How do I care for IVs and tubes?

ACS Answer

Tubes and IV (intravenous) lines allow liquid medication to flow into the body. They are thin, flexible plastic lines that run from a bottle of medication into a tiny needle placed in a vein in your body. Some patients may have a small tube permanently placed in the chest. Special needles are then put into the tube. Some patients may have right atrial catheters that require no needles. People receiving chemotherapy, antibiotics, hyperalimentation, tube feedings, or oxygen at home may have to learn to use many tubes and IV lines. A home health nurse will help you learn how to tell the lines apart. Usually, chemotherapy and antibiotics are administered by a nurse who comes to your home. You and your family will be able to manage most other IV medications.

What to do

IVs

• Concentrate on only 1 set of lines at a time. If you become frustrated, just take a deep breath and start again.
• Color code each set of lines with colored tape. For example, blue for oxygen, red for chemotherapy, green for antibiotics, etc. Keep a record of what you have marked.
• For permanent IV sites (e.g., Hickman, Port-a-cath, Infusaport):
  • Carry clamps at all times.
  • If a tube breaks and you notice blood, clamp the tube above the place where the blood is leaking from and call your doctor immediately.
  • Shower with your back to the nozzle; change the dressing if it gets wet.
  • Watch for redness, swelling, pain, and tenderness at the site.
  • Use a calendar to record when you change injection caps and dressings and to note delivery dates, daily weights, and urine testing results. It is also helpful to record daily fluid intake and output.
• Keep IV site clean and dry.
• Wash hands well with soap and water before inspecting or touching IV site.
• Check the IV site daily:
  • Look for any tenderness, pain, redness, burning, swelling, or warmth. Also look for any decrease in the flow rate of IV; drainage; or temperature of more than 100.5F.
  • If any of the above symptoms occur, remove dressing and inspect the site, then carefully apply a new dressing, and report findings to your doctor.
• If the IV comes out or the site begins to bleed, call your doctor or nurse immediately.
• Keep a daily log of the procedures you performed.

Hyperalimentation (TPN or total parenteral nutrition)

• Your doctor or home care nurse will teach you how to begin and end each infusion.
• Infuse slowly overnight, so that you have more free time during the day.
• If you find that your sleep is disturbed by frequent voiding, TPN may be infused during the day or early evening.
• Preparation typically takes 45–60 minutes a day by someone who is trained.
• TPN is available premixed. It costs more, but it may be covered by insurance.
• Intravenous fat emulsions are usually given with TPN 2-7 times a week to provide essential fatty acids, and to increase calorie intake:
  • These can be infused by gravity (without a pump) in adults, but a pump is needed for children.
  • Fat emulsions can be needled into the TPN solution directly.
• Take TPN in a room near a bathroom so that you do not have to drag the pump too far. (Thick pile carpets slow down progress when walking with a pump.)
• The pump needs to be plugged into a 3-prong outlet, but adapters can be used.
• When fully charged, most pumps can run for 6 hours without needing to be plugged in.
• Use a clean work area for supplies.
• If possible, use a separate place in the refrigerator (or a separate refrigerator if possible) for IV solutions.
• Dispose of needles and syringes in a metal coffee can with a lid or in a specially provided container.
• Routinely check expiration date on all supplies.
• Fluid and electrolyte status will be monitored through blood drawn by the home care nurse.

Tube feedings

• Tubes may be temporary, such as the nasogastric (NG) tube, which runs from nose to stomach, or permanent, such as jejunostomy or gastrostomy tubes, which are surgically placed in the upper intestine or stomach.
• Tube feedings are best given at night.
• Feedings usually consist of products like Ensure or Sustacal:
  • Warm to room temperature before infusing.
  • Check placement of NG tubes as instructed by doctor or nurse.
  • Pour feeding into special IV bag.
  • Allow feeding to run through the entire tubing. Tap the tube to get rid of air bubbles. (It takes about 3–4 feet of air in the IV tube before problems are caused.)
  •  Attach tube containing feeding to NG, gastrostomy, or jejunostomy site. Tape the site.
  • Set pump to required rate.
  • Add more feeding to bag as necessary.
• Rinse tubes with water after the infusion is completed.
• Cap off the tube as instructed.
• Assess skin around tubes daily for redness, drainage, or skin breakdown.
• Apply petroleum jelly to the nostrils if NG tube is in place.
• Change tape at NG tube every other day.
• Weigh yourself daily and record the weight.

Do not

• Engage in an activity that may dislodge the tube or IV
• Take the IV out by pulling it up -- instead, slide it straight out
• Rub the IV site if it is bleeding
• Speed up infusion to finish on time (ask doctor or nurse how to handle this situation)
• Neglect to taper (gradually stop) infusion
• Go out with clamps if you have a permanent IV access site
• Shower if attached to pump; it is an electrical hazard
• Dispose of needles and syringes anywhere except in a metal can with a lid
• Forget to weigh yourself daily
• Forget to check expiration dates on supplies

Call the doctor about any of the following symptoms

• If you notice redness, swelling, drainage, pain, tenderness, or warmth at an IV site, or at the site of a permanent IV access device
• If your temperature exceeds 100.5°F
• If there is bleeding from the IV access site
• If you notice a change in the patient’s mental status (e.g., more tired, confused)
• If you become increasingly short of breath
• If you have diarrhea for more than 1 day

Related Resources

Find books that cover this and other cancer topics at the American Cancer Society bookstore.

Recommended Consultation

You should consider discussing this question with your doctor or health care team.

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