Did you figure this out yet? If you didn’t, not to worry about it. It’s not something we hope you will have any personal experience with but if you do, it can be life saving. That is the lead article for July’s issue of The Mortar & Pestle.
HPTP is the acronym for the home parenteral therapy program. If you know of anyone who has had to be on an intravenous antibiotic therapy for anywhere from two weeks to two months, they have had the benefit of the home parenteral therapy program or HPTP for short. This is reserved for those patients with serious bacterial infections that will not respond to standard oral therapy and must be placed on a regimen that has the antibiotic delivered directly into the blood stream. As mentioned this therapy may be as short as two weeks after hospital treatment, followed usually by a course of oral antibiotic therapy. Depending on the severity of the infection, therapy can be much longer and it is not unusual to see intravenous therapy of this nature continued for two to three months.
Thankfully there are small, portable computerized intravenous pumps that are programmed to deliver antibiotic at a defined rate necessary to maintain an adequate antibiotic blood level. Usually the pump is connected to an intravenous bag containing antibiotic mixed in normal saline (sodium chloride 0.9%) or dextrose 5% in water (D5W). The computer will deliver the antibiotic infusion, according to a programmed schedule. In order to keep the vein being used open, the pump never stops the flow but will maintain a minimum flow of intravenous mixture so there is always at least a low rate of intravenous fluid flow being maintained followed by the more rapid infusion of fluid at timed intervals.
The little pump with antibiotic filled bag is carried with the patient at all times in a small “fanny pack-like” pouch and belt, that has the pouch slung at the waist and turned around so it can be accessed easily in front of the patient wearing the small kit. The antibiotic filled intravenous bag is prepared by our pharmacy according to the physician’s orders while the programming of the pump is looked after by the Homecare nursing staff. The patient’s responsibility, depending on their own comfort level, would be the change the bag each day and otherwise to continue with their daily routine, even if their activity level has been reduced.
It should be mentioned that there are occasions when the patient does still go into a clinic setting for their antibiotic dose. Recently, Lethbridge Homecare took over the responsibility for HPTP so there are a few patients who do make the daily trip to Homecare to receive their antibiotic dose which is more often an intramuscular injection of a small volume of antibiotic solution. This is usually reserved for shorter courses of antibiotic therapy, with the larger majority of patients receiving their intravenous antibiotic via continuous infusion by programmable pump as previously described.
This is a far cry from previous practices where the patient is either in hospital hooked up to an intravenous bag that feeds the intravenous antibiotic solution by gravity, which then requires a bag change two to four times daily. Alternatively, the patient makes a trip into the hospital emergency department or outpatient clinic to receive their intravenous antibiotic dose. This could require multiple trips into the hospital emergency department.
The second article in this month’s newsletter is very timely and important to us all – Fighting Antibiotic Resistance.