>> 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 work space, 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 safely take in your home.
This video will provide you with the instructions
on how to infuse or administer 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 infusion 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 it can get to room temperature.
If you forget to remove your medication ahead of time,
it's okay, the cold medication will not hurt you
but the cold fluid may feel a bit uncomfortable
when it's infusing and it may take a bit longer
to finish infusing.
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 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 hands, or wave them,
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 important
to wash for 20 whole seconds each time.
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 placemats
on top of the selected work surface.
Wipe the work surface and/or the placemat down
with a household cleaning agent
like Clorox wipes, 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 you did the first time.
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 four to five alcohol pads,
two prefilled normal saline syringes,
one prefilled heparin syringe,
if prescribed by your provider,
one medication bag, one gravity tubing IV set,
one red cap, one IV pole.
Arrange your supplies above your clean SASH placemat
according to the picture.
Place the alcohol pads above
their respective place on the board.
Place a 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.
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 medicine is correct,
and that it matches what is on the 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.
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 cap on the syringe
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 the 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 that 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 placemat
under or by the first S.
Repeat this step for the other syringes on your board.
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 placemat,
which is for administer or antibiotic.
Now, extend your IV pole to its fullest height.
Now, you are ready to attach the tubing
to the medication bag.
Roll the clamp down on the tubing.
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 medicine 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 tubing spike touches anything,
throw that tubing away and begin again
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.
Now it is time to prime your tubing.
To prime means that we need to make sure
that the fluid runs 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.
Squeeze the drip chamber until it's half full.
Find the roller clamp on the tubing.
Open the roller clamp by rolling up with your thumb
and watch the fluid as it runs through the tubing.
When the fluid has reached the end of the tubing,
you will notice a few drips
coming out of the end of the tubing.
As soon as you see this, close the roller clamp
by rolling down to stop the flow.
Now keep the clamp on the tubing closed
until we're ready to infuse, good job.
Now it's almost time to connect
and administer your medication.
But, before we do, we must scrub the hub
and flush the IV line with saline.
But 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 endcap
or scrub the hub on your IV line.
You may be wondering what's an endcap?
The endcap protects your IV line from bacteria.
It is very important to keep the endcap
clean to prevent infection.
The one shown here is in blue
but your endcap could be of another color,
depending on your home infusion provider.
You may ask your nurse what color your endcap is.
No matter the color though,
remember it is very important to keep clean.
To clean the endcap of your IV line,
we will scrub the hub by using the alcohol pad
located right before the first S on your SASH placemat.
Remove the outer wrapping to expose the alcohol square.
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.
Ready to flush?
We will now flush the IV line with saline.
Now, while keeping the endcap 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 into 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 saline in at a time.
Stop and push one to 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 IV 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.
You are ready to connect your medication
tubing to the IV line.
Your orders will tell you how many drips
you should see each minute.
And we want to be prepared,
so make sure to first double check
and review the three questions found
across the top of your SASH placemat.
Did you check your 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 placemat,
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 your other hand, locate the end of the gravity tubing
and remove the protective cap
on the end of the gravity tubing.
Connect the gravity tubing to your IV line
by using the same push and twist motion that 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 infusion.
Now, go ahead and open the clamp on your IV line
and on the gravity tubing.
You should see the medication drips
through the drip chamber.
To adjust the rate on your gravity tubing,
you must watch the clock.
Use the roller clamp to control
the speed of the drops in the drip chamber.
Adjust the roller clamp until you can see
the prescribed number of drops per minute
in your drip chamber.
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 your line.
If you notice this, don't panic.
Stop and call your infusion provider for help.
Continue to monitor your IV infusion for completion.
If your IV bag is empty and the drip chamber is less
than half full, that means your infusion is complete.
Now, close the roller clamp on the gravity 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.
Make sure you have a red cap available.
Before you disconnect the gravity tubing from your IV line,
wash or sanitize your hands for a full 20 seconds.
Keep the excess gravity tubing on the IV pole
and remove the red cap from the plastic wrapping.
Disconnect the gravity tubing from your IV line
and apply the clean red cap.
to the end of the gravity tubing.
When it's 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 gravity tubing set.
Remember, never use the same tubing
for two different medications.
Now that your infusion is complete,
go back to your SASH placemats.
Now it's time to flush your IV line again,
Using the saline syringe
on the second S on your SASH placemat.
You will repeat the same flushing steps
you used in the beginning of your infusion.
Do you remember?
Always wash or sanitize your hands for a full 20 seconds.
Now, scrub the hub of your catheter for 15 seconds
using the alcohol pad from your SASH placemat,
the one before the second S.
Remember, once you have cleaned the hub,
you do not want anything to touch it.
If the hub falls from your hands after you've cleaned it,
simply wash your hands again
and, with a new clean alcohol pad, clean it again.
Be sure to hold the IV line and the 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 placemat.
Remove the cap from the saline syringe
and attach it to the hub on your IV line,
which should still be in your other hand.
To attach the syringe, you will 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 about 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 IV 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.
You do not want to remove the endcap from your IV line.
The final step of the SASH placemat 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
but please ask your nurse or pharmacist
for further instruction.
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 syringe,
using the stop and push method.
Remove the heparin syringe,
being careful not to remove your hub.
Close the clamp on your IV line.
Now, wash or sanitize your hands for a full 20 seconds.
Congratulations, you have successfully
infused your medication, good job.
Enjoy your day.