Ambulatory IV antibiotics delivered by an elastomeric pump for cancer patients

This information sheet is for patients and their carers/companions to provide an overview of the use of IV antibiotics delivered by an elastomeric pump. The administration of IV antibiotics delivered by an elastomeric pump enables patients to return to their own home or stay in CUH accommodation whilst continuing to receive intravenous antibiotics.

Patients will be admitted to the virtual ward for follow up and attend the Haematology Day Unit daily for review and for the pre-filled antibiotic pump containing IV piperacillin/tazobactam to be changed.

This treatment will be started within the Cancer Directorate and patients will need to meet certain criteria to be discharged using the elastomeric antibiotic pump.

Using the pump

The elastomeric pump is a disposable pump that will be pre-filled with an IV antibiotic named piperacillin/tazobactam. The pump is designed to be used only once and then discarded in the haematology day unit when the infusion is finished, and the pump is empty.

The medication is held in a balloon within a hard outer shell. The elastomeric pump will be attached to your central line. The IV antibiotic pump is designed to continuously infuse for 24 hours without you having to do anything.

When you are discharged from the inpatient ward to the CUH virtual ward they will contact you once a day to remotely monitor your heart rate, temperature, oxygen levels and blood pressure. The required equipment to do this will be supplied by the virtual ward team.

You will also need to attend the Haematology Day Unit for a clinical review and for a new elastomeric pump to be attached.

We will give you a bag to carry your pump. It is advisable to keep the pump at the same level as your elbow. You will be able to carry out your daily tasks as normal, but it is advisable for you not to undertake any vigorous activity. You can have a bath or shower, but you must avoid your pump and your central line from getting wet.

Your pump should remain at room temperature throughout. You may find it useful to place the pump under your pillow at night. This helps to maintain a constant temperature and avoid the pump from getting caught up.

Benefits

• You will be able to spend time away from hospital either at home or in the CUH accommodation allowing you to rest.
• Your family member can stay with you at all times – this would not possible if you were an inpatient on the ward.
• You will receive the same treatment as on the ward except we will see you at an allotted time, between the hours of 08.00-19.00hrs
• You will be attached to a pump to deliver your treatment, which will be held in a small waist bag. This will allow you to continue with your daily life away from the hospital.
• If you are staying at home, it is hoped that this will add a greater degree of privacy, independence, and normality to your treatment experience.
• It can help reduce the risk of an hospital acquired infection.
• Your inpatient stay may be shorter.

Can I stay at home during my treatment?

Your consultant must agree to you being at home during this stage of your treatment.

To stay at home you must:

• You must live within a 60-minute drive from the hospital and agree to return to the hospital if you have any problems with your pump, day or night.
• Have a family member or friend available to drive you to the hospital at any time of the day or night.
• Have a mobile phone and be contactable at all times.
• Agree to contact the hospital if you experience any problems or become anxious about any aspect of your treatment.

It is advisable, but not mandatory, for a family member or friend to be with you

CUH Accommodation

If you are staying in the CUH (non-clinical) accommodation this will be booked for you by a member of the day unit team.

• Keys will need to be collected from Sanctuary Housing reception before 4pm and returned when your stay is complete.
• The accommodation comprises of a living area, kitchen, and bedrooms with ensuite bathroom. You will need to share a bedroom with your family member or friend.
• The kitchen is fully equipped and there are local supermarkets within close distance of the hospital for your supplies.
• There is no charge for staying in this accommodation.
• You should have someone staying with you and should be contactable by phone at all times.

What happens when I attend the day unit?

• You will be given appointment times to attend for your treatment. The length of your appointment will be dependent on the type of treatment you are receiving.
• You will be seen by a nurse, who will check your temperature, pulse and blood pressure. Depending on your treatment you may also be weighed at each visit.
• Symptoms such as nausea, vomiting, diarrhoea and fatigue will be assessed each time you visit.
• You will be seen by a doctor if the nurse feels that it is necessary.
• If required, you will have blood tests. You may have to wait for the results of these tests
• If necessary, other investigations such as an ECG or urine test will be carried out
• You will receive your prescribed treatment and be connected to your pump as required.

What happens when the virtual ward makes contact?

• You will be contacted once a day by a member of the virtual ward. This will be after you have left the haematology day unit.
• The virtual ward nurse will ask you questions relating to your vital signs.
• You will be able to highlight any other concerns that you have or discuss any symptoms you may be concerned about

Risks

As with any treatment there are risks involved in being discharged from an inpatient area. The main potential risk is a mechanical failure with the pump or your IV line. This may present as leaking, swelling or discomfort around your line. If this happens you must contact the virtual ward or the emergency number provided.

If you are discharged with an elastomeric pump you will have met strict inclusion criteria however if you become unwell, please contact the cancer acute oncology emergency number. You will then be advised if you need to attend the hospital for a medical review.

What if I become unwell during my treatment as an ambulatory patient?

It is important that you contact the hospital using the emergency telephone number if you develop any of the following symptoms:

• Temperature of 38°C taken twice, an hour apart, within a 12-hour period or above 38.5 °C on one reading
• Shivers or hot flushes
• Persistent episodes of nausea, vomiting or diarrhoea
• Shortness of breath or difficulties with your breathing
• Redness or pain around your hickman line site or PICC

The 24-hour emergency number is:

• 01223 274225 for Haematology patients
• 01223 274224 for Oncology patients

Depending on your symptoms it may be necessary to admit you to hospital. Staff will advise you where to go to be reviewed. If the day unit is open you will be seen there, if possible. Other arrangements will be made if this is not possible.

If you are asked to come to the hospital to be seen, it is important that you leave home straight away.

If you are experiencing any infective symptoms such as a runny nose, sneezing, diarrhoea or vomiting please inform us before you attend the hospital as we may need to arrange for you to be seen in a side room.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay if you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (EPIC). It is available via your home computer or mobile device.

More information is available on the My Chart section on our website.

Contacts

Acute Oncology 24 hour Emergency number – 01223 274225