Forum topic

 Anne Marie, I think I went to a class in Emmeryville where you were one of the presenters ( many years ago). Anyway I have been a hospital PICC nurse since 1989 and have worked PD as a home infusion nurse for thirteen years now. We change our caps every seven days and prn on all CVCs in the home setting. We also have the same policy in the hospital that employs me. home care patients often are authorized for only a certain number of visits. In the first week of treatment (for therapies like abx and TPN) they are often allowed only 1-2 visits. After week one many payors will only allow one visit and if we are lucky 1-2 prn visits. If the patient requires more or if there is an unanticipated visit the agency often has to absorb the cost. Luckily,I have always worked for agencies that though they are aware of the guidelines have always put their patients first. I understand some are not this way. One agency that I know of will only take patients that can come into an infusion office, That way they save lots of money (decreased nursing time and especially travel time) and make their money on the drug and therapy.  I often find that the patients and caregivers (if well trained) often take better care of their CVCs than some of the nurses (sorry to say). In addtion,the CVCs are not be accessed by multiple nurses and multiple multiple times like they are in the hospital setting. They often look much better than the caps I change weekly in the hospital.