Nursing homes can apply to have the ability to administer intravenous fluids and antibiotics. More nursing homes have received approval to give IV fluids and medications to their residents.
The same nursing homes have training in the proper care of IV sites and administration of these fluids.
Intravenous fluids (IV) can be given to residents for signs and symptoms of dehydration, various types of infections, and many other reasons. Many types of IV antibiotics can be administered in the nursing home, including heavy-duty antibiotics such as ertapenem, linezolid, and more.
Most nursing homes do administer IV fluids and antibiotics. They have become mini step-down units for the hospitals in providing care to the residents. Therefore they need the ability to deliver the medications the patients require.
The good news is, the nursing home pharmacy is the one that reconstitutes and mixes the antibiotics in the IV fluid. Having the pharmacy mix the medications leaves less chance for error when preparing the medicines.
The nurses are in charge of caring for the IV site and administering the medications. They will be the ones changing your PICC line dressing site, flushing the lines, and making sure the IV site looks healthy.
Should the nursing homes be administering IV hydration and antibiotics?
The findings and studies have shown that nursing home patients should be treated in the nursing home if the nursing staff has adequate training and access to hydration and antibiotics.
When a nursing home resident needs IV treatment, and the facility isn’t able to administer it, the patient will be sent to the hospital. They will then receive intravenous fluids or antibiotics during their hospital stay.
The nursing home may lack the skills or capacity to give this sort of treatment. There isn’t a problem with nursing homes that do not offer these services to their residents. The homes that do not provide IV suite a need for a particular patient group of residents that do not require this treatment.
If its possible, nursing homes should apply for approval to administer life-saving treatments to residents. Having the ability to manage intravenous hydration and medications can help prevent the resident from hospitalization.
Peripheral intravenous (IV) catheters allow for the safe infusion of medications, hydration/fluids, blood products, and nutritional supplements. (Robert L Frank, 2019) These IVs are meant for short periods of use. If a more extended period of intravenous hydration or antibiotics is required, the patient should have a different type of catheter placed.
What do Intravenous (IV) antibiotics treat?
Antibiotic medications can be used to treat multiple infections, including urinary tract infections, pneumonia, upper urinary infections, or deep skin infections.
IV antibiotics are not usually the first-line treatment. They are typically given with more serious infections, absorption issues, and better bioavailability if the medication in the body. There are also times when the patient is unable to swallow medications and must be administered via an alternate route.
Do Nursing homes have a training program in the administration of intravenous fluids and antibiotics?
Many nursing homes provide training to their nurses in IV hydration and administration of intravenous antibiotics.
Studies showed that nursing homes that provided this training in theory and practical intravenous treatment had positive outcomes for their patients.
Nursing homes need to develop training programs leading to sufficient expertise and capacity of the nurses. By having proper training, the residents in need of intravenous fluids or antibiotics, ended up being treated locally rather than in the hospital.
Would you be happier receiving IV hydration and antibiotics in the nursing home or in the hospital?
Now that you know nursing homes administer all kinds of IV antibiotics and hydration, which would you prefer receiving your therapy? When you’re in the hospital, you are in a facility set up to handle mostly acute care issues and life-threatening issues.
Nursing homes have the ideal setup for administering IV therapy. They are usually less chaotic, with fewer moving pieces when compared to a hospital.
They have long-term care pharmacies that deliver your IV medications premeasured and ready to go. Plus, nursing homes are usually closer to your family members, allowing them to visit you during your stay.
There will be times when the hospital is the ideal setting. Certain intravenous medications such as levophed, high volume IV hydration, and certain high-cost IV medications are best given in the hospital.
Certain IV medications require a higher level of medical monitoring. This monitoring is done by continuous monitoring of vitals by medical equipment and nursing and medical staff.
Why would I need IV hydration?
Dehydration can lead to serious problems for the patient. They are at an increased risk of urinary tract infections, increased falls, delirium, and confusion.
Dehydration in the elderly is one of the common ailments affecting the elderly. Older persons often refuse to drink adequate amounts of fluid.
Taking in enough water is essential when dealing with any person, never mind the elderly who are already at increased risk for dehydration.
Unfortunately, many elderly have dementia and are unable to voice their concerns to the medical providers.
If a resident is unable to voice their needs, the nursing staff and CNAs must track the intake and output of the patient. This way, they can determine if the patient needs IV hydration.
The elderly often have difficulty swallowing food and fluids (dysphagia). Suffering from dysphagia can lead to decreased fluid intake even if the resident tries to stay hydrated by drinking fluids. IV hydration can help supplement the patient’s fluid needs.
Peripheral IV versus a central line in the nursing home
Peripheral IVs have short cannulas (tubes the enter the skin and vein), which are easier to place and usually have fewer complications than longer cannula IVs.
These Peripheral IVs are usually safer, with less chance of infection and less painful to place.
Peripheral IVs should only be utilized when less invasive routes of administration could not be used. If the provider can use the regular “PO” (by mouth) route of administration, then the provider should.
These sort canula IVs are also safer with patients on medications like Coumadin, Aspirin, and Plavix because they allow for direct pressure on the insertion site to help stop the bleeding.
Unfortunately, if the patient requires medications that are caustic to the veins or are going to be in place for a while, it is recommended that a central line be placed.
There are medications such as vasopressors and certain antibiotics that can be caustic and damaging to the blood vessels.
Central lines can be used with patients that have a history of IV drug abuse due to abuse of their veins. It is also helpful with patients that are very challenging to start a peripheral IV, such as someone severely dehydrated or frail.
Do nursing homes offer hydration via rectal catheters?
A rather rare form of hydration to residents in the nursing home involves a rectal catheter. This method offers an easy route to provide medications and fluids quickly. This route is especially useful with difficult IV access.
According to the authors, “This method of medication delivery provided a useful alternative treatment modality to address challenging medication and fluid administration conditions.”
“A limb with a significant motor or sensory deficit may be used safely for temporary placement of a peripheral IV catheter, provided the limb is monitored closely until a preferable site for venous access can be found.” (Robert L Frank, 2019)
I have not found any nursing homes that utilize a rectal catheter for administering hydration to its residents. Just because I have not had experience with rectal hydration doesn’t mean that it doesn’t occur. There are studies that show this route is a safe method of providing hydration to the resident. (Bob Parker & Siegfried Kreis, 2018)
Overall, rectal tube hydration appears reserved for the hospital setting.
When should patients be worried about IV hydration?
When done correctly, there are not many worries regarding peripheral IV treatment. There are sometimes when there may be some concerns regarding IV therapy.
If the staff placing the IV has not been properly trained in the placement of the PIV, this can lead to poor outcomes with the line.
Another concern is the location the IV will be placed on the patient. For instance, there is some evidence regarding avoiding starting IVs on patients’ paralyzed arm.
Starting PIV on the lower extremities should be avoided at all times while in the nursing home. It is best to reserve IVs to areas other than the arms/hands to the hospitals.
There are certain times when it can be more challenging for the nurse to place a peripheral IV. The two top reasons are obesity and poor venous access.
Some elderly residents have fragile skin/veins, which can make it challenging to place the IV. Obese residents are challenging at times due to difficulty in locating the vein for IV access.
Other times for you to be concerned include getting a nurse who doesn’t have much experience and training placing peripheral IVs. The nurse may struggle to locate and place the IV resulting in multiple “sticks” of the patients. They may also overshoot the vein or not consider the presence of nerves.
Sometimes the veins are not visible to the provider attempting to place a PIV. When the veins are difficult to locate, it creates a challenge for all levels of trained staff.
Some facilities have infrared light pens, which reflects everything but the vein itself. There are doppler ultrasound guidance devices, but this is usually reserved for central line placement.
Just because a vein is large, doesn’t mean it is a suitable vein for IV access. Sometimes these veins are firm from being accessed multiple times either from blood draws or history of IV drug use.
If a vein was recently accessed, the provider should look for an alternative site. You want to give the veins a chance to heal before reaccessing the vein.
When there is swelling at the site or bruising, it is recommended that another IV site be selected. There are increased risks for bleeding and clots when there is phlebitis at the site.
If my nursing home offers intravenous therapy, what can I do to prepare for the IV insertions?
When you know that the nursing home will be starting a new peripheral IV, you may want to prepare ahead of time. Some of the things you can do as a patient include
- Applying warm compresses to the potential IV site. Warm compresses will allow the veins to dilate, allowing for easier insertion of the cannula.
- Stay under covers in the morning to keep your body warm, which allows your veins to stay dilated.
- Ask for medication if you have lots of anxiety regarding blood draws. Some medical providers will prescribe medications that will help.
- Ask for EMLA cream in advance (must be sent by the pharmacy). EMLA cream is lidocaine and prilocaine, which is applied 1 hour before IV insertion.
- If EMLA cream is not available, sometimes the provider placing the IV may have “Vapocoolant sprays,” which helps numb/cool the skin resulting in less discomfort.
- When they are starting IV, place your arm below the heart level. This allows for gravity to enhance the dilation of the veins to the arm.
- Remind the provider to wash their hands before the placement of the IV.
Nursing homes do administer IV hydration and intravenous antibiotics to their patients. There are specific steps the facility had to take to get approvals to offer IV therapy.
Some facilities chose not to offer IV therapy, which can work for certain types of nursing homes. Most patients will never need to receive intravenous therapy, so these homes still do well.
It is important to ask the admissions person at the nursing home you are thinking about going to identify their services. If you feel you may potentially need IV therapy, you should go to a nursing home that offers this service.
Macy Catheter. Nursing Home Residents: Addressing Dehydration. https://www.macycatheter.com/nursing-home-residents-addressing-dehydration/ Retrieved December 10, 2019
Provision of intravenous therapy in a skilled nursing facility. Journal of Intravenous Nursing. 1991 Nov-Dec;14(6):366-70. MEDLINE https://www.ncbi.nlm.nih.gov/pubmed/1748918 Retrieved December 10, 2019