Ganciclovir by IV : Gay & Black Glossary

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Ganciclovir by IV

Introduction

These are instructions for home IV Ganciclovir to clear up CMV (Cytomegalo Virus), an opportunistic infection that often hits people with compromised immune systems, such as transplant patients or AIDS patients. These instructions are conservative. We both pre and post flush and discard the primary tubing and bag each day and the secondary tubing and bag twice a day.

You need to know few terms:

primary
the large low bag containing dextrose solution used to flush the lines.
secondary
the small high bag containing Ganciclovir medication.
catheter
The thin blue tube on your forearm that runs up into a vein.
spike
The pointed end of the tubing that goes into the bag.
peripheral
An IV inserted usually into your forearm. The catheter is about 4 cm (1.57 in) long. It can be kept in up to 3 days. They can be placed in relatively small veins.
midline
An IV inserted usually into your forearm. The catheter is about 14 cm (5.51 in) long. They can be kept in up to a month. They need to be placed in a large vein. These are the most temperamental of the various types.
PICC
An IV inserted usually into your forearm. The catheter reaches almost to your heart. They can be kept in up to 3 months. They need to be placed in a large vein.
Groshong ™
An IV that enters your chest goes up under the skin to your jugular vein and then down almost to the heart. It can be kept in over a year. This is also the option when you have no suitable arm veins. The lawyers at Oblon, Spivak, McClelland Maire and Neustatt insist that I bore you with the following bit of trivia. GROSHONG is a trademark of C.R Bard Inc and its related company BCR Inc.

Materials

The hospital will provide almost everything you need, including a biohazard container, with the following exceptions. You will need to find these yourself: Check your supplies for the coming week. You will need:

Morning Ritual

Preparation

  1. Take the two bags you will need out of the refrigerator and allow them to come to room temperature. Cold infusion could shrink your veins.
  2. Clean your table with alcohol. Allow it to dry.
  3. Remove the white bandage from your arm. Save it to reapply later.
  4. Remove the tape so that the catheter stopcock dangles freely.
  5. Adjust the IV pole to the correct height.
  6. Wash your hands with anti-bacterial pump soap such as Germistat. Avoid touching anything unnecessarily once your hands are clean, e.g. your notes, the IV pole, a door knob, the phone, a light switch, a pen, a chair, the tape on your wrist, the bandage on your wrist, some scissors, a bed, your clothes, your face, your hair etc.
  7. Gather supplies. You will need:
    • primary bag of dextrose
    • secondary bag of Ganciclovir
    • two 10 ml syringes
    • two bottles of saline
    • primary and secondary tubing
    • Y connector needle adapter (built into secondary tubing for at-home use.)
    • 7 alcohol swabs
    • two red end caps
    • alcohol
    • tape
    • paper towels
  8. Open four alcohol swabs and leave them resting on their wrappers.

Setup Primary

  1. Close the primary clamp.
  2. Hang the primary dextrose bag on the lower hook. You can find the lowering hanger (a bar with hooks on both ends) for the primary in the secondary tubing kit.
  3. Remove and discard the blue plug from the primary bag.
  4. Remove and discard the primary tubing spike cover.
  5. Twist and push the primary tubing spike into the primary dextrose bag.
  6. Fill the primary drip chamber half full by squeezing it. Be careful not to overfill or you won’t be able to see the drips. If you do overfill, you an empty it by hanging the bag upside down and squeezing the chamber.
  7. Clear tubing of air. Don’t remove tubing cap!

Setup Secondary

  1. Close secondary clamp.
  2. Hang the secondary Ganciclovir bag high.
  3. Clean upper Y port on the primary tubing with an alcohol swab.
  4. Remove and discard the needle sheath on the secondary tubing.
  5. Insert needle on the secondary tubing into upper Y connector on the primary tubing.
  6. Before you attach the ganciclovir bag, back fill the secondary tube using the secondary clamp, until the secondary drip chamber is half full. Squeeze the secondary drip chamber if necessary. Be careful not to overfill or you won’t be able to see the drips. If you do overfill, you an empty it by hanging the bag upside down and squeezing the chamber.
  7. Remove and discard blue plug from the secondary Ganciclovir bag.
  8. Twist and push the secondary tubing spike into the secondary Ganciclovir bag.
  9. Replace the secondary Ganciclovir bag high on the hook.
  10. Ensure the secondary tubing is clear of air bubbles.

Pre Flush

  1. Clean the top of a saline bottle with alcohol. Allow it to dry. Then open it.
  2. Remove the syringe cap, setting the cap aside.
  3. Fill the syringe with saline by first squirting air into the saline bottle.
  4. Remove any air bubbles from the syringe.
  5. Replace the syringe cap.
  6. Clean the outside of the catheter cap with alcohol. Allow it to dry.
  7. Loosen the blue cap on the end of the primary tubing, but don’t remove it just yet.
  8. Remove and discard the red catheter end cap.
  9. Clean the catheter end with alcohol.
  10. Remove and discard the cap from the syringe.
  11. Attach the syringe to the catheter.
  12. Open the catheter stopcock.
  13. Briskly press the plunger. Don’t force!.
  14. Close the catheter stopcock.
  15. Detach and discard the syringe.

Run the IV

  1. Check that the primary and secondary clamps are closed and the catheter stopcock is also closed.
  2. Remove and discard the blue end cap on the end of the primary tubing. Be careful that the catheter end touches nothing while you are removing the blue end cap.
  3. Attach the primary tubing to the catheter. Attach only finger tight.
  4. Open the catheter stopcock.
  5. Leaving the secondary clamp closed, adjust the primary clamp to 7 drops every 15 seconds (100 ml/hour).
  6. If it won’t run you can try the following:
    • Make sure you are viewing the lower primary drip chamber. The secondary should be doing nothing at this point.
    • Check for kinks.
    • Check that the catheter is not twisted.
    • Check that you have the primary clamp fully open, not fully closed. Roll the wheel toward the big end of the clamp.
    • Check that the slide clamp is not impeding flow.
    • Check for incomplete connections.
    • Check that the catheter stopcock is open.
    • Apply gentle heat to your vein.
    • Try bending your arm in different ways.
    • Reflush with saline.
    • Extend the pole higher, or use a higher hook for the bag temporarily.
    • Relax. Panicking will shrink your veins and impede flow.
    • Give it time. Be patient.
  7. Let the primary run for 2 minutes. It won’t hurt to go longer, but don’t go shorter.
  8. Fully open the secondary clamp to allow the Ganciclovir to start flowing.
  9. Readjust the primary clamp to control the flow rate to 7 drops every 15 seconds. Too slow is fine, but too fast is not. It should run 60 minutes. Make sure you are viewing the upper secondary drip chamber.
  10. Monitor the rate and adjust as necessary, especially when you change positions.

Stop the IV

  1. When the Ganciclovir is complete, the flow will automatically switch to the lower primary dextrose bag.
  2. Close the secondary clamp.
  3. Continue to flush with dextrose from the primary dextrose bag for two minutes. It won’t hurt to go longer, but not shorter.
  4. Close the primary clamp.
  5. Close the catheter stopcock.
  6. Reclean your table.
  7. Rewash your hands. Avoid touching anything unnecessarily once your hands are clean.
  8. Open three alcohol swabs and leave them resting on their wrappers.

Post Flush

  1. Clean the top of a saline bottle with alcohol. Allow it to dry. Then open it.
  2. Remove the syringe cap, setting the cap aside.
  3. Fill the syringe with saline by first squirting air into the saline bottle.
  4. Remove any air bubbles from the syringe.
  5. Replace the syringe cap.
  6. Clean the outside of the catheter connection with alcohol.
  7. Disconnect the tubing from the catheter.
  8. Place a fresh cap on the end of the primary tubing. Hold the cap by the big end.
  9. Clean the catheter end with alcohol.
  10. Remove and discard the cap from the syringe.
  11. Attach the syringe to the catheter.
  12. Open the catheter stopcock.
  13. Briskly press the plunger. Don’t force!.
  14. Close the catheter stopcock.
  15. Detach and discard the syringe.

Wrapping Up

  1. Place a fresh red cap on the catheter. Hold the cap by the small end.
  2. Leave both bags and tubing in place for use in the evening.
  3. Make doubly sure the catheter stopcock is closed.
  4. Tape the catheter tube back to your wrist.
  5. Reapply the white bandage, padding the catheter stopcock and taping the bandage in place.

Evening Ritual

The evening ritual is identical with four differences:
  1. You have to first backflush and remove the old secondary Ganciclovir bag and secondary tubing and dispose of them in the biohazard bag. You replace the secondary tubing and Y adapter.
  2. You reuse the same primary tubing and same primary dextrose bag so that part of setup is not necessary.
  3. You don’t need to recap the tubing when you are done since you discard the tubing and bags.
  4. You must put all the bags and tubing in the biohazard bin rather than leaving them set up.
Gather supplies. You will need:

Chelation Therapy

Chelation therapy requires a similar procedure. Chelation is used to clean out the arteries and veins and to remove heavy metals from the body. It costs about $2000.00 CAD . However, if it were done it conjunction with other IV therapy, the additional cost would be negligible. Why not make chelation a routine addition to any other IV therapy except where contraindicated?

Disclaimer

I am not a medical professional. These are my notes I made from my 5-day instruction at St. Paul’s hospital with Trina Zubach in the summer of 2000, preparing me to handle the Ganciclovir IV at home for myself. You might use these notes as a base to create instructions for the procedures taught by your health care provider. Since equipment and procedures vary considerably between hospitals and even between IV specialists in those hospitals, use these only as a rough guide.

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