immediately if damp, soiled, or loose. • FLUSHING: SASH protocol (Saline-Administer-Saline-Heparin). 10 mL normal saline before and after each use. Heparin lock per facility protocol (often 10 units/mL for ports, 100 units/mL for others). • CAP CHANGES: Needleless connectors changed every 72-96 hours per manufacturer. • SCRUB THE HUB: Vigorous friction scrub for 15 seconds with 70% alcohol or CHG-alcohol before each access. • BLOOD RETURN: Verify before each infusion. Absence may indicate thrombosis or malposition.

2.3 Complications of Vascular Access

SECTION 3: HOME BIOLOGIC INFUSIONS FOR IBD

Biologic therapy has revolutionized IBD treatment. Home infusion of IV biologics offers convenience while maintaining safety. Subcutaneous biologics can be self-administered after proper training.

3.1 IV Biologics for Home Infusion

3.2 Infusion Reaction Management

INFUSION REACTIONS: Most common with infliximab (especially if antibodies develop). Can be immediate or delayed. MILD REACTIONS (flushing, headache, nausea): • Slow or pause infusion • Administer diphenhydramine 25-50 mg IV/PO • Acetaminophen 650 mg PO • Resume at slower rate when symptoms resolve MODERATE REACTIONS (chest tightness, dyspnea, hypotension): • STOP infusion • Maintain IV access • Diphenhydramine + hydrocortisone 100 mg IV • Monitor vital signs closely • Contact prescribing provider • May attempt rechallenge at very slow rate with close monitoring SEVERE/ANAPHYLAXIS (stridor, severe hypotension, respiratory distress): • STOP infusion immediately • Call 911 / Emergency Services • Epinephrine 0.3-0.5 mg IM (EpiPen or equivalent) • Position supine with legs elevated • Prepare for CPR if needed • DISCONTINUE biologic permanently

3.3 Home Infusion Requirements for Biologics

Before transitioning to home infusion:

• Complete at least 3 uneventful infusions in supervised setting (clinic or infusion center)

• No history of moderate or severe infusion reactions

• Patient and caregiver educated on reaction recognition and emergency response

• Emergency medications available (EpiPen, diphenhydramine)

• RN present for entire infusion (home infusion companies provide nursing)

• Written emergency plan and contact numbers provided

SECTION 4: SUBCUTANEOUS BIOLOGIC SELF-ADMINISTRATION

Many biologics are available in subcutaneous formulations, allowing patients to self-administer at home after proper training. Nursing plays a critical role in education and competency verification.

4.1 Subcutaneous Biologics for GI Conditions

4.2 Self-Injection Teaching Protocol

STEP-BY-STEP PATIENT EDUCATION: 1. PREPARATION: • Remove medication from refrigerator 30-45 minutes before injection (room temperature reduces pain) • Inspect solution: should be clear to slightly opalescent; do not use if cloudy, discolored, or particles visible • Gather supplies: alcohol wipes, sharps container, bandage • Wash hands thoroughly 2. SITE SELECTION: • Abdomen (2 inches from navel), thigh (front/outer), upper arm (with assistance) • ROTATE sites - never inject same location consecutively • Avoid bruised, tender, scarred, or stretch-marked skin • Clean site with alcohol; allow to dry 3. INJECTION TECHNIQUE: • Pinch skin (for thin patients) or spread taut (for adequate subcutaneous tissue) • Insert needle at 45-90° angle depending on device/needle length • Inject medication slowly and steadily • Hold for 10 seconds after injection complete (autoinjectors often have visual/audible confirmation) • Do not rub injection site 4. AFTER INJECTION: • Apply gentle pressure with bandage if bleeding • Dispose of device in sharps container immediately • Document injection date, site, and any reactions • Store next dose in refrigerator

SECTION 5: HOME PARENTERAL NUTRITION (HPN)

Home parenteral nutrition is life-sustaining therapy for patients with intestinal failure who cannot meet nutritional needs enterally. GI conditions requiring HPN include short bowel syndrome, severe Crohn's disease, radiation enteritis, and motility disorders.

5.1 Indications for HPN

• Short Bowel Syndrome: <200 cm small bowel remaining (or <100 cm without colon); insufficient absorptive surface

• Severe Crohn's Disease: Multiple resections, high-output fistulas, severe malabsorption

• Radiation Enteritis: Post-radiation damage to bowel causing chronic malabsorption

• Severe Motility Disorders: Chronic intestinal pseudo-obstruction, refractory gastroparesis

• Mesenteric Ischemia: Post-infarction with inadequate remaining bowel

5.2 Components of PN Formulation

5.3 HPN Administration

CYCLING: Most HPN is cycled over 10-14 hours (usually overnight) to allow freedom during the day and prevent liver complications. Gradually ramp up at start and taper at end to prevent hypo/hyperglycemia. INFUSION PUMP: Electronic pump with programmable rates; patients trained on troubleshooting alarms (air-in-line, occlusion, low battery). ASEPTIC TECHNIQUE: Critical for preventing CLABSI - the most serious HPN complication. Patients/caregivers must demonstrate competency before discharge. STORAGE: PN bags refrigerated; remove 30-60 min before infusion. Check expiration date. Inspect for precipitates, color changes, cracks in bag.

5.4 HPN Complications

SECTION 6: OTHER HOME INFUSION THERAPIES

6.1 IV Hydration Therapy

Chronic dehydration is common in GI patients with high-output stomas, short bowel syndrome, or severe gastroparesis. Home IV hydration can prevent frequent ED visits and hospitalizations.

TYPICAL PROTOCOL: 1-2 liters normal saline or lactated Ringer's infused over 2-4 hours, 2-5 times per week depending on patient needs and output.

MONITORING: Daily weights, urine output, orthostatic symptoms, electrolytes periodically. Adjust volume/frequency based on response.

6.2 IV Iron Infusions

Iron deficiency is extremely common in GI patients (IBD, GI bleeding, malabsorption). IV iron repletes stores faster than oral and bypasses GI absorption issues.

IV IRON REACTION MANAGEMENT: Most reactions are NOT true anaphylaxis but 'Fishbane reactions' - flushing, chest tightness, back/joint pain due to complement activation. Management: Stop infusion, give diphenhydramine, usually can resume at slower rate. True anaphylaxis rare but requires epinephrine and emergency response.

6.3 Home Antimicrobial Therapy

GI patients may require prolonged IV antibiotics for infections such as:

• Complicated C. difficile (IV metronidazole or vancomycin enemas) • Intra-abdominal abscess (often 2-4 weeks of antibiotics after drainage) • Catheter-related bloodstream infections (typically 10-14 days after line removal) • Fistula-related infections in Crohn's disease

OUTPATIENT PARENTERAL ANTIMICROBIAL THERAPY (OPAT): Allows completion of IV antibiotic course at home with nursing visits or patient self-administration. Requires stable patient, appropriate vascular access, and monitoring plan for efficacy and toxicity.

SECTION 7: TELEHEALTH AND REMOTE MONITORING

Technology enables closer monitoring of home infusion patients, earlier detection of complications, and efficient nurse-patient communication.

7.1 Remote Patient Monitoring

• Daily weight monitoring with Bluetooth-connected scales • Blood glucose monitoring for PN patients • Symptom tracking apps with alert thresholds • Photo documentation of catheter sites, injection sites • Medication adherence tracking

7.2 Virtual Nursing Visits

Video visits can supplement in-person care for: • Self-injection teaching reinforcement and competency verification • Catheter site assessment (with patient camera) • Pump troubleshooting • Symptom assessment and triage • Nutrition counseling and lab review • Psychosocial support

BEST PRACTICES FOR TELEHEALTH NURSING: • Ensure HIPAA-compliant platform • Test technology before scheduled visit • Have patient have good lighting on catheter site/injection area • Document visit thoroughly including visual findings • Establish clear escalation criteria for in-person evaluation • Provide 24/7 on-call support contact

SECTION 8: CASE STUDIES

Case Study 1: Home Infliximab Transition

PATIENT: Sarah M., 34-year-old female with Crohn's disease HISTORY: Stable on infliximab 5 mg/kg every 8 weeks for 2 years. Has completed 12 infusions without reaction. Works full-time and requests home infusion for convenience. ACCESS: Peripheral IV for each infusion

QUESTIONS:

1. Is she a good candidate for home infusion? Why or why not?

2. What education is needed before first home infusion?

3. What supplies/emergency equipment should be present?

ANSWERS: 1. YES, excellent candidate: 12 uneventful infusions (exceeds minimum 3), no history of reactions, stable disease, motivated patient, works full-time (quality of life benefit). 2. Education: Signs/symptoms of infusion reaction and what to do; importance of premedications; when to call the nurse vs. 911; catheter care if PICC placed; documentation of infusion dates. 3. Emergency supplies: Epinephrine (EpiPen) at bedside; diphenhydramine (PO and injectable); blood pressure cuff for vital signs; phone readily accessible; emergency contact numbers posted; RN remains for entire infusion.

Case Study 2: HPN Complication

PATIENT: Michael T., 52-year-old male with short bowel syndrome HISTORY: On HPN x 18 months via tunneled Hickman catheter. Receiving PN 5 nights/week. Calls home infusion company reporting fever 101.8°F, chills, and feeling 'terrible' that started during his PN infusion last night.

QUESTIONS:

1. What is the most likely diagnosis?

2. What immediate actions should the home infusion nurse take?

3. What is the likely outcome for his catheter?

ANSWERS: 1. CLABSI (Central Line-Associated Bloodstream Infection) - classic presentation with fever/chills during or after infusion. Must rule out other sources but CLABSI is high on differential. 2. Immediate actions: Stop current PN infusion; do NOT flush or use the line until evaluated; instruct patient to go to ED or call provider immediately; blood cultures needed (peripheral AND through the line if provider wants to attempt salvage); start empiric antibiotics after cultures. 3. Catheter may need removal - depends on organism identified, clinical response, and whether attempting line salvage with antibiotic lock therapy. S. aureus and fungal infections typically require removal. Some gram-negative and coag-negative staph infections can be treated with line in place if patient responds well to antibiotics.

Case Study 3: Self-Injection Teaching

PATIENT: Emily R., 28-year-old female with ulcerative colitis HISTORY: Completed IV vedolizumab induction. Transitioning to vedolizumab SQ (Entyvio pen) every 2 weeks for maintenance. First self-injection teaching session today.

QUESTIONS:

1. What are the key teaching points for autoinjector use?

2. How do you verify competency?

ANSWERS: 1. Key teaching points: • Remove from refrigerator 30 minutes before (reduces pain) • Check expiration date and inspect solution • Clean site with alcohol, let dry • Abdomen or thigh injection sites; rotate each time • Press firmly against skin and hold button until click and window shows complete • Hold 10 seconds after click before removing • Do not rub injection site • Dispose in sharps container immediately • Track injection dates and sites 2. Competency verification: • Return demonstration - patient performs injection on self with nurse observing • Verbalize steps including what to do if reaction occurs • Demonstrate proper sharps disposal • Identify when to call provider (signs of infection, severe reaction, missed dose) • Document teaching and return demonstration in patient record