>> 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 12 sections,
Introduction, How to Get Started, Hand Hygiene,
Prepare a Clean Work Space, Gather Supplies,
Arrange Supplies. Prepare Supplies,
Disconnect and Unload the Pump,
Load the Pump, Scrub the Hub, Pulse Flush,
Ready to Connect.
Your medical provider has prescribed an IV medication
for you that you can safely take in your home.
Your medication is infused using an electronic pump
and remains connected to you for 24 hours a day.
This video will provide you with instructions
on how to infuse or administer your medication when needed.
The pump used in this video may be different from your pump.
If it is different, please ask your nurse
or pharmacist for specific instructions
on the type of pump you are using.
Additionally, any special instructions based on your drug
will be provided by your nurse or pharmacist.
Please watch this video as many times as you need.
If you have a caregiver, family member,
or 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 that
you remove 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 medicine will not hurt you,
but the cold fluid may feel a bit uncomfortable
while it's infusing, and it may take a little bit longer
to finish infusing.
Your pharmacist or nurse will also tell you
how long each medication bag should run
before it's time to change it again.
You should change the bag at the same time of each day
on the days that you are due to change the bag.
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,
it is okay to 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 or rub
for 20 whole seconds each time.
For each infusion, it is important to find a clean,
dry, hard work surface to set up medication and supplies.
You can place the provided SASH placement
on the top of the work surface.
Wipe the surface and the SASH mat down
with a household cleaning agent, like Clorox wipes,
or Lysol, and a paper towel, or an alcohol pad,
and then 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 would 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 your electronic pump,
four to five alcohol pads, two prefilled normal saline
syringes, one prefilled heparin syringe,
if prescribed by your provider,
a new medication bag with IV tubing,
and a carrier pouch.
Arrange your supplies on your clean SASH board
according to the steps on the board.
Place the alcohol pads in their place on the board.
Place a saline syringe over each S.
Place your medication bag over the A.
If flushing with heparin is prescribed,
then place a heparin syringe over the H.
S is for Saline, A is for Administer or Antibiotic,
the second S is for Saline,
and the 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 always important to 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 then 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 your hands for 20 full 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.
It looks like this.
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 mat on 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.
You may notice that your medication may come
with the tubing already attached to the medication bag.
If this is the case, you may simply need
to remove the medication and attached tubing
from the plastic bag and place it back over the A
on the SASH mat, which is for Administer or Antibiotic.
Now, your SASH mat is all set.
Depending on the pump you have at home,
you may need to ask your nurse or pharmacist
how to use your pump.
We will be using the BodyGuard pump in this demonstration.
If you already have a BodyGuard pump
and a medication that is ready for a bag change,
remove your pump and the empty medication bag
from your carrying pouch.
Place the pump on your clean work surface.
Push the Stop button if the pump is still infusing
and hold the Power button down until the pump powers off.
Okay, now we will disconnect the medication tubing
from your IV line, but we wanna make sure that
you do not remove the end cap on your IV line.
You may be wondering what's an end cap?
The end cap protects your IV line from bacteria.
It is very important to keep the end cap clean
to prevent infection.
The one shown here is blue,
but your end cap could be another color,
depending on your home infusion provider.
You can ask your nurse what color your end cap is.
No matter the color, remember, it is very important
to keep clean.
To disconnect the medication tubing from your IV line,
grasp the end cap with one hand,
and with the other, unscrew the medication tubing
until it's disconnected.
Remove the medication tubing and the bag from the pump
by lifting the latch to open the pump door.
Lift the tubing from the pump and discard in normal trash.
Now, wash or sanitize your hands.
Remember to wash or rub for a full 20 seconds.
Now it's time to load the pump.
Place the new medication bag and attached tubing
next to the pump.
On the tubing, locate the section of tubing
with the black plastic piece or the black LEGO piece..
This is the section of the tubing that is loaded
into the pump.
Line the tubing up with the pump
and slide the black piece with the smooth side facing up
into the channel.
Close the door to the pump and secure the latch.
Open the slide clamp on the medication tubing.
Power the pump on by clicking the Power button.
You will hear the pump make a beeping sound
and perform a self-check.
The pump will then ask you to select Repeat or Resume.
You should select Repeat to repeat the program
with the new bag of medication.
The pump screen will show you the settings.
Check the settings on your prescription form
against the settings on the pump screen.
Follow the directions for scrolling
through the screen on the pump.
Now that you have loaded your pump,
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 end cap or scrub the hub
on your IV line.
Remember, we said that it was important for you
to keep the end cap clean to prevent infection, right?
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 mat.
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 again,
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 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 to the hub
in a push and twist motion,
almost 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 the medication in at a time.
Stop, and push one to two milliliters more.
Stop, and push a little bit more.
Keep doing this until all of the syringe is empty.
Flushing this way each time helps to 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 opened, 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.
Now you're ready to connect your medication tubing
to your IV line.
But before you do, check to make sure that
you have answered the three questions
found on the top of your SASH board.
Did you check the prescription?
Did you check the medication expiration date,
or the 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 board,
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 medication
tubing and remove the protective cap
on the end of the tubing.
Connect the exposed end of the medication tubing
to your IV line by using the same push and twist motion
you used before to screw the saline syringe onto the hub.
Once you have secured the connection,
check all the clamps one last time,
to ensure that they're all open.
Push the Start or OK button to start your infusion.
You will see the drop icon on the pump screen
and the green light blinking on the face of the pump.
If your pump alarms instead,
then read what the screen is saying.
You may need to recheck to be sure that all clamps are open.
Check the tubing for kinks as well.
If you get an alarm, and you are unsure what to do,
please call your infusion pharmacy immediately.
Now, place the pump back in your pouch.
Congratulations, you did it, enjoy your day.