Archive for home infusion


What is TPN?

TPN stands for Total Parenteral Nutrition.  What does that mean?  Healthy individuals get their nutrition via the digestive tract, or the “enteral” route.  Thus, “parenteral” means that a route other than the digestive tract is used to obtain nutrition.  TPN is ordered for patients who, for whatever reason, cannot obtain adequate nutrition through their digestive tract.  This could be because of a blockage or a leak in the digestive tract.  Some patients have absorption issues as well, perhaps due to short bowel syndrome.  In short, when the digestive tract is not functional, TPN is necessary for patients to maintain adequate nutrition.

TPN is administered into a vein, generally through a PICC (peripherally inserted central catheter) line, but can also be administered through a central line or port-a-cath.  Patients may be on TPN for many weeks or months until their issues resolve.  Throughout the course of therapy, patients may or may not be able to ingest anything orally; whatever the case, they will not get any substantive nutrition via the oral route.


Because patients are not getting any other true form of nutrition, the TPN formula needs to contain all of the essential nutrients a body needs to be healthy.  This includes proteins, carbohydrates, fats, electrolytes, vitamins, and minerals.  There are standard formulations that are available, and these are often what are used by large hospital systems.  Infusion Solutions, however, batches each TPN formula to meet the individual dietary needs of the patient.  This leads to optimal nutrition and a better chance of restoring health.

TPN bag

The TPN formula is monitored by the Infusion Solutions team, including pharmacists, nurses, and dieticians.  The formula can be adjusted as necessary based on lab markers and the progress of the disease state.  The rate of TPN administration can also be changed under some circumstances.  Generally, patients are initially started on a continuous cycle and are given their TPN over a 24 hour period.  As patients progress, it may be possible to move to an 18, 15, or even a 12-hour infusion cycle.  This can certainly improve the quality of life for those patients managing this infusion at home.

The TPN itself comes in a 2-3 liter bag, and most patients infuse one bag per day.  The bag itself is connected to a portable infusion pump that has been pre-programmed by the pharmacy team to deliver the TPN over a specified amount of time.  The whole system fits nicely into a small backpack that can be worn by the patient or hung nearby throughout the infusion.  As with all home infusion therapies, the intent is for the patient to be as mobile as he or she would like to accommodate their lifestyle.

tpn backpack

All therapies come with some inherent risk, and TPN is no different.  Caution must be taken to ensure that the PICC line and insertion site remain clean and free of infection.  Glucose abnormalities (hyper- or hypoglycemia) and liver dysfunction can also be a concern.  Patients on long-term TPN may be at risk for gall bladder inflammation and refeeding syndrome.  Essentially, there are issues that can arise when the digestive tract is not being used for prolonged periods of time, and so care is taken to mitigate or avoid these known complications.

Infusion Solutions has built a well-deserved reputation as this region’s foremost provider of TPN and other nutritional therapies.  If you have additional questions related to TPN or any other home infusion, please call our Bellingham office at 360-933-4892.  Additional resources can be found on our website:


Intrathecal pump

When a competing home infusion company abruptly stopped servicing intrathecal pump patients in our service territory, Infusion Solutions stepped up to provide this care. We completed the training and are now ready to lend a hand to those that can benefit. 

If you or anyone you know has such a pump, please reach out to us for assistance with managing the refills in the comfort of your own home.  Our nurses will come to your home and complete a patient assessment.  They can then access, interrogate, refill, and/or reprogram the pump according to physician orders.

If you are unaware of intracthecal pumps and would like to learn more, please read on.  We are happy to be able to provide this service to this group of patients!


The fluid filled space around your spinal cord is called the intrathecal space. Cerebrospinal fluid (CSF) flows through this area, bathing and protecting your brain and spinal cord. An intrathecal drug pump works much more efficiently than oral medication because it delivers medicine directly into the CSF, bypassing the path that oral medication takes through your body. You generally need about 1/300 the amount of medication with a pump than when taken orally.

The pump is a round metal device about the size of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a catheter, is surgically placed in the intrathecal space of the spine and is connected to the pump. A space inside the pump called the reservoir holds the medication. Some of the commom medications utilized are morphine, ziconitide, and baclofen.

In general, these pumps are used to better control either pain or muscle spasticity. Patients with cancer, failed back surgeries, cerebral palsy, and muscular dystrophy (among other conditions) may benefit from these intrathecal pumps. They can experience a great improvement in their quality of life, and be better able to function in their daily activities.

Medicare Coverage for Home Infusion

Ah, election time…how I love the hordes of direct mailers, the nasty negative campaign ads, and the elusive non-answers given to moderator questions at the debates. But yet there is hope at election time. Hope that there can still be change for the better, that our elected officials will overcome their political biases and work together for the better of all Americans. One easy fix for the slew of problems facing our nation’s health care system is to change Medicare guidelines to expand coverage for home infusion patients. We recently published an article explaining in detail how the lack of Medicare funding increases patient costs, puts patients at risks, and how it can be addressed by our lawmakers. We encourage you to reach out to your elected officials and let them know about this issue. Read on for the full text of the article.



Recently, we received a referral from Peace Health Hospital to provide intravenous antibiotics to a patient living in Blaine.  This gentleman was admitted to the hospital for endocarditis, which is an infection of the heart valves.  The standard treatment protocol includes 6-8 weeks of antibiotics delivered through an IV line.  Since the patient cannot stay in a hospital for that long (without racking up a huge bill), home IV services such as ours are asked to provide care for these patients in their homes.  It is safe, efficient, and cost-effective for the medical system.  Patients love it because they get to heal in the comfort of their own home environment.

Sadly, the patient in Blaine was covered by Medicare.  This means that he would not have access to home infusion services, because Medicare does not pay for a majority of the costs associated with the care.  Medicare Part D will help cover the costs of the drugs involved, but not the supplies, equipment, and pharmacy-related services that make up more than half the cost of the therapy.  This patient now had three choices: travel to and from the hospital out-patient facility everyday for his medicine; check into a skilled nursing home for 6-8 weeks; or pay us out-of-pocket for our services.

Since the patient lived in Blaine, driving to the hospital daily was not an option due to his health and the travel time involved.  And although our cash rates are fair, the patient did not have the funds to pay us for our services.  His one remaining option was to go to a skilled nursing facility, even though his wish was to be at home with a supportive family.

Why does Medicare put patients in this position?  Why would they cover the services at the hospital, at nursing homes, and at outpatient clinics, but not at home?  Virtually all national private insurance companies, state Medicaid programs, and managed care organizations (such as Group Health) provide coverage for home infusion, but Medicare itself does not.

For most insurance companies, the decision to cover is obvious.  First, the cost of home infusion is far less than the same therapy delivered at a hospital or a skilled nursing home.  Second, the data is clear that patients suffering from infection are far better off at home, as they are much less likely to experience secondary infections that may result in unnecessary re-admissions to the hospital.  And last, most patients who are able certainly prefer to be at home, which offers a psychological boost and can further expedite the healing process.

Medicare could save hundreds of millions of dollars annually, protect patients from the risk of re-infection, potentially shorten the duration of therapy, and vastly improve the quality of life for patients.  Instead, time and money is wasted, patients are put at risk, and the U.S. taxpayer continues to foot the ever-increasing bill.

The Centers for Medicare and Medicaid Services (CMS) is the governmental agency that oversees Medicare.  They do not have the authority to change the coverage criteria for Medicare beneficiaries.  Instead, it is up to Congress to enact this change.  Given the current economic climate and the need to control health care spending, you would think that your representatives would be eager to cast a vote which closes this egregious coverage gap for our seniors and disabled Americans.  It is a rare win-win for all sides–a great opportunity to maintain Medicare solvency and do what is best for patients.

It is always effective to contact your local, state, and national representatives to let them know about this issue.  Urge them to become a co-sponsor of the House (H.R. 2195) and Senate (S. 1203) bills already introduced by their colleagues in Congress.

And if you or anyone you know has been put in a similar situation due to the lack of Medicare coverage, please reach out to us at Infusion Solutions.  We would be grateful for the opportunity to share your story with elected officials and industry leaders to further the argument to enact change now.

When it comes to healing and health, there is truly no place like home.