This article was medically reviewed by Dr. Marsha Kallich.
If you have been diagnosed with a chronic infection or are living with an autoimmune disease, the idea of taking medication to control symptoms and treat the condition is likely at the forefront of your mind. But you may be surprised if your doctor recommends that you receive treatment via infusion therapy.
Infusion therapy most commonly involves the intravenous (IV) administration of a medication or fluid, meaning it is introduced directly into a vein or catheter. Alternatively, it is sometimes provided through injection of the drug into muscle. Infusion therapy does not involve the better-known oral administration of medications.
The specific approach used depends on the disease being treated and the type of drug. These treatments, which can be performed in an outpatient facility, can be life-sustaining, but many patients are unfamiliar with the process of preparing for and receiving infusion therapy. If your doctor has suggested that you receive these types of infusions, you will feel more comfortable if you understand what to expect, as ID Care’s Dr. Marsha Kallich explains in this Infusion Therapy Guide for Patients.
While many patients associate infusion therapy with cancer, it can also be used to deliver medications for an array of other conditions. In many cases, this route is chosen because drugs given orally are administered at lower doses and are unlikely to be as effective as infused treatments.
Infusion therapy is also given when:
- Patients are unable to take medications orally.
- Preferred drugs only come in IV or injectable form.
- Prescribed medications will lose their effectiveness if digested.
- An illness is very severe or chronic.
- A medication needs to be introduced very quickly or very slowly.
- A patient is infected with highly resistant bacteria.
During the infusion therapy process, which for many patients involves a series of treatments, nurses use a catheter or needle to administer medications such as antibiotics or biologics into the bloodstream. Alternatively, some medications can be administered with an injection into skin, muscle, or fat. All of these medications are referred to as parenteral, meaning that they are given by a route other than the mouth.
Infusion therapy can be provided in several settings:
- Hospitals: Infusion therapy sometimes begins in a hospital, and then patients continue it on an outpatient basis after they have been discharged. These types of infusions may be given in nursing homes, as well.
- Infusion centers: These facilities are the most common settings for comfortable outpatient infusion therapy. Doctor’s offices and other outpatient facilities sometimes also offer it, as well.
- At home: Doctors sometimes allow patients to administer their own infusions at home, especially if these individuals are younger, working, and too busy to repeatedly visit an infusion center. Another option is for nurses to administer these in-home infusions.
Wherever infusion therapy is to be given, doctors must first check patients’ health histories and bloodwork to ensure that they are good candidates for this type of treatment and that they will receive the best medications for their needs.
Once underway, each session for an infusion or injection can take from half an hour to about 2 hours. These treatments do not hurt (other than the occasional mild burning from the medication or the quick pinch of an injection or an IV being started). ID Care seeks to make the experience even easier by providing comfortable reclining chairs, flat-screen TVs, free WIFI, bathrooms that are accessible throughout the process, and a highly trained, pleasant nursing staff to care for patients.
“The good news about infusion therapy is that it’s simple and comfortable for patients,” Dr. Kallich said. “Beyond coming for an initial checkup and then setting up their appointments, patients don’t need to plan ahead, fast, eat at a specific time, or bring anything, except maybe some reading material. All they need to do is show up and relax while we take care of everything — including following up with anyone who misses an appointment and monitoring to make sure treatment is going well so that our patients can achieve their intended results.”
What is an Infusion?
It’s important that an Infusion Therapy Guide for Patients answer a key and frequently asked question: What is an infusion?
Infusions introduce fluid medications directly into the bloodstream. Most often, infusion treatment involves IV therapy, in which medication enters the bloodstream through a needle. But alternatively, drugs can be infused into a vein through a catheter.
There are also several ways to inject fluid medications. Injections are much quicker than infusions and enter a different part of the body before they reach the bloodstream.
Injections can be given:
- Subcutaneously, where they are injected into fat or skin.
- Intramuscularly, where they are injected into muscle tissue.
- Into spinal cord fluid through a process called an epidural.
Most infusion therapy, including all medications that are considered biologics, is given intravenously. On the other hand, a smaller group of drugs, including treatments for osteoporosis and some for syphilis, are injected.
Preparing to Receive Infusion Therapy
If you have a condition that may benefit from infusion treatment, you will most likely be referred for this therapy by your hospital or doctor — in many cases a rheumatologist, urologist, or gastroenterologist. The infectious disease doctors at ID Care work in partnership with these physicians to treat patients. While specialists, such as rheumatologists, typically specify which medicine they want a patient to take, infectious disease doctors like those at ID Care use their expertise to choose antibiotics to treat infections, based on the individual’s condition and his or her laboratory culture results.
The process may be a bit different if you have cellulitis, as patients with this condition sometimes arrive at ID Care offices without doctors’ referrals but nonetheless can receive swift treatment.
If the referring physician has not done so, any patient sent to an ID Care doctor for infusion therapy will receive an evaluation, a set of tests, and instructions before infusion therapy is initiated to protect against the development of new health problems or side effects from the prescribed medication. “For instance, many biologics lower resistance to tuberculosis or hepatitis B, so if needed, we can start a prophylactic medication before infusion therapy to protect against the reactivation of these,” Dr. Kallich said. “In addition, it is important to establish a patient’s baseline functions, renal and hepatic, for example, to establish dosing and reduce the risk of toxicities or side effects.”
Doctors also take a thorough allergy history to help ensure that a patient won’t have an unexpected reaction to the drug selected for them, and they consult a list of the patient’s current medications to avoid drug interactions.
Depending on a patient’s condition, and especially in cases of cellulitis, infusions may begin on the same day an introductory appointment and testing occur. The schedule of infusions will depend on the drug being given and the patient’s condition, with some medications given only once, others administered twice a year, and still others every few weeks or months for a sustained period.
Choosing Whether to Have an Indwelling Port for Infusion
Whether to have an indwelling port temporarily implanted in the body versus having an IV started anew with each treatment is a personal decision between patients and their doctors.
While Dr. Kallich avoids establishing indwelling ports as frequently as possible to decrease the risk of infection or clot formation at the IV site, she said the decision often depends on how many infusion treatments a patient is expected to receive.
“If the therapy will be given just once every six months, as with osteoporosis treatment, then an indwelling port is not needed,” Dr. Kallich said. “But for someone who will be on antibiotics for six weeks for an osteomyelitis bone infection, it will be easier on them to have an indwelling port, because they won’t be getting stuck with a needle every day for 42 days.”
Patients considering an indwelling port should know that they will be encouraged to avoid heavy lifting, vigorous sporting activities, and getting the port wet.
If a patient is opposed to having an indwelling port or has a history of blood clots, starting a new IV for each session is a reasonable option.
The Most Common Conditions Treated with Infusion Therapy
No Infusion Therapy Guide for Patients would be complete without a discussion of the types of diseases that can be treated with infused medications.
Common conditions that require infusion therapy include:
- Congestive heart failure
- Dehydration or malnutrition
- Gastrointestinal diseases, such as ulcerative colitis and Crohn’s disease
- Immune deficiency disorders such as psoriatic or rheumatoid arthritis, multiple sclerosis, lupus, and psoriasis
- Infections, including sepsis, pneumonia, cellulitis, C. difficile, or those that affect the bones (often in the feet for diabetics), joints, heart valves, or the urinary tract
- Nausea, especially when profound, caused by treatments for other conditions
The Top Types of Infusions
Numerous types of medications can be given as IV-infused or injected therapies, depending on the health condition being treated, and ID Care facilities offer most of them.
Besides chemotherapy, the main categories of infused medications are:
- Antibiotics for infections
- Antifungals and antivirals
- Anti-nausea drugs
- Biologics, drugs produced from living organisms, for autoimmune diseases
- Bisphosphonates, which slow the breakdown of bone, and monoclonal antibodies, which introduce proteins that stimulate the immune system, for osteoporosis
- Blood clotting promoters or reducers for people with heart or blood disorders
- Corticosteroids for people with immune deficiency disorders
- Immunoglobulin, or plasma, to help the immune system fight disease in people whose bodies don’t manufacture it on their own
- Inotropic heart medications, which change the force of the heartbeat to treat conditions including congestive heart failure and hypertension
- Iron for anemia
- Nutrition formulas or saline for hydration
Some of these medications, such as antibiotics, may be started in the hospital before the patient moves to an outpatient setting. Others, such as osteoporosis drugs or immunoglobulin, are usually administered only in outpatient facilities.
While ID Care provides comprehensive infusion therapy by offering a substantial array of treatments across many conditions, there are a few therapies it does not administer — mainly chemotherapy and antibiotics that must be given several times per day. Although there is always a doctor on duty at every practice location, these medications are not offered because nurses are not available overnight to administer them.
Is Infusion Therapy Risky?
While infusion therapy is extremely safe, complications and side effects are possible due to either the medications given or the method of delivery.
At ID Care, infectious disease specialists and nurses take special care to avoid these issues, which include the possibility of infection in patients who have indwelling ports. Before and after treatment, the ports are cleaned and flushed by nurses with washed, gloved hands. “When not in use, we make sure these ports are tucked in so they will not get manhandled,” Dr. Kallich added. “We tell patients to steer clear of them.”
When it comes to the medications given, a patient may infrequently experience infusion therapy side effects such as an allergic reaction like a rash or hives. Nausea and fever also arise occasionally in patients taking infused medications.
Some medications cause side effects that don’t signal danger but can affect quality of life. ID Care doctors make sure to warn patients to expect these symptoms, such as bone achiness that can occur with osteoporosis treatment.
In very rare circumstances, the catheter used to administer the infusion therapy (eg PICC line or midline) can cause blood clots, blood vessel damage, or air bubbles in veins that stand in the way of blood flow and can lead to serious complications. But these situations are not usual with proper administration and oversight of treatments.
ID Care Offers Comprehensive Infusion Therapy
Across all the facilities that offer parenteral therapies, ID Care’s infusion centers offer particularly well-rounded treatment — every day of the year.
“Infusions are handled by highly trained nurses, and every patient is seen by one of our doctors for a checkup, health history review, and testing before the initiation of therapy,” Dr. Kallich said. “Furthermore, when patients embark on a prolonged course of therapy, doctors routinely check on their progress and monitor their bloodwork. There is always a doctor on premise, and one is called in if a nurse is not happy with a patient’s progress or notices that a new health issue has cropped up.”
At ID Care, patients learn about all their potential treatment options and settings, get answers to their questions, and are advised to look out for certain side effects that may signal complications — such as diarrhea, rash, and fever. Patients are also warned about medication side effects that do not indicate danger but can be surprising if unexpected.
Many people wonder: Can infusion therapy be done at home? ID Care can arrange that, although the practice has found that occasionally patients switch back to in-facility care after administering a few treatments on their own. Patients who stick with at-home care have an advantage with ID Care, because infectious disease doctors in the practice carefully monitor their progress.
For patients considering receiving infusion therapy at ID Care, Dr. Kallich offers her three top tips:
- Trust that ID Care can offer you a substantial array of services to treat a multitude of medical problems.
- Don’t be afraid, as the practice’s nurses and doctors will take very good care of you.
- Know that your ID Care medical team is committed to supporting the best possible health outcomes for you.
Doctors within ID Care are experts in outpatient infusion therapy as well as in preventing, diagnosing, and treating all infectious diseases. To learn more about ID Care’s infusion care or consult with an infectious disease doctor, call 908-281-0221 or visit idcare.com.