Understanding Intravenous Therapies for Chronic Illness

Advances in pharmaceuticals have resulted in intravenous (IV) therapies that can provide long-term relief for multiple chronic illnesses. Conditions such as Crohn's disease, ulcerative colitis (UC), multiple sclerosis (MS), rheumatoid arthritis (RA), migraines, and autoimmune disorders may be treated with IV therapy.

Often oral therapies no longer provide adequate symptom relief, and the provider will consider IV therapy. Dosing for IV therapy may occur annually, semi-annually or weekly. These infusions may replace daily oral medication therapies. 

Your provider should review the potential risks and benefits of any alternatives to your current regimen. Understanding this information will allow you to make an informed decision to proceed with the IV therapy.

When considering IV therapy, you need to complete your research thoroughly. Online studies may be found on the manufacturer's website regarding the effectiveness of their treatment. 

While these studies provide important information regarding the treatment, you should seek out non-biased sources of IV research information. For instance, websites that house these pharmaceutical studies include the National Library of Medicine.

Cost is another consideration for IV therapies. These medications have costs that can range up to thousands of dollars. Collaborating with your insurance provider to avoid unanticipated costs would be best. Dealing with insurance providers can be challenging, and many organizations that offer infusion services have specially trained individuals who specialize in obtaining medication prior authorizations.

It would be best to ask for an estimate when considering IV therapy. These may come from the location where the IV therapies will be administered or directly from the insurance provider. Additional options exist if you decide the cost is out of your budget. 

Many pharmaceutical companies offer patient assistance programs that range from copay assistance to free medications. Newer therapies may be available at little to no cost for you through clinical trials. These trials typically combine therapies, including an existing known effective treatment and the new therapy being studied.

Once you have decided to proceed with the IV therapy and the prior authorization has been completed, you will be scheduled for an appointment at an infusion center. Infusion centers may be part of a health system and are found in a hospital or outpatient setting. 

Independent infusion centers are also available for IV therapy. Your insurance provider will often specify which type of infusion center you must visit for your treatment. If an IV therapy has a high risk of an infusion reaction, you may be required to use a hospital infusion center. 

Once the first doses have been administered without difficulty, you may be required to move to an outpatient location to avoid additional fees. These fees are often termed "facility fees" and may range in price up to several hundred dollars. When scheduling your appointment, ask if the infusion center charges these fees and if your insurance provider will cover them.

Here are some tips to follow before your infusion:

• Be sure to stay well hydrated – this will promote dilation of the veins and may result in easier IV access for the team.
• Dress in layers and bring a blanket if you tend to get cold – the infusion will be at or below room temperature and will likely cause you to feel cooler during the procedure.
• Bring something to read or other activity to keep you occupied – some infusions may take several hours to complete.
• Share any previous reactions or issues with medications or IV therapy with the team – this will help them anticipate potential complications.

When you arrive at the infusion center, you will be taken to the procedure area. Most centers utilize recliners designed for infusions, while others may use a stretcher or hospital bed. 

Your height and weight may be checked as certain medications are dosed based on body surface area (BSA). Your vital signs (blood pressure, pulse, breathing rate and temperature) will be measured before the infusion.

The next step in the process is the insertion of an IV catheter. The team may use special equipment to visualize your veins, such as a Vein Finder or a special ultrasound machine. The catheter will be connected to a special container (bag or bottle) that contains the medication you are receiving. 

The container is then routed to the IV catheter through special tubing. Some medications may also require a special filter that connects to the tubing before the IV catheter. The team will then program an intravenous pump to control the infusion rate over the prescribed time. This time may vary from a few minutes to several hours, depending on the type of medication.

During the infusion, the team will closely monitor you for signs of an infusion reaction. You should report any shortness of breath, itching, back pain or anything unusual. The team will provide specific medications if an infusion reaction occurs, and the infusion may be resumed at a slower pace or canceled.

The team will seek the guidance of your provider for the next steps. While rare, severe infusion reactions may require additional treatment in an emergency room.

If the medication you are receiving is known to cause reactions, you may be given doses of Tylenol, Benadryl or a steroid as a means of prevention. If these pre-medications are administered, you typically wait at least 30 minutes before the infusion begins.

Your vital signs will be checked regularly, sometimes every 15 minutes, while the infusion rate increases. Vital signs will again be reviewed after the infusion. Some medications will require you to remain in the infusion center for some time after therapy completion to ensure no adverse effects. 

Depending on the medication, this observation time may vary from 30 minutes to a few hours. Be sure to ask the scheduler how long you should anticipate being at the infusion center for your therapy.

Once the therapy and observation periods are completed, the IV catheter will be removed, pressure held to the site to stop bleeding and a bandage applied. You will be advised to leave the bandage in place for a certain amount of time, up to 24 hours. 

You will be given patient education materials, including what to watch for after you leave the infusion center. Things to watch for may include shortness of breath, rash, itching, redness or drainage at the IV catheter insertion site.

Overall, IV therapies for chronic illnesses may provide long-term relief of symptoms from various medical conditions. Further, IV medications may be more effective than traditional oral medication and have a longer interval between doses. 

Steven Marshall Dr. Steven Marshall, DNP, MSN, BSN, RN is a freelance Health and Medical writer with over 35 years of health care experience. He has worked in clinical and leadership roles throughout settings, including critical care, emergency care, air and ground transport, inpatient rehabilitation, oncology, infectious disease, ambulatory care clinics, and infusion therapy. He founded See Doc Nurse Write in 2023 to provide content sharing his clinical knowledge and experience across larger audiences.  Read More