- Caring for the Patient With Cancer at Home: A Guide for Patients and Families
- Anxiety, fear, and emotional distress
- Appetite, poor
- Blood counts
- Blood in stool
- Blood in urine
- Fluids (lack of) and dehydration
- Grooming and appearance
- Hair loss
- Leg cramps
- Mouth, bleeding in
- Mouth dryness
- Mouth sores
- Nausea and vomiting
- Scars and wounds
- Shortness of breath
- Skin color changes
- Skin dryness
- Skin (pressure) sores
- Sleep problems
- Stomas (or ostomies)
- Swallowing problems
- Treatment at home
- Tubes and IV lines
- Weight changes
- When death is approaching
- To learn more
Tubes and IV lines
Tubes and intravenous, or IV, lines allow liquid medicines, fluids, and even nourishment to flow into the body. See the section called “Treatment at home” for more information on tubes and IV lines.
Intravenous (IV) lines are thin, flexible, plastic hoses that run from a bottle or bag of medicine into a tiny needle or intravenous catheter (a small, flexible tube) placed in a vein in your body. Some patients have a port (like a small drum) permanently placed in the chest or arm. Special needles are then put into the port. Some patients have long-term tubes (catheters) that require no needles.
Some medicines are injected into the catheter. Other medicines and fluids are given slowly (infused). The speed (rate) of the infusion is set by a roller clamp on the tube, by a balloon that squeezes out the medicine, or by an electronic pump.
Tube feedings give liquid food through a tube placed in the stomach or the small intestine. The tube may go in through the nose or through your skin and into the stomach.
Oxygen may be given through masks or little tubes placed just inside the nostrils (called a nasal cannula). Tubing connects the mask or cannula to the oxygen tank or oxygen concentrator.
An important difference between these types of tubes is that anything that goes in the IV line must be sterile (completely germ-free) to avoid putting germs into the bloodstream and causing infections. IV equipment is used only once. It must be handled carefully to keep germs out of the body. After it’s used, it’s thrown out and replaced with new, sterile equipment fresh out of the package.
Tube feedings and oxygen tubes are kept clean, but don’t have to be sterile. Tube feeding or oxygen equipment can be re-used as long as it’s used by the same person. When tube feeding bags need cleaning, liquid soap and water are fine.
People getting chemo, antibiotics, hyperalimentation (hi-per-al-uh-men-TAY-shun, also called total parenteral nutrition, or TPN), tube feedings, and/or oxygen at home may be faced with many tubes and IV lines that they must learn to keep track of and use safely. At first it may seem confusing, but you can master taking care of many tubes or lines. A home health nurse will help you learn. Usually, chemo and blood products are given by a nurse who comes to your home. You and your family will be able to manage most other IV medicines. If you can’t, other plans will be made to get treatment.
What the patient can do
- Focus on only 1 set of lines at a time. If you get frustrated, take a deep breath and start again.
- Color code each set of lines with colored tape. For example, red for chemo, green for antibiotics, etc. Keep a record of what you have marked. You might want to use blue tape on oxygen tubes to keep them clearly separate from the IV lines.
- For permanent IV sites (such as Hickman®, Port-a-Cath®, PasPort®, or Infusaport®):
- Keep extra clamps handy at all times.
- If a tube breaks and you notice blood leaking out, clamp the tube between your body and the leak and call your doctor right away.
- Shower facing away from the showerhead. If you have an electric pump, unplug it before showering or bathing to avoid an electrical hazard. Try to keep the dressing dry, and change it 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’s also helpful to record your daily fluid intake and output (how much liquid you drink and infuse, and how much urine you put out.) Your doctor or nurse will tell you what things you need to keep track of.
- Keep the IV site clean and dry.
- Avoid the temptation to speed up your IV medicines or fluids. Many IV medicines and fluids can harm you if they go in too fast.
- Wash your hands well with soap and water before touching the IV site.
- Check the IV site daily:
- Look for any tenderness, pain, redness, burning, swelling, or warmth; any slowing of the flow rate of the IV; or drainage (bloody, yellowish, or clear). Any of these might mean the site is getting infected or clogged.
- Be sure the tape is holding the IV in place and the dressing is clean and dry.
- Take your temperature each day to see if you have a fever. (See the section called “Fever.”)
- If you notice any of the above symptoms, take off the dressing, look at the IV site, and tell your doctor or home health nurse what you found.
- If the IV comes out or the site begins to bleed, call your doctor or nurse right away.
- Avoid activities that may pull out the IV or rub on the dressing.
- Keep a daily log of procedures performed.
Hyperalimentation (TPN or total parenteral nutrition)
- Your home care nurse will teach you exactly how to begin and end each infusion.
- Infuse TPN slowly overnight so that you have more free time during the day.
- If you find that you are having trouble sleeping because you need to go to the bathroom often, TPN may be infused during the day or early evening. It must still go in slowly.
- Intravenous fat emulsions are usually given along with TPN 2 to 7 times a week. They provide essential fatty acids and increase calorie intake. Fat emulsions can be added to the TPN solution through a port on the TPN tubing. These can be infused by gravity (without a pump) in adults. Your home health nurse will show you how to set the speed by using the roller clamp and timing it to give you the right number of drops per minute. A pump is needed for children.
- Infuse TPN in a room near a bathroom so that you do not have to carry the pump too far. Use a night light so that if you need to get up at night, you don’t trip over or pull the tubing.
- Most pumps are battery powered. Check with the home health nurse about how long the pump can run before new batteries are needed. Be sure that you have enough batteries for your type of pump, and know how to put them in.
- Keep a clean work area for supplies.
- If possible, use a separate place in the refrigerator (or a separate refrigerator if you have an extra one) for IV solutions.
- Throw away needles and syringes in a metal coffee can with a lid, in a bleach bottle, or in a used needle container provided by the home health team. Keep the container out of the reach of children, pets, and others. Your home health nurse will take it when it’s full.
- Always check the expiration date on all your supplies.
- Home health care nurses will draw blood samples to check blood counts.
- The tubes used for tube feedings may be short or long term. The nasogastric (NG) tube, which runs from nose to stomach, is short term. Jejunostomy tubes (J-tubes) or gastrostomy tubes (G-tubes), which are surgically placed in the upper intestine or stomach and come out through the belly, are for long-term use.
- Tube feedings are best given at night.
- Feedings are usually products such as Ensure or Sustacal.
- Give tube feedings at room temperature. Most do not need to be refrigerated.
- Check the placement of NG tubes as instructed by your doctor or nurse.
- Pour the feeding liquid into the special feeding bag.
- Allow the liquid to run through the entire tubing. Tap the tube to make air bubbles rise. (It takes about 3 to 4 feet of air in the tube before it causes problems.)
- Attach the tube containing the liquid food to NG, G-tube, or J-tube. Tape the connection.
- Set the pump to the required rate.
- Add more feeding liquid to bag as needed.
- Rinse tubes and bag with water after the feeding is completed.
- Cap off the tube as instructed.
- Feedings can also be given with large syringes instead of bags and tubing. Be sure you are comfortable using whichever method you are taught.
- Check the skin around the tubes each day for redness, drainage, or skin problems.
- Apply petroleum jelly (such as Vaseline) to the nostrils if an NG tube is in place.
- Change the tape at the NG tube every other day. Be sure the skin around the nose and nostril is not sore, red, or painful.
- Always keep the feeding tubes securely taped in place. If the tube seems to be coming out, tape it in place but don’t use it. Call your doctor or home health nurse to find out what needs to be done.
- Weigh yourself each day and write down dates and weights.
- Be sure you know how to turn the oxygen on and off and set the flow rate. Never increase the oxygen flow above the prescribed level.
- The nurse will show you how to use the oxygen mask or nasal cannula.
- Use a water-based lubricant, rather than petroleum jelly, on the lips and cheeks.
- If the nasal cannula rubs your upper lip, you can put a small piece of gauze or fabric under it for padding.
- Keep a new tank of oxygen available at all times. Even if you use an oxygen machine, you will need a small tank for when you leave the house and during power failures.
- If you use a tank, be sure it’s attached to a stable cart so it won’t fall or roll.
- Do not smoke or go near sparks or flames while using oxygen. Keep sparks and flames away from tanks, oxygen machines, and tubing.
What caregivers can do
- Learn as much as you can about how to use the tubes and equipment, and practice while the home health nurse is there to watch you. You may need to do these tasks when the patient can’t.
- Help the patient. At first, you will probably both feel more comfortable if you do these treatments together.
- Keep home health nurses’ phone numbers handy, and call when you have questions or problems.
- Be sure that the patient keeps all appointments.
- Watch for confusion, especially at night.
Call the doctor if the patient:
- Has redness, swelling, drainage, pain, tenderness, or warmth at an IV site or at the site of a permanent IV access device
- Has a temperature of 100.5° F or higher when taken by mouth
- Is bleeding from the IV or access site
- Can’t flush or use their catheter or tube
- Becomes confused, disoriented, or unusually drowsy
- Becomes more short of breath
- Develops a cough
- Has diarrhea for more than 1 day
Last Medical Review: 11/05/2013
Last Revised: 11/05/2013