Outpatient IV antibiotic therapy

Who is the leaflet for? What is its aim?

This leaflet is to give patients and carers information about outpatient IV antibiotic therapy.

What is outpatient IV antibiotic therapy?

Antibiotics are medications that are active against bugs or germs called bacteria. These may be given by mouth or into the vein (intravenously or IV). IV antibiotics are usually given to patients in hospital but in certain conditions they may be given in a hospital clinic or at home. This is called Outpatient Parenteral Antimicrobial Therapy (OPAT).

How does the antibiotic get into the vein?

The antibiotic is given into your vein through a venous access device. This device is a flexible hollow plastic tube which is inserted into the vein using a needle. The needle is removed and the device is left in place and secured using a dressing.

What type of venous access device will I have?

There are various types of devices available including butterflies, cannula, peripherally inserted central catheters (PICC) and Hickman lines. Your doctor or nurse will decide which one is most suitable for you, depending on your veins and the expected duration of the IV antibiotic therapy. They will provide you with the relevant information and explain how the venous access device will be inserted.

Do I have to remain in hospital or can I be at home for my IV treatment?

IV antibiotic therapy is usually given in the hospital. However, for certain conditions, IV antibiotic therapy can be given safely in an outpatient clinic or at home. If this is appropriate, you will be referred to the OPAT to see if they can organise this for you.

When will I see a doctor?

You will see a doctor at the start of your IV antibiotic treatment and at least once a week during the course of your treatment at the Cambridge Infusion Centre. A letter will be sent to your GP at the start of your IV antibiotic therapy and every time that you are seen by a doctor.

Who will give me the IV antibiotics and care for my venous access device?

There are various ways that your antibiotic can be given. Some patients opt to come to Cambridge Infusion Centre/OPAT clinic daily for a nurse to give the antibiotics. Some patients can have either a district nurse or a Sciensus nurse come to their home each day to give IV antibiotics. Some patients choose to self-administer or for a relative to learn how to administer their own antibiotics with special instruction from the Specialist Nurse. Only those deemed safe to administer their own antibiotics will be allowed to use this method. At the weekly review in the OPAT clinic when you see the doctor, the Specialist Nurse will examine the venous access device, clean the exit site and change the dressing.

How will I know if something is wrong?

This leaflet includes the contact numbers of the OPAT – please do not hesitate to contact us if you have any concerns about the IV antibiotic therapy. Complications are rare. If you develop a drug rash, diarrhoea or problem with your venous access device, please contact the OPAT specialist nurse or doctor for advice. If you develop a severe rash with swelling and/or difficulty breathing call 999 for an ambulance and go to the nearest hospital accident and emergency department.

How can I help to care for my venous access device?

The exit site of the vascular access device will be covered by a transparent dressing and should be kept clean and dry in order to prevent infection. You should avoid excessive movement of the arm or heavy lifting as this may dislodge the line. If you notice any problems with your line please contact The OPAT team as soon as possible.

Can I have a bath/shower or go swimming?

You can have a bath or shower provided that the line is kept clean and dry. The line should not be immersed in the bath. If the dressing becomes wet underneath, please let the OPAT specialist nurses know. Swimming is not recommended because the line may become dislodged or infected.

How is the line removed when it is no longer needed?

A nurse will remove the line when it is no longer needed. A sterile dry dressing will be placed at the exit site to protect it. This can be removed after 24 hours.

Benefits

The benefit to you is that you will be able to be at home rather than in hospital during the course of your IV antibiotic therapy. You will also be looked after by the OPAT team and will be seen by the OPAT specialist nurses or doctor at least once a week during your IV antibiotic course.

Risks

The risks of having outpatient IV antibiotic therapy are very low. You will be carefully assessed before you start the treatment and also monitored by the OPAT while you are receiving your treatment.

The first dose of IV antibiotic will be given in hospital and you will be checked before you leave. You may experience a reaction to the IV antibiotic or a problem with the vascular access device such as blockage or infection.

If you develop a drug rash, diarrhoea or problem with your vascular access device, please contact the OPAT specialist nurses or doctor for advice.

If you develop a severe rash with swelling and/or difficulty breathing call 999 for an ambulance and go to the nearest hospital accident and emergency department.

Alternatives

The alternative to having outpatient IV antibiotic therapy is to remain in hospital for the whole course of your IV antibiotic treatment.

Contacts/further information

OPAT specialist nurses

Monday to Friday 08:00 to 18:00: 01223 596369.

Please note- The OPAT nurses are not available weekends or bank holidays.

Out of hours, weekends and bank holidays: 01223 245151 and ask for on-call Infectious Diseases Registrar.

References/sources of evidence

1. Infectious Diseases Society of America Practice Guidelines for Outpatient Parenteral Antibiotic Therapy
2. OPAT proposal
3. OPAT Operational Policy