Home Infusion Services During Cancer Care

Home infusion is treatment given into a vein or under the skin at your own home instead of at a clinic. It usually runs through a catheter — a thin tube into a vein — and is controlled by an infusion pump.

FDA defines an infusion pump as "a medical device that delivers fluids, such as nutrients and medications, into a patient's body in controlled amounts." It confirms these are "in widespread use in clinical settings such as hospitals, nursing homes, and in the home."

There is more than one kind. FDA lists large volume pumps, patient-controlled analgesia pumps for pain, elastomeric pumps, syringe pumps, enteral pumps and insulin pumps. Some sit by a bed. Others, called ambulatory pumps, are "designed to be portable or wearable" — the kind carried in a pouch for days of continuous chemotherapy.

You are now doing at home what a nurse does in a clinic. The rest of this page is about doing it safely.

Call 911 for trouble breathing, chest pain, or collapse during or after an infusion. FDA's instruction is simple: "Call 911 for any health emergencies."

Call your team the same day for any of these. MedlinePlus lists them for central venous catheters, and FDA repeats the first one.

• A temperature of 100.4°F (38°C) or higher. That is CDC's threshold for people with cancer. CDC notes that "fever may be the only sign that you have an infection." Chills count too.
• Bleeding, redness or swelling at the catheter site.
• Pain near the site, or in your neck, face, chest or arm.
• A catheter that is leaking, cut or cracked.
• A catheter that has come out of the vein, or moved.
• A line that will not flush. MedlinePlus is firm: "Do not force it. Call your provider if it is not working."
• Shortness of breath or dizziness.
• A burning smell, sparks or a charred connector on the pump. FDA lists fire and electrical hazards among reported pump problems.

Get one specific thing in writing before your first infusion: the after-hours number, and who actually answers it at 2am.

Home infusion almost always involves three separate organizations, and they are not the same phone number.

Your oncology team prescribes and monitors. A pharmacy compounds the medicine and delivers it. A home nursing agency teaches you and visits. Each has its own hours, its own on-call system, and its own view of your record.

Medicare describes the pieces it pays for under Part B. Equipment and supplies count as durable medical equipment, including "pumps, IV poles, tubing, and catheters for infusion therapy." The services side covers what is needed to give the drug safely at home, including "nursing visits, caregiver training, and patient monitoring."

Get a named contact and a direct number for all three. Write down which one handles a pump alarm, which handles a blocked line, and which handles a missed delivery.

FDA sets out what training should look like. "Complete training on safe use of your infusion pump." Ask for a hands-on demonstration rather than a leaflet. "Consider inviting your family or other care partners to complete the training." And: "Ask questions and take notes."

Then: "Read your pump's Instructions for Use and User Guide and keep them handy." Learn what the screen shows when things are normal, what the alarm types mean, and what the error messages mean.

FDA also says to "work with your health care provider prior to setting up your infusion pump." Do not unbox it alone the night before.

These are FDA's own instructions for home use.

Check the medicine first. "Confirm that you are using the correct prescription medication." "Check all expiration dates before using a medicine." Know how it should be stored.

Then set up. "Wash your hands thoroughly for 20 seconds" with liquid soap. "Always place your pump and supplies on a clean surface." "Keep food and drinks away from the area around your pump." "Monitor children and animals when they are near the pump area."

One easily missed rule: keep phones and radio transmitters "at least six inches away from your pump."

During the infusion, do not walk away and forget it. FDA says to "monitor your pump during an infusion to be sure it is working properly" and to "note infusion start and stop times." Check the tubing for "leaks, kinks, twists, and disconnects." And check that "programmed rates and dosages match your medicine's label."

That last one is a real safety step. Read the pump screen. Read the bag label. Compare them out loud.

Change tubing on the schedule in your pump's instructions, not when it looks dirty.

FDA is direct: "Do not ignore alarms."

There is a documented reason for that emphasis. FDA's own list of reported infusion pump problems includes alarms that fail to sound when there is an occlusion or air in the tubing, and false occlusion alarms with no real blockage. It also names a trap that builds over weeks: "Warnings are displayed so often that users come to ignore them."

The same list includes software errors that display the pump as inoperable, keystrokes read as multiple presses causing a wrong rate, cracked casing after a drop, and batteries that overheat or fail early.

So: "Change batteries according to your health care provider's directions." "Always keep an extra supply of new batteries with you." Keep spares at home and spares in the bag you leave the house with. Plan for a power cut before there is one.

If you suspect over-infusion or under-infusion, FDA says to check the tubing and contact your provider.

The catheter is the part most likely to cause an infection.

MedlinePlus explains why flushing matters: "Flushing helps keep the catheter clean. It also prevents blood clots from blocking the catheter." Supplies are saline syringes, which are clear, and sometimes heparin syringes, which are yellow, plus alcohol wipes, sterile gloves and a sharps container. Wash your hands for 30 seconds. Push the saline slowly, in small pushes rather than one shove.

Dressings have their own schedule. MedlinePlus: "You should change the dressing about once a week. You will need to change it sooner if it becomes loose or gets wet or dirty." The technique uses two pairs of gloves — clean ones to take the old dressing off, sterile ones to clean the skin and put the new one on.

Every change is also an inspection. "Check your skin for redness, swelling, or any bleeding or other drainage around the catheter."

Water rules: keep dressings secure and the site dry, and "do not let the catheter site go under water if you are soaking in the bathtub."

Medicare covers home infusion therapy under Part B. You "pay 20% of the Medicare-approved amount" for both services and equipment, and the Part B deductible applies to equipment and supplies. What you actually owe varies with other insurance, whether the provider accepts assignment, and where the service is given.

Ask the supplier for the per-infusion cost in writing before the first delivery, not after it.

If the pump misbehaves, FDA wants it reported in three places, not one: "Your health care provider, Your pump supplier, The FDA online or at 1-800-332-1088."

That third report is the one people skip. It is how patterns across thousands of pumps get found.

• FDA — Infusion Pumps: Tips for Using Your Pump at Home
• FDA — Examples of Reported Infusion Pump Problems
• FDA — Infusion Pumps
• MedlinePlus — Central venous catheter: flushing
• MedlinePlus — Central venous catheter: dressing change
• Medicare.gov — Home infusion therapy services, equipment & supplies
• CDC — Watch Out for Fever (Preventing Infections in Cancer Patients)