How, exactly does IV antibiotics work?

[Ephedra]

Just thinking ahead.  If I had to go to IV antibiotics, how does all this work?  

I know that I would need to travel a distance to get the PICC inserted.  Do they do the first infusion at that time?  I would need to be capable of driving myself home is why I ask.  It wouldn't be so powerful to initiate some sort of massive herx, would it?  I wouldn't be to sick to drive home would I?  And I am assuming that, from there forward I would do my own infusions - right?  Anyone have any experience with IV antibiotics?  I am clueless!  But I just want to be more prepared if it comes down to it.

Thanks!

[cave76]

Oh my!

[Ephedra]

No I am not joking!!  LOL!  I am not going to be treated like an invalid by some nurse!  Not going to put anyone in charge of MY health.  And I think I may have that option.  If anything would happen, infection or whatever the blame would be on them.  And they don't care anyhow!  It's their job and they're getting paid, so why would they care if I got some sort of massive infection and died??  Not likely to happen, but just saying.    

[cave76]

"What if I pay for this and no insurance company will be involved?"

Whoa!!! LOL If you're serious, I can list a dozens hurdles for that path.
I just wrote some out, but deleted them after I thought perhaps you're just joking.

[Ephedra]

Thanks Jackie!  I am a little apprehensive but I try to not be too apprehensive.  I need to be prepared as I am fully aware that my thought process is not very good and quick.  I don't want to be faced with a split second decision and make the wrong choice.  And I don't want to sound like a delirious fool either by asking the doctor idiotic questions.  LOL!  

Thanks a lot cave!  What if I pay for this and no insurance company will be involved?  Not going to want to be bothered by some nurse.  I look horrible and probably feel worse than I look, which is bad.  When I don't feel well, I just want to be left alone.  So I am hoping I have that option.  I can do all of that stuff myself.    

Much thanks Ricobord!  What kind of Rocephin shots do you get?  You mentioned not having a PICC.  Certainly not going to want a catheter hanging from my arm.  Don't want anyone to know I am sick.  I don't want to be questioned and babied or bothered, I know some people do but I am not one of them.  

[Ricobord]

I do the Rocephin shots 4 days in a row, then take 3 days off.  It's a little over 5ml, which is a lot of volume. Most of the time, it requires two injections.  It's a caustic medication, so it's mixed with lidocain for a shot. Sometimes, by the 4th day in a week, it's hard to find a good spot. I'm always relieved to have 3 days off, but by the next week, I can tell I need the next dose.

It's definitely a trade off for a PICC line, and from what I understand, most people prefer the PICC line.  I think the Bicillin shots were easier to tolerate, but I think the Rocephin is working well for me now, so I'm going to stick with it.

When I did Bicillin shots I didn't feel I could give them to myself. The needle was longer than the one for Rocephin. (The Bicillin is done as a "deep IM" injection.)  A nurse friend of mine would come over and do them for me when my husband was out of town. She had done IM injections in the past and was good at it. A handful of times, I went to my doctor's office where a nurse did it.  (None of them were very good at it. I had to explain to them to go slow, etc.)  I can do the Rocephin shots myself, but it's awkward and no fun.

The shots are not a time saver as I have to ice up first, then more ice for a few minutes after, then a hot pack for a while to restore circulation to help absorb the medication and avoid soreness.  

Plus, I have to prep the Rocephin injection, which takes about 10 minutes. I had to get trained on that at my doc's office. It's a little tedious, but certainly do-able.   (The Bicillin was easier. I got prefilled syringes that were stored in the fridge and we only had to warm them up.)

There are a couple other options... the chest port (not very popular) and another kind of line in the arm that stays under the skin so there's no line hanging out. That one has to be swapped out every week, so it has its downside, too.

The great part about all of this intimidating medical-ese is that most people feel better on IV meds or shots.  Sometimes, a patient who can't tolerate them early in treatment, can successfully take them later after orals have knocked down the infection somewhat.  You and your doctor work together to figure out what's best for you.  

I asked for IV meds early on as I knew I'd need them given my hefty neuro symptoms. I'm really glad I'm on them again now, as orals had stopped working.

[cave76]

Short version:

1. You get the catheter placed in your arm. Usually just above the elbow.
2. That is usually done at a hospital or an infusion site (which is often, but not always, at a hospital)
3. The placement of the catheter is then checked via a fluoroscope/xray. (Always insist that is done. No short cuts, no matter how experienced the nurse!)
4. Then your first infusion of Rocephin or whatever is done at the hospital usually via an IV drip. This might take from 30 minutes to 1 hour. The longer the better.
5. After it's obvious that no severe reaction to the med will occur (sometimes you're asked to stay about another hour) then you're sent home. It's advised that someone drive you.
6. The next day a Home Health Nurse will come to your home to inspect the insertion site, perhaps change the dressing and give you instructions.
7. Your insertion site will be sore and probably have a reddish appearance around it. That's normal BUT at ANY time if red lines appear radiating out from the site------ call the Home Health Agency right away! That could be a sign of infection (and bad luck). Rarely is there a problem like that.

[When your doctor orders IV that always comes with a Home Health Agency included or (rarely) instructions for a person to appear at the infusion department daily. I don't know who makes the decision to have you do a 'push' or 'drip' infusion. My doctor decided a push was best and I totally agree! It allows for more freedom for the patient. An agency nurse will be assigned to you. She will be visiting you or calling you daily at first in order to check for possible infection and dressing changes. You can 'fire' that nurse if you feel she isn't following sterile technique. I had to do  that at least once.

Assuming a ''push" is the method, each week a refrigerated box of 7 large syringes filled with Rocephin (assuming a daily infusion) will be delivered to you. Those need to be kept refrigerated but at least an hour or two before doing the push they need to be taken from the fridge. You then hook that syringe up to the end of your catheter that's protruding from your arm. (Details later) You then 'push' a small amount into your arm SLOWLY (details later), wait a couple minutes then another 'push' until the contents of the large syringe are gone. Should take about 40 minutes. I never rushed that process! Too fast and too much will be dumped near your heart.]

8. The nurse will visit you once a week after the first few days. (She might even be the one bringing the pre-filled syringes.) She will change your dressings, take blood pressure and other 'housekeeping' activities.

So all you have to do is infuse once a day, have the nurse visit you once a week. You can always call the agency if you have a question. Once, in the beginning, I panicked because I couldn't get the med to go in! Because my insertion site was nearer the elbow than ordinary I was crimping my line and blocking the med! They un-confused me over the telephone. LOL

Ephedra, you did mention having a nurse friend help you. Ain't gonna happen. LOL The agency is in charge and they and your doctor and insurance company are in full command of your health. If she wants to help in other ways, that's great.

Oh and the most important thing?

AT ALL TIMES, WITHOUT FAIL, STERILE TECHNIQUE HAS TO BE FOLLOWED