Name of the Procedure:

Home Infusion Therapy, Continuous Chemotherapy Infusion (S9330)

Common name(s): Home chemotherapy infusion
Technical/medical term: Continuous (twenty-four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.

Summary

Home infusion chemotherapy is a medical service that allows patients to receive continuous chemotherapy treatment at home over a 24-hour period or longer. This service includes everything from the medication and necessary equipment to the coordination of care and pharmacy services. Note that nursing visits and drugs are billed separately.

Purpose

Medical Conditions or Problems:

• Cancer or other conditions requiring continuous chemotherapy.

Goals/Expected Outcomes:

• To manage and treat malignancies effectively while allowing the patient to stay in the comfort of their home.
• To decrease the need for frequent hospital visits, potentially reducing the risk of hospital-acquired infections and improving the patient’s quality of life.

Indications

Symptoms or Conditions:

• Diagnosis of cancer requiring continuous chemotherapy.
• Intolerance or contraindications to intermittent chemotherapy dosing.

Patient Criteria:

• Stable clinical condition permitting home-based care.
• Reliable caregiver at home and ability to comply with medical instructions.

Preparation

Pre-procedure Instructions:

• Discuss all medications with healthcare provider to avoid interactions.
• Phone consultation with home infusion nurse to review the process.

Diagnostic Tests or Assessments:

• Blood tests to check organ function.
• Pre-infusion consultation to assess vein access and overall health.

Procedure Description

1. Insertion of Infusion Device:
   • A healthcare professional inserts a peripherally inserted central catheter (PICC) or uses an implanted port if already available.
2. Equipment Setup:
   • The infusion pump is programmed, and medication is prepared by a pharmacy.
3. Infusion Process:
   • Infusion pump and medication are delivered to the patient’s home.
   • A nurse or trained caregiver attaches the infusion pump to the catheter.
   • Continuous delivery of chemotherapy over a 24-hour period or more.
4. Care Coordination:
   • Ongoing monitoring, remote consultations, and coordination of ancillary services (e.g., delivery of additional medication).

Tools/Equipment:

• Portable infusion pump, infusion sets, PICC line or port, sterile dressings, medications.

Anesthesia/Sedation:

• Not typically required for the process at home.

Duration

• Continuous administration over a period of 24 hours or more.
• Therapy duration depends on the prescribed chemotherapy regimen.

Setting

• The procedure is primarily performed in the patient’s home.

Personnel

• Registered nurses specialized in home infusion.
• Pharmacists for medication preparation.
• Healthcare provider (e.g., oncologist) for overall care coordination.

Risks and Complications

Common Risks:

• Local infection at catheter site.
• Occlusion or dislodgement of the catheter.

Rare Risks:

• Severe allergic reaction to chemotherapy.
• Line sepsis or systemic infection.

Management:

• Routine monitoring by home care nurses.
• Immediate contact with healthcare provider if complications arise.

Benefits

Expected Benefits:

• Improved convenience and comfort by staying at home.
• Reduced hospital visits and associated costs.
• Potentially lower risk of hospital-acquired infections.

Realization:

• Benefits are typically noticed after the first few rounds of therapy, contingent upon individual response.

Recovery

Post-procedure Care:

• Regular follow-up appointments with healthcare provider.
• Careful monitoring of infusion site.

Recovery Time:

• Varies depending on individual response and specific treatment regimen.
• Generally, no significant downtime beyond the normal side effects of chemotherapy.

Restrictions/Follow-Up:

• Avoid strenuous activities; ensure cleanliness around the catheter site.
• Adhere strictly to follow-up schedules with the healthcare team.

Alternatives

Other Treatment Options:

• In-hospital or outpatient clinic-based chemotherapy.
• Oral chemotherapy, if applicable.

Pros and Cons:

• In-Hospital:
  • Pros: Close monitoring, immediate access to emergency care.
  • Cons: More time-consuming, higher risk of hospital-acquired infections.
• Oral Chemotherapy:
  • Pros: Convenience, no need for infusion.
  • Cons: Not suitable for all chemotherapy drugs, adherence issues.

Patient Experience

During the Procedure:

• May feel minor discomfort during catheter insertion.
• Generally should feel minimal discomfort during continuous infusion.

After the Procedure:

• May experience side effects typical of chemotherapy (e.g., fatigue, nausea).
• Home care nurse provides instructions for self-care, pain management, and addressing potential discomforts.

Pain Management and Comfort Measures:

• The healthcare team will outline appropriate measures for managing pain and maintaining comfort during the treatment process.