>> Narrator: This video has been provided
by the Johns Hopkins Home Care Group
and the Johns Hopkins Division of Infectious Diseases.
Thank you in advance for watching this video.
This video will be presented in 13 sections:
Introduction, how to get started,
hand hygiene, prepare a clean workspace,
gather supplies, arrange supplies,
prepare supplies, spike the bag,
prime the medication tubing, scrub the hub,
pulse flush, ready to connect, disconnect and flush.
Your medical provider has prescribed
an IV medication for you that you can use safely
in your home.
This video will provide you with the instructions
on how to have used your medication when needed.
Your nurse or pharmacist
will also give you special instructions for your medication.
Please watch this video as many times as you need.
If you have a caregiver, family member,
or a friend helping you, please have them watch it as well.
How to get started.
Your nurse will tell you how to store your medication.
This also can be found on your medication label
and on your pharmacy prescription.
Your nurse will tell you when to take your medication
and how often.
If your medication is refrigerated,
we recommend removing your medication
from the refrigerator at least two hours before
it's time to infuse so that you can get it
to room temperature.
If you forget to remove your medication ahead of time,
it's okay, the cold medicine will not hurt you,
but the cold fluid may feel a bit uncomfortable
while it's infusing and it may take a bit longer
to finish infusing.
Hand hygiene.
Now, the first thing to do is to make sure
that you have a clean work surface and clean hands.
So let's talk about how we properly clean our hands.
If your hands are visibly dirty, wash your hands
using soap and warm water for at least 20 seconds.
Dry with a clean paper towel.
If your hands are not visibly dirty,
you can use an alcohol-based hand sanitizer.
Place a dime-sized amount of sanitizer
in the palm of your hand, rub your hands together vigorously
for at least 20 seconds until your hands are dry.
Make sure you rub between your fingers
and the backs of your hands.
Never blow on your hand or waive or wipe them
to speed up the drying.
You will wash or sanitize your hands several times
throughout this process.
Whether you wash or use hand sanitizer,
remember that it is always important to wash
for a whole 20 seconds each time.
Prepare a clean work space.
Before each infusion, it is important to find a clean,
dry, hard work surface
to set up your medication and supplies.
You can place the provided SASH place mat
on the top of the selected work surface.
Wipe the surface and the SASH place mat down
with a household cleaning agent like Clorox Wipes or Lysol
and a paper towel or an alcohol pad and allow it to dry.
Now, wash or sanitize your hands again for a full 20 seconds
the same way we did the first time.
Gather supplies.
The next step will be to gather your supplies.
Your home infusion agency should provide these supplies.
If you are missing any supplies,
please call your home infusion agency.
You will need two prefilled normal saline syringes,
one prefilled Heparin syringe,
if prescribed by your provider,
one medication bag, four to five alcohol pads,
one IV pole, and one red cap.
Arrange your supplies above your clean SASH place mat
according to the picture.
Place the alcohol pads above their respective place
on the board.
Place the saline syringe above each S,
place your medication bag above the A.
If flushing with Heparin is prescribed,
place a Heparin syringe above the H.
S is for saline, A is for administer or antibiotic.
The other S is for saline, and H is for heparin if needed.
You will also need the most recent medication orders
from your home infusion provider.
Now, check the label on the medication bag
and compare it to your prescription.
It is important to always check the medication label
on the bag to make sure that your name is correct,
the medication and the dose of medication is correct,
and that it matches what is on your prescription.
Look at the expiration date or the do not use after date
on the medication label.
If any of this information is incorrect, stop,
and call your infusion pharmacy immediately.
Now, wash or sanitize your hands
for a full 20 seconds.
Remember, if sanitizing,
you want to always get a good amount in your palm.
Then rub until dry.
Good job.
Prepare supplies.
We are now ready to prepare our supplies.
Start with the first saline syringe
and remove the syringe from the plastic wrapper.
Remove the protective end of the saline
and place the cap flat-side down on the table.
You will need to replace the cap on the syringe later,
so you want to make sure that the inside of the cap
doesn't touch anything or get dirty.
Hold the syringe with the end up and plunger at the bottom.
Pull back on the syringe plunger slightly
to break the seal on the syringe.
You will be able to see the tiny air bubble in the syringe.
Slowly push the plunger up
to let the tiny air bubble out.
Once the air is removed, pick up the cap from the table
and replace the cap on the end of the syringe.
Place the syringe on the SASH place mat
under or by the first S.
Repeat this step for the other syringes on your board,
and once you have done this, you are ready to move
to the next step.
Remove any protective covering
from your medication bag and tubing.
Place your medication bag and the tubing
over the A on the SASH place mat
which is for administer or antibiotic.
Now, extend your IV pole to its full height.
Spike the bag.
Now you're ready to attach the tubing
to the medication bag.
The dial on your tubing is called a flow regulator.
This allows you to adjust the flow rate of your infusion
using numbers on the dial.
This is why it's called dial-a-flow.
As we prepare our tubing, we want to make sure
the dial is turned to open for now.
Keeping the medication bag in front of you
on your hard work surface, grip the medication bag
at the entrance site, and pull the protective cap
off the medication bag.
Do not twist, just pull.
Continue to grip the bag at the entrance site.
Pick up the tubing with your other hand
while taking off the clear protective cap
over the tubing spike.
Once you remove the tab, the tubing spike
cannot touch anything.
If the spike touches anything, throw that tubing away,
and begin with a new tubing set.
Now, insert the tubing spike into the medication bag
where you just pulled off the tab.
You will use a push and twist motion like
putting a key into an ignition.
You will know the bag is spiked correctly
when you see the tip of the tubing spike
in the medication bag and you see the medicine
in the drip chamber.
Awesome, you have successfully spiked your bag.
Prime the medication tubing.
Now it is time to prime your tubing.
To prime means that we need to make sure
that the fluid runs out through the tubing
and all the air is eliminated.
First, wash or sanitize your hands for a full 20 seconds.
Then, hang the medication bag on the fully extended IV pole.
Then, squeeze the drip chamber until it is half full.
Remember to make sure your dial is turned
to the word open and then check the clamp on the tubing
to make sure that it's open.
Watch the fluid as it runs out of the tubing.
When the fluid has reached the end of the tubing,
you will notice a few drips coming out
at the end of the tubing.
As soon as you see this, close the clamp on the tubing.
This will stop the flow.
Now, turn the dial on your tubing
so the rate on your prescription
matches the rate selected on the dial.
Keep the clamp on the tubing closed
until we are ready to infuse.
Good job.
Scrub the hub.
Now, it is almost time to connect
and administer your medication.
But before we do, we must scrub the hub
and flush the IV line with saline.
Can you guess what comes first?
You got it, wash or sanitize your hands.
Remember to wash or rub for a full 20 seconds.
We will then clean the end cap or scrub the hub
on your IV line.
You may be wondering what's an end cap?
The end cap also called the hub
protects your IV line from bacteria.
It is very important to keep the end cap clean
to prevent infection.
The one shown here is in blue.
But your end cap could be of another color
depending on the home infusion provider.
You can ask your nurse what color your end cap is.
No matter the color, remember it is important to clean.
To clean the end cap of your IV line,
we will scrub the hub by using the alcohol pad
located right before the S on your SASH place mat.
Wrap the alcohol square over
and around the sides of the hub.
Scrub the hub with the alcohol square
for at least 15 seconds.
Throw the used alcohol square in the trash.
Once you have cleaned the hub,
you do not want to get it dirty by allowing it
to sit on a surface or hang loose.
But if you do, it's okay,
you will just need to wash your hands
and re-clean again with a new alcohol square.
Pulse flush.
Ready to flush?
We will now flush the IV line with saline.
Now, while keeping the end cap or hub clean in one hand,
grasp the saline syringe with your other hand.
Remove the cover that is on the saline syringe
and attach the syringe to the hub of the IV line
by screwing the syringe onto the hub
in the same push and twist motion as before.
Like putting a key onto an ignition.
Good, now that you have connected the syringe,
open the clamp on your IV line and slowly push
about one to two milliliters of medication in at a time.
Stop and push one to two milliliters more.
Stop and push in a little bit more.
Keep doing this until all the syringe is empty.
Flushing this way each time helps keep your IV line
from getting clogged.
If you are unable to flush your line
or find that it takes a lot of effort
to push in the fluid from the syringe,
double-check to make sure that the clamp
on your IV line is open.
If your clamp is open, and you still have difficulty,
stop, and call your infusion provider.
Once you have emptied the syringe,
you should disconnect the syringe from your IV line
and throw it away.
Be careful to disconnect the empty syringe only.
Remember, you do not want to remove the hub
from your IV line.
Ready to connect.
You are ready to connect your medication tubing
to your IV line.
But before you do, double-check to make sure
that you have answered the three questions
found across the top of your SASH place mat.
Did you check the prescription?
Did you check the expiration or do not use after date?
Did you wash your hands?
Go ahead, wash or sanitize your hands
for a full 20 seconds.
Now, you must scrub the hub again
for at least 15 seconds.
Do you remember what to do?
Use the next alcohol pad on your SASH place mat,
the one before the A.
Unwrap the pad, and wrap the alcohol square
around and over the hub while applying friction
just the same way we did before.
Remember, we call this scrubbing the hub.
When done, throw out the used alcohol square.
Now, hold the clean hub in one hand
and keep it clean.
With the other hand, locate the end
of the dial-a-flow tubing and remove the protective cap
on the end of the dial-a-flow tubing.
Connect the dial-a-flow tubing to your IV line
by using the same push and twist motion you used before
to screw the saline syringe onto the hub.
There, now you are all connected
and ready to begin your infusion.
Before you open your clamps,
you want to make sure that your IV pole
is extended fully and that your medication bag
stays above the level of your heart
during the time of infusion.
Now, go ahead and open the clamp on your IV line
and on the dial-a-flow tubing.
You should see the medication drips
through the drip chamber.
To adjust the rate on your dial-a-flow tubing,
you will turn the numbers on the dial
to match the rate on your doctor's order.
Remember to keep the IV pole fully extended
so that the medication bag remains
above the level of your heart.
If the bag is below the level of your heart,
it can slow or stop the infusion
and cause blood to back up in the IV line.
If you notice this, don't panic.
Stop, and call your infusion provider for help.
Continue to monitor your infusion for completion.
When your IV bag is empty,
and the drip chamber is less than half full,
that means your infusion is complete.
Now, close the clamp on the dial-a-flow tubing.
Remember, you can use the same tubing
for up to 24 hours.
If you have another infusion with the same medication
later on today, you can reuse this tubing.
If so, here's what you'll do.
First, make sure you have a red cap available.
Before you disconnect the dial-a-flow tubing
from your IV line, wash or sanitize your hands
for a full 20 seconds.
Disconnect and flush.
Keep the excess dial-a-flow tubing on the IV pole,
and remove the cap from the plastic wrapping.
Disconnect the dial-a-flow tubing
from your IV line and apply the clean red cap
to the end of the dial-a-flow tubing.
When it is time to prepare a new medication bag
for the next infusion, you will throw out the old bag.
Using the saved tubing,
repeat the process of washing or sanitizing your hands
for 20 seconds, spiking a new bag,
and re-priming the tubing for the new infusion.
If it is a new day, you must begin the whole process again
with a whole new dial-a-flow tubing set.
Remember, never use the same tubing
for two different medications.
Now that your infusion is complete,
go back to your SASH place mat.
It is now time to flush your IV line again,
using the same syringe on the second S
on your SASH place mat.
You will repeat the same flushing steps you used
at the beginning of your infusion.
Do you remember?
Always wash or sanitize your hands
for a full 20 seconds.
Now, using the alcohol pad from your SASH place mat,
the one before the second S,
scrub the hub of your catheter for 15 seconds.
Remember, once you have cleaned the hub,
you do not want anything to touch it.
If the hub falls from your hands
after you have cleaned it,
simply wash your hands and clean it again
with a new clean alcohol pad.
Be sure to hold the IV line and hub,
but do not touch the tip of the sides with your fingers.
With your free hand, pick up the saline syringe
located on the second S of your SASH place mat.
Remove the cap of the saline syringe
and attach it to the hub of your IV line
which should be in your other hand.
To attach the syringe, you will use a push and twist motion
like putting a key into an ignition.
Once you have connected the syringe,
open the clamp on your IV line and slowly push it out
one to two milliliters of saline in at a time.
Stop and push one to two milliliters more.
Stop and push in a little bit more.
Keep doing this until all the syringe is empty.
If you cannot flush your line
or find that it takes a lot of difficulty
to push in the fluid from the syringe,
double-check to make sure that the clamp
on the IV line is open.
If your clamp is open and you still have difficulty,
stop and call your infusion provider.
Once you have emptied the syringe,
you should disconnect the syringe from your IV line
and throw it away.
Be careful to disconnect the empty syringe only.
Do not remove the end cap from your line.
The final step of the SASH place mat is H for heparin.
Heparin is a blood thinner used to keep your IV line
from clotting with blood.
Depending on the type of IV line you have,
you may not be required to use heparin.
Please ask your nurse or pharmacist for further direction.
Before using your heparin, use the final alcohol pad
before the H to clean the hub very well.
Attach the heparin syringe to the hub
and flush as you did with the saline
using the stop and push method.
Remove the heparin syringe being careful
not to remove your hub.
Close the clamp on your IV line.
Wash or sanitize your hands for a full 20 seconds.
Congratulations, you have
successfully infused your medication.
Good job, enjoy your day.