Do you guys start peripherals at home?

Esme12, ASN, BSN, RN · Feb 4, 2012

When I worked home health we did but with PICC lines many agsancies have become hesitant. Have you tries another hospital that may be nearby? I would aslo call your local childrens hospital and ask for which agencies provide these services. Doesn't your pedi know?

JustBeachyNurse, LPN · Feb 4, 2012

Most of the cases in my area are referred to the local outpatient infusion centers (whether hospital, pediatric hospital, or freestanding facility based) for monthly peripheral IV infusions. My agency will consider peripheral IV dosing on a case by case basis and whether the case is one of our 'permanent' cases (daily care, long term) or a case that we only see once a month. It also depends on the duration of the infusion and what other assessments and/or monitoring is required. The opportunity may also be limited by insurance parameters and the ability to obtain the medication. (My agency does not supply medications, the patient's pharmacy does. Many local pharmacies cannot obtain specialty medications especially injectables and infusions due to availability, need, and lack of appropriate insurance reimbursement)

What did your pediatrician and/or referring specialist recommend? Was it your idea to do the home infusion or did the physician offer it as an option? If the physician suggested it as an option then he/she should be able to refer you to an agency that offers that service. You can also see if your insurance company has case management services that can help facilitate such a request/order.

cayenne06, MSN, CNM · Feb 4, 2012

It was our ped's idea, but we can't find an agency to do it.Even through our children's hospital, which is where we go now.

JustBeachyNurse, LPN · Feb 4, 2012

Sounds like you need to defer back to your pediatrician or your health insurance company. I can tell you some pediatric agencies use a lot of LPN's, and depending on the state scope of practice may limit initiating/maintaining IV lines.

If your daughter has been ill for so long, do you have a case manager/nurse case manager with your insurance company or even at the children's hospital? Sometimes they are the best source for knowing what is available and practical for your area. If there isn't a routine need for intermittent outpatient peripheral IV infusions that could also be the reason that no agency offers the service. It might not pay to maintain the skill in staff members if they aren't going to use the skill.

kids · Feb 4, 2012

If you haven't already, bust out the yellow pages and call every single agency. Be sure to check under Home CARE, not just Home Health. I started peripheral IVs and infused kids on a near daily basis for the Home CARE agency I worked (I recently moved cross-country) and for the last couple of years I almost exclusively did infusion related visits that were about 50/50 kids and adults.

The Home CARE agency I worked for didn't market themselves as providing infusion services yet we were the exclusive home infusion contractor for one university hospital's hemophilia program and were also contracted by a couple of nation-wide home infusion companies. I had the job and they got the contracts because I was (a) very comfortable with adults and kids (b) very competent with all aspects of home infusion and © I was willing to do it, lol.

caliotter3 · Feb 4, 2012

Once worked with a client who was receiving a nonapproved drug by IV. My agency warned me not to do anything with his central line, I wasn't even supposed to chart that it existed. One time I left the house as the IV nurse entered. I have no idea how the client obtained the IV nurse to do this service for him. I would imagine that whoever set him up with the medication helped him find someone to do the administration. I would ask the pediatrician to help you with this.

RachRN66 · Feb 4, 2012

I've been a home health nurse for a very long time. Yes, we start PIVs. Mostly for lasix protocol for CHF patients, but often we get a short term antibiodic in the home that we will do with a PIV. If the antibiodic is to last for longer than 3-4 weeks we generally contact the MD and ask if we can send them to radiology to have a PICC inserted. We also have an infusion clinic in the area that does more of the "monthly infusions", We seldom see those patients. But we have a few clients that can't get out to go to the infusion clinic, so we provide services for them. What you need to look for is a home health agency that has their own pharmacy (I work for a company like that) because as other posters have stated you are responsible for getting your own med through the pharmacy and if you use Rite-Aid, you may not be able to get the med in the home setting. Sometimes your insurance provider can be helpful. For example, they may contract with CareMark or other "national pharmacies" the may provide the med for you. There is a whole issue of what your insurance will cover in the home setting also. So you should check with them for assistance, and also check with discharge planners/social workers that work at your old hospital. And you could check with the "more local" hospital to see if they would consider administering the med on a monthly basis through out patient. [sorry....i just read OP again and see you did try the local hospital..are there any others nearby?] I hope you find what you need!

annaedRN, RN · Feb 4, 2012

some of the infusion companies have their own infusion nurses that may come out and provide that servcie for you.

PediLove2147, BSN, RN · Feb 5, 2012

I did private duty nursing and the kiddo I worked with got an IgG infusion once a month. We did nothing for it except give him Motrin beforehand. An infusion company came, put in a PIV and stayed for the infusion.