Heplock to home hospice?

[BmoreRN82]

Can patients be discharged from the hospital to home hospice with a peripheral IV/heplock? We had a patient who was receiving pain meds via IV therapy and late into the day, the family and case manager decided to initiate steps to get the patient sent home that night. An agency accepted the patient and were sending a hospice nurse to his house that same night. We were divided about whether we should keep a heplock in for immediate use by the hospice nurse or if we should remove it. I ended up just removing the IVs to err on caution. If given MD orders, would it have been ok to send the patient to home hospice with a heplock?

[Call me Al]

In my hospice, we evaluate a pt before they are discharged to determine if they are hospice appropriate and what kind of pain control they will need before they are sent home. We would have also communicated to the hospital nurse to get an order to keep the hemlock if it was needed. Typically, if the pt needed IV pain meds they would have been sent to our inpatient center and not home. Thank you for considering the hospice nurse and the needs of the pt. I think you did the right thing to take it out.

[Anna Flaxis, BSN, RN]

Absolutely, they can! There is a good chance the hospice patient will be receiving home infusion services, whether through hospice or through a home infusion service, and having the heplock already in place will save the patient a poke or two to get a new one started. Whether the longer term plan is to do something different like using orals, an implanted pump, or subcutaneous infusions, at least having a heplock in place at discharge and when the hospice service is initiated will give them the short term option of initiating IV pain control right away. You will need a physician's order to leave it in place, and make sure that the catheter is well secured and wrapped to prevent dislodgment, that patient and family teaching with verbal repetition of your instructions is done, and an assessment of the PIV is documented.

[RNsRWe, ASN, RN]

Absolutely, they can! There is a good chance the hospice patient will be receiving home infusion services, whether through hospice or through a home infusion service, and having the heplock already in place will save the patient a poke or two to get a new one started. Whether the longer term plan is to do something different like using orals, an implanted pump, or subcutaneous infusions, at least having a heplock in place at discharge and when the hospice service is initiated will give them the short term option of initiating IV pain control right away. You will need a physician's order to leave it in place, and make sure that the catheter is well secured and wrapped to prevent dislodgment, that patient and family teaching with verbal repetition of your instructions is done, and an assessment of the PIV is documented.

Interesting how different this is than when I worked the floor (and discharged to home hospice) a few years back. At that time, the answer was an absolute, unequivocal NO. The thinking was that if this patient needed IV anything, a PICC line should be placed. Peripheral IVs were to be removed and replaced q3days (if not before for signs of compromise); if one was already in place and we sent him home with that, what was the guarantee that a nurse would be there to see it to assess and change within the next 48 hours?

Ultimately, the peripheral IV was always removed and either replaced with a PICC or IV meds d/c'd in favor of orals, supps, etc.

Maybe it matters what facility or State; maybe my info is now outdated. Either way, interesting to read.

[VANurse2010]

Interesting how different this is than when I worked the floor (and discharged to home hospice) a few years back. At that time, the answer was an absolute, unequivocal NO. The thinking was that if this patient needed IV anything, a PICC line should be placed. Peripheral IVs were to be removed and replaced q3days (if not before for signs of compromise); if one was already in place and we sent him home with that, what was the guarantee that a nurse would be there to see it to assess and change within the next 48 hours?

Ultimately, the peripheral IV was always removed and either replaced with a PICC or IV meds d/c'd in favor of orals, supps, etc.

Maybe it matters what facility or State; maybe my info is now outdated. Either way, interesting to read.

The policy where I work now is that PIVs may remain in place as long as they are patent and show no signs of infection or discomfort for the patient.

[tnbutterfly - Mary, BSN]

Thread moved to the Hospice Nursing forum. Hopefully some of our hospice nurses will give input regarding policies where they work.

[TammyG]

We prefer not to take a patient with a peripheral IV, but will certainly do so if there is a good reason and if the IV is in good shape and we will have enough nursing coverage to properly monitor. I can't recall a recent patient receiving home IV through a peripheral, though I suppose there could be if there is very limited IV infusions needed in the near term.

[toomuchbaloney]

Hospice actually prefers not to use peripheral IVs as they are too easily dislodged or compromised. Most of the continuous infusions employed in the field can be delivered subcutaneously and all of the agencies I have worked with prefer that route. It is fine that you took it out but most agencies wouldn't have had a problem with it's presence and would have made use of it as necessary while it was patent and functional.

It is unfortunate that you didn't have clear guidance from the admitting hospice team relative to what would be helpful and what should be dc'd. As a previous poster mentioned, the receiving agency is generally in contact with the discharging facility to help coordinate the transition.

I have hydrated hospice patients using peripheral IVs when they have gotten viral infections during their care and become dehydrated. Visiting children are often responsible but they are SO worth it.