Intravenous Drug and Nutrition Therapy

Intravenous therapy involves the introduction of fluids directly into a person’s bloodstream through a vein. It’s the fastest way to deliver medications and nutrients, which is why it’s the most common parenteral method of administering them. The word “parenteral” simply refers to any method that doesn’t involve the digestive tract. A person might require parenteral medications or parenteral feeding if they have a medically complex condition that prevents them from eating or taking medications orally, if rapid onset of the medication is necessary, or if the medication must be administered in a controlled way over time. Some intravenous drugs are also administered that way because if they are taken orally, they will be broken down by stomach enzymes before they can take effect.

In preparation for intravenous therapy, an IV catheter is inserted into a patient’s vein, so that healthcare providers can access it continuously without having to insert a needle multiple times. The IV fluids can then be delivered through an injection with a syringe, or via infusion therapy (also known as a drip), which uses the force from gravity to deliver the medication over a period of time. Infusion therapy is most commonly used to treat serious, complex, or chronic conditions that cannot be treated with oral medications, including cancer; diseases of the gastrointestinal tract; dehydration caused by nausea, vomiting, and diarrhea; and infectious diseases that respond best to parenteral medications, such as Osteomyelitis.

Long-term intravenous medication therapy and parenteral feeding usually require a central venous catheter (CVC), which can stay in place for weeks or months and is inserted into a vein in a person’s neck, chest, arm or groin. There are three main types of CVC: a tunnelled catheter, an implanted port and a peripherally inserted central catheter (PICC).

Many medications can be given intravenously. Some of the most commonly administered intravenous drugs are:

• Chemotherapy drugs
• Intravenous antibiotics
• Antifungals
• Pain medications
• Drugs for low blood pressure
• Immunoglobulin medications

IV antibiotics may be necessary to fight infections caused by wounds, as well as infectious diseases like pneumonia, meningitis, osteomyelitis and bacteremia. Antibiotics for sepsis are also commonly administered intravenously.

Parenteral feeding is the intravenous administration of nutrition for people who cannot eat, digest or absorb food. IV fluids for parenteral feeding may include protein, carbohydrates, fats, sugar, minerals, electrolytes, vitamins and other trace elements.

Some conditions that might make parenteral feeding necessary are:

• Crohn’s disease
• Cancer
• Short bowel syndrome
• Ischemic bowel disease

IV antibiotic therapy and other intravenous medication regimens may be administered individually, together, or in conjunction with parenteral feeding. In long-term acute care settings, patients often require one or more forms of intravenous therapy, including antibiotics, cardiovascular medications, total or partial nutrition, pain relievers and sedatives.

Complications of Intravenous Therapy

Intravenous therapy is generally safe, but it can cause both mild and severe complications, including:

• Infection at the injection site — this can lead to fever, chills, redness, pain and swelling.
• Damage to the vein or blood vessels at the injection site — if the parenteral medication leaks through a damaged vein, it may cause damage to the surrounding tissue.
• Air embolism — if air gets into the syringe or the intravenous medication bag, it may enter the patient’s bloodstream and cause a heart attack or stroke.
• Blood clots — intravenous therapy can cause blood clots that may block important blood vessels, leading to tissue damage or death. A deep vein thrombosis is one type of dangerous blood clot that can be caused by intravenous therapy.

The most common side effects of parenteral feeding include:

• Changes in heartbeat
• Confusion
• Convulsions or seizures
• Difficulty breathing
• Fast weight gain or weight loss
• Fatigue
• Fever or chills
• Increased urination
• Memory loss
• Stomach pain
• Swelling in hands, feet or leg

Intravenous therapy, especially in the form of IV antibiotics and parenteral feeding, is often necessitated by an emergent or medically complex condition like sepsis, so the benefits outweigh the relatively small risk of complications in almost all scenarios.

Intravenous Therapy and Recovery

Medically complex conditions that require intravenous therapy — whether in the form of parenteral medication, parenteral feeding or IV fluids — can involve many parts of the body and require thorough oversight and management from a healthcare provider.

If you or a loved one are in need of intravenous or infusion therapy, Kindred Hospitals could be the right choice for you. Our interdisciplinary team approach to care ensures that patients receive the right intravenous treatment at the right time to facilitate their recovery and ease the transition from hospital to home.

Intravenous therapy at Kindred might be the best course if you or a loved one require parenteral administration of IV therapies including:

• Total or partial nutrition
• Sedation
• Cardiovascular medication
• Anticoagulation
• Antibiotics

“When a person requires intravenous therapy for IV antibiotics, fluids, or nutrition, they’re often very sick or need medications for a long period of time,” says Dr. Dean French, Chief Medical Officer. “Oftentimes, these patients have medically complex conditions and require care from a variety of specialists and physicians. At Kindred, patients who are receiving intravenous drugs and parenteral feeding are given an extended recovery window and are cared for by an interdisciplinary team of physicians and nurses that create individualized care plans based on the specific needs of each person. This gives every patient the best chance for a successful recovery.”

Success Spotlight: Keysha's Story

Keysha lived at home until a bout with the flu led to her developing serious lung problems and difficulty breathing. She was admitted to a general hospital and physicians began to treat her for severe caloric malnutrition as well as pneumonia. She was placed on a ventilator to assist her breathing and given a feeding tube to deliver much-needed nutrition to aid her recovery.

After Keysha had been weaned from the ventilator and stabilized, she was transferred to Kindred Hospital for ongoing dietary management, medical care and rehabilitation. At first she was extremely weak and deconditioned and required assistance from her caregivers for the majority of her needs and mobility. Also complicating her recovery was the fact that Keysha had no appetite. This required the feeding tube to be left in place; however, once she began participating in physical and occupational therapy she regained her appetite and made excellent progress with her dietitian, progressing to finally being able to have the feeding tube removed.

In the rehab gym, Keysha always brought with her a positive attitude that was noticeable and brightened up the room every time she came in. Aided by her unwavering dedication to recover and a great deal of motivation from family and staff, Keysha made a full recovery and was able to fully regain her independence and mobility as she continued to get stronger with each passing day.

“To everyone I have had the pleasure of meeting, you are the best!” Keysha affirmed just before she was discharged home to be with her family once again. “You demonstrate your dedication to your job by encouraging your patients to do just a little bit more until you reach your goal without becoming anxious by taking it one day at a time.”

Success Spotlight: Simyoulim's Story

“I was told I had six months to live – without my doctor and all my caregivers I wouldn’t be here today.”

Simyoulim came to Kindred Hospital about six months after being told she had only this amount of time to live due to the breast cancer that had metastasized throughout her body. Her primary oncologist who recommended that she come to Kindred had been treating her with chemotherapy, and after her long struggle Simyoulim was in a very delicate condition, depending on a ventilator to support her lungs, a feeding tube for nutrition and IV lines to administer medication and fluids.

At the beginning of her stay at Kindred, Simyoulim was treated by her respiratory therapists, started a course of IV antibiotics and began receiving much-needed nutritional support. Her caregivers also managed the drainage tubes in her chest and closely monitored her heart as she was suffering from an irregular heartbeat. With her mother and brother at her side, and with abundant support and encouragement from her team of caregivers, Simyoulim slowly began to regain her strength and reached a major milestone when she was able to be successfully weaned from the ventilator.

Simyoulim’s speech pathologist ensured that she was able to swallow safely and use her voice again. This enabled Simyoulim to begin drinking and eating a modified diet at first, leading to a normal diet and being able to have the feeding tube and IV lines removed. Other major accomplishments included regaining the ability at first to sit up then get out of bed, and then walk and even climb stairs unassisted in the therapy gym. Her physical and occupational therapists were instrumental in helping Simyoulim regain her mobility and independence over the tasks of daily life and her positive attitude once again drew everyone to her side, helping her reach her next milestone.

By the time Simyoulim was discharged from Kindred to return home she was a different person and looked forward to some normalcy once again. “My mom and brother were my number one supporters,” Simyoulim expressed. “But everyone helped me fight my illness and my oncologist found solutions and was there for me from day one. I was told I had six months to live – without him and all my caregivers I wouldn’t be here today.”

“There isn’t just one person that we can thank in particular because everyone was special and helped my daughter so much,” Simyoulim’s mother acknowledged. “Her doctors, therapists, nurses, CNAs and her speech therapist were incredibly helpful and I could tell that everyone loved my daughter.”