Giving Factor at Home Through an IV

You have been asked to give your child factor at home through an IV (a tube that is placed in a vein using a needle). This information will tell you how to start the IV and how to infuse (give) the factor medicine through the IV.

Getting ready

• Pick a well-lit work area.
• Clean and disinfect your workspace. Use an alcohol prep pad or antibacterial cleaner.
• Wash your hands with soap and water. Dry them well.

Gather your supplies

These are the supplies you will need to start the IV and give the factor:

• One 1 mL Chloraprep® applicator (chlorhexidine gluconate 2% and isopropyl alcohol 70%)
• 2 saline flushes (prefilled 5 mL syringes)
• Butterfly needle with IV tubing attached
• Tourniquet (band that is used to squeeze the arm)
• Sterile gauze pads (several pieces)
• Self-stick bandage
• Empty syringes (5 mL or 10 mL, depending on the factor dose)
• Factor (powder) and diluent (liquid)
• 2 alcohol pads
• A piece of medical tape (about 2 inches long)
• Sharps container
• Wastebasket

Starting the IV

• Clean your hands again, using soap and water or an alcohol-based hand sanitizer.
• Open the butterfly needle package.
• With the cover still on the needle, attach your saline flush to the end of the butterfly needle tubing. Take care not to touch the connection points.
• Remove the cap from the butterfly needle.
• Slowly push the saline through the tubing until you see a drop on the tip of the needle. This is called priming the tubing.
• Lay the needle inside its package. Do not allow the needle to touch the work surface.
• Remove the plastic caps from the factor and the diluent.
• Use an alcohol pad to clean the rubber top on the factor.
• Use a second alcohol pad to clean the rubber top of the diluent.
• Mix the factor with the diluent according to the package insert.
• Fill the empty syringe with the correct amount of factor.
• Check the syringe for air bubbles. With the needle pointing upward, gently tap the syringe with your hand to make the air bubbles float to the top. Then, push the air out until you see a drop of factor at the top of the needle.
• Remove the saline flush from the end of the butterfly tubing.
• Attach the syringe with factor to the end of the butterfly tubing.
• Lay the butterfly needle with syringe attached, down on your clean work surface.

Find a vein

Place the tourniquet firmly around the arm. It should be about 3 inches above where the needle will be inserted. The tourniquet should be tight, but it should not cause discomfort.

Look and feel for the vein. Good spots to look are the back of the hand, back of the forearm, and the inside of the elbow. Start looking low and move up the arm as needed. If you do not see a vein, you can feel for one with your finger, not your thumb. If you are unable to find a vein, release the tourniquet and repeat the steps on the opposite arm.

If you are having trouble finding a vein:

• Have your child drink plenty of water.
• Have your child hang their arm down and pump their fist.
• Cover your child’s arm or hand with a clean, warm towel.

Once you find a vein

• Open the Chloraprep applicator and remove it from the package. Do not touch the sponge tip.
• Pinch the wings of the applicator to release the solution; you should hear a pop.
• Press on the skin to be cleaned 3 times. Then clean the area where the needle will be inserted with Chloraprep® in a circular pattern.
• Clean the skin for 30 seconds.
• Let the skin dry for 30 seconds. Do not blot or wipe. Do not blow on the cleaned skin. Let it air dry.
• Pick up the butterfly needle.
• With the bevel of the needle pointing up (see picture), insert it at a 15 to 30 degree angle to pierce the skin.

• Push the needle into the vein; you should see a small amount of blood enter the tubing. This is called a flashback, and it lets you know that the needle is in the vein.
• Once you see the flashback, stop advancing the needle.
• You can place a piece of medical tape over the base of the needle before you infuse the medicine to help keep the needle in place.
• Release the tourniquet.
• Infuse half of the factor by pushing the plunger into the syringe that is attached to the IV tubing. If your child develops pain or swelling at the site at any time during the infusion:
  • Stop the infusion and remove the needle.
  • Hold a gauze pad over the site with firm pressure until the bleeding stops.
  • Remove the syringe with factor from the end of the tubing.
  • Place the butterfly needle and tubing in the sharps container.
  • Start over with a new butterfly needle following the steps above.
  • Insert the new butterfly needle in a different vein.
• Halfway through the infusion, check for blood return by gently pulling back on the syringe plunger.
  • If you see blood return, infuse the remaining factor.
  • If you do not see blood return, slightly reposition the needle.
  • If there is still no blood return, remove the needle from the arm, then remove the syringe with the factor from the end of the tubing. Do not throw away the syringe with the factor. Place the butterfly needle in the sharps container and start over with a new butterfly needle.
• After infusing the factor, remove the empty factor syringe and attach a 5ml syringe with saline to the tubing. Flush with 3ml to 5ml of saline.
• Remove the butterfly needle.
• Apply pressure to the site with a gauze pad for 1 minute.
• Place the self-stick bandage on the site.
• Place the needle in the sharps container. Dispose of other used supplies in the regular trash.
• Wash your hands.

Reminders

• Your care team will teach you how to start the IV and give the infusion. If you are unsure about a step or have any questions, please ask.
• Rotate to a new site with each infusion.
• Always document the lot number, date, and time of every infusion in your factor log.

Questions?

If you have questions or concerns about giving factor at home through an IV, please call the Hematology clinic at 901-595-5041. If you are calling after hours or on the weekend, dial 901-595-3300 and ask for the nursing coordinator or the doctor on call. If you are outside the Memphis area, dial toll-free 1-866-278-5833 and press 0 when the call connects.