Home i.v. - peripheral venous catheter or butterfly

Question

Dear ladies and gentlemen,
I have just had a home i.v. therapy. As this has been my first i.v. therapy, I have been stayed 2.5 of the 14 days in hospital, the rest of the time at home. The infusion of daily 3 x 2g meropenem was running over the whole time through a peripheral venous catheter. I did not have any side effects due to the meropenem, however, the peripheral venous catheter had to be changed for 6 times altogether, as the catheter was blocked; a reddening or pain occurred or the infusion was running into the tissue. Often the vein was inflammed at discharge of the catheter.
I have now heard from my physiotherapist, that some patients get the i.v. therapy with a butterfly instead of a peripheral venous catheter, that is placed anew for each infusion and is afterwards immediately discharged.
My question is now: which of both methods can be recommended? With which method the danger of getting a long-term damage to the vein is the smallest?
I want furthermore to add, that a friend of mine who is physician would place the butterfly, so that you can assume that the infusion is done professionally.
Thank you for your efforts!

Answer

Hello,
in general, an i.v. antibiotic therapy is done via a peripheral venous catheter. This i.v. line has the advantage, that in case of several daily infusions, no further venous puncture is necessary and few "injuries" of the vein occur. Especially in case of the home i.v. and a three times daily drug infusion, a peripheral venous cather is of advantage, as otherwise professionals have to puncture the vein anew three times a day and also at the weekend. In case of a well placed catheter and a good care of the catheter (e.g. purging always satisfyingly with NaCl after the antibiotic application, probably also blocking with heparin), the vein catheters hold for 5-10 days. A good teaching of the patient as preparation for an ambulant i.v. therapy, that also implies the handling of the venous catheter, is a requirement for an uncomplicated course of an ambulant i.v. therapy.
It is known however, like it seems to be in your case, that a frequent change of the i.v. line can be necessary. In case no cause can be found for this, there is also the possiblitiy of a punction with a butterfly several times a day. This has the advantage, that also smaller veins can be punctered and used for the infusion, however, also disadvantages have to be mentioned here. Besides the problem that has already been mentioned above, that professionals have to be available at all days a week it comes in addition that not always the same location can be punctered and therefore many little injuries (14x3=42) come together with punctionning of different locations and can also lead to inflammations. In summary it can be said, that the performance of an antibiotic i.v. therapy with the help of butterflies is indeed possible, however presents in general a clearly inferior alternative compared to the peripheral venous catheter.
I hope to have answered your question and send you best regards,
Yours Dr. med. Christina Smaczny

14.01.2014