Outpatient IV Therapy Offers Better Options For Lyme Disease Patients

BRIDGEPORT — Patients who need long-term antibiotic treatment for Lyme Disease and extended intravenous therapy for other conditions can benefit from a new IV Therapy program at St Vincent’s Medical Center, according to Donna Caserta, RN, Intravenous Resource Nurse.

The program, known as POPS (PICC OutPatient Services), offers patients who need IV therapy for longer than seven days a convenient approach to treatment without overnight hospitalization.

Ms Caserta said she and her staff are working hard to let physicians and patients know that the service makes it possible to insert a PICC (peripherally inserted central catheter) line that can remain in an arm for up to a year.

Once inserted the PICC line enables patients to self-medicate and avoid unnecessary visits to hospitals or infusion centers. She said the Outpatient IV service is good news for patients because it is convenient, comfortable and quick. Appointments are scheduled within 24 hours of the physician’s orders, and procedures are performed in a comfortable setting in medical center.

Ms Caserta expects her team to insert about 200 PICC lines this year. In addition to those suffering from Lyme Disease, the extended IV therapy, facilitated by the PICC line, benefits patients diagnosed with osteomyelitis, cellulitis, MRSA (a bacterial infection) and endocarditis, as well as those undergoing certain chemotherapies.

 “Patients often come in nervous and don’t know what to expect. We take the time to explain the procedure and show them the equipment,” said Ms Caserta. “They’re pleasantly surprised when we perform the procedure. ‘It’s over already? That’s no so bad,’ they say.  Some fall asleep, rest or watch TV. Before they know it, we’re done.”

The catheter, a soft silicone tube, is inserted into the upper arm above the elbow. It is threaded through the large vein to the top of the heart. The end of the catheter that remains on the surface of the arm is held in place by a transparent dressing and closed by clips that can be easily opened when a patient injects the medication.

According to Ms Caserta, the entire procedure is quick and painless for the patient because the insertion is guided by ultrasound.  The skin where the PICC will be inserted is numbed using a special anesthetic cream, and a Novocain-tipped needle is then inserted with ultrasound guidance. After the procedure the patient goes for a chest X-ray to check that the end of the tube is in the correct position.

Once the PICC line is inserted, the patient can go to the St Vincent’s Infusion Center, where their first dose of medication will be administered. After that, a nurse will visit the home and show the patient and significant other how to do it for themselves.

Ms Caserta’s other team members include Erin Devlin, RN, Nancy Engel, RN, and Kim Matty, RN.

Michael Herman, MD, chairman of the Department of Medicine at St Vincent’s, serves as medical director of the program.

“Lyme Disease patients generally only require about 15 minutes a day to administer the antibiotic through the line,” she said, adding that care of the PICC line usually requires changing the dressing once a week, a task which can be performed by the support person.

Her staff is also available to coordinate follow-up with local home-care companies and to handle any issues on an outpatient basis.

The St Vincent’s program also inserts Midline catheters, which are shorter and can stay in a vein for up to two months. The type of medication and duration of therapy determine the type of catheter that will be inserted, said Ms Caserta.

Nursing home residents are also good candidates for the program. A facility’s medical director can simply write an order and transportation is provided by the extended care facility.

Ms Caserta said the new intravenous outpatient service has been well received by patients and is a “better, more effective way to administer antibiotics for Lyme Disease and other conditions. We saw a real need to do this. The patients and insurers love it. It’s a great resource.”

The Outpatient IV Therapy Program staff are PICC certified nurses with years of experience in PICC service.

For more information, questions about patient eligibility or to schedule an appointment, call Donna Caserta, IV Resource Nurse, at 203-576-5186, or send email to DCaserta@StVincents.org.