COMPOUNDING – UNIQUE SOLUTIONS FOR INDIVIDUAL NEEDS

Total parenteral nutrition (TPN) therapy provides intravenous nutritional support for patients who cannot ingest food. A patient who suffers from a poorly functioning gastrointestinal tract or whose disease state requires bowel rest benefits greatly from this therapy. TPN therapy provides a source of protein, carbohydrates, fats, minerals and vitamins to provide optimal nutrition to ensure healing and wellness.

Whether adult or child, formulations can be modified to provide for each patient’s individual fluid, electrolyte and caloric needs. We work closely with each patient’s doctor and dietician to meet their nutritional goals.

Disease states that may require TPN therapy include:

• Pancreatitis
• Crohn’s disease or ulcerative colitis
• Bowel obstruction
• Short bowel syndrome

Please contact a Carmichael’s representative to discuss any TPN therapy needs, to request additional information or to check your insurance or other available coverage.

Intradialytic Parenteral Nutrition (IDPN) therapy is a valuable source of protein and calories for chronic hemodialysis patients who, despite aggressive oral supplementation, still develop decreased albumin levels, weight loss and muscle loss.

Malnutrition is of great concern in dialysis patients because of its association with morbidity, increased hospitalization and mortality. Studies have documented that 20%-60% of chronic hemodialysis patients are malnourished. Low serum albumin levels are one of the strongest predictors of survival in both peritoneal and hemodialysis patients. Improving nutritional intake in this population typically has been difficult or unsuccessful. Even after correcting anemia and inadequate dialysis, many patients remained malnourished. Studies have suggested that patients on dialysis and patients with albumin levels less than 3.4 have benefited from the addition of IDPN therapy.

Services – Our clinical team of pharmacists, technicians and nurses can derive individual formulation to provide for each patient’s individual nutritional needs and the following:

• Direct delivery to the dialysis unit in an efficient and timely manner;
• Intravenous (IV) pumps, poles and tubing for administration;
• Refrigeration for proper storage of IDPN, upon request; and,
• 24 hours a day on-call services.

Benefits:

• Improvement in patient’s appetite, strength and overall well-being;
• Replacement of nutrients lost during the dialysis process;
• Increase in dry body weight;
• Increase in serum albumin levels;
• Decrease in overall hospitalization rates; and,
• Improvement in wound healing outcomes.

Criteria for Initiating IDPN Therapy (Oral supplementation should be attempted prior to initiating IV nutritional support):

• Albumin levels less than or equal to 3.4 gm/dL; or
• Prealbumin levels less than 15 mg/dL; or
• Serum creatinine less than 8mg/dL; or
• Weight loss greater than 10% of estimated ideal body weight or greater than 20% of usual body weight; or
• Dietary history of decreased intake of protein less than 0.8gm/kg/day or caloric intake of less than 25kcal/kg/day; or,
• Clinical examination results consistent with a diagnosis of moderate to severe malnutrition.

Please contact a Carmichael’s representative to discuss any IDPN therapy needs, to request additional information or to check your insurance or other available coverage. Many private insurance companies will approve IDPN therapy with sufficient documentation indicating level of need from their clinician. Medicare patients who have permanent impairment of their gastrointestinal tract may qualify for IDPN therapy.

Antibiotic therapy generally is the use of antibiotics to treat, prevent or improve illness. Once a patient has been diagnosed with an infection, but has the capacity to recuperate at home, Carmichael’s can provide antibiotic therapy to fully facilitate the patient’s healing process within the comforts of the patient’s own home.

Some of the most common infections that may be treated with antibiotic therapy include:

• Pneumonia
• Serious cases of Sinusitis
• Bronchitis
• Osteomyelitis
• Cellulitis
• Staph infections

The delivery system for antibiotic therapy includes one of the following:

• An ambulatory pump that allows the patient to move around;
• A stationary pump that hangs from a pole and is immobile; or,
• An elastomeric pump – a disposable, automated infusion system.

Carmichael’s requires a referral from the patient’s doctor or the hospital caseworker in order to deliver the proper medications and application equipment. Carmichael’s will deliver the medication, delivery system and the IV site maintenance supplies for the convenience of our patients. We coordinate patient education with the home health agency that will be attending the patient in order that the patient understands everything about the medication and the workings of the delivery system. All patients are monitored for the duration of the therapy. At Carmichael’s, we consider ourselves the liaison for coordination of care between the physician, the pharmacist and the nursing staff.

Please contact a Carmichael’s representative to discuss any antibiotic therapy needs, to request additional information or to check your insurance or other available coverage.

Pain management therapy generally is employed for easing the suffering and improving the quality of life of those living with pain. The majority of our pain management clients are hospice patients and chronic pain sufferers. Our pain management infusion medications can be delivered intravenously or subcutaneously and Carmichael’s knowledgeable staff will work closely with the patient’s doctor and nurses to achieve appropriate levels of pain relief to assure a good quality of life. Pain pumps can be programmed to provide both a continuous infusion and an as-needed bolus delivery for breakthrough pain.

Carmichael’s provides medications, IV supplies and a pump to deliver the medication, which is administered either by a hospice nurse or a home health nurse.

Please contact a Carmichael’s representative to discuss any pain management therapy needs, to request additional information or to check your insurance or other available coverage.

Hydration therapy treats dehydration and replaces fluid loss secondary to many disease conditions or medical treatments, such as:

• Hyperemesis gravidarum (HG) during pregnancy
• Crohn’s disease
• Chemotherapy
• Radiation therapy

Carmichael’s requires a referral from the patient’s doctor or the hospital caseworker in order to deliver the proper medications and application equipment.

The delivery system for hydration therapy includes one of the following:

• An ambulatory pump that allows the patient to move around;
• A stationary pump, on an IV pole for patients who are less mobile; or,
• The appropriate rate-regulated tubing, which does not require a pump.

Please contact a Carmichael’s representative to discuss any hydration therapy needs, to request additional information or to check your insurance or other available coverage.

Specialized infusion therapy includes Intravenous Immunoglobulin Therapy (IVIG) and Inotropic Infusion Therapy.

Intravenous Immunoglobulin Therapy (IVIG)

Intravenous immunoglobulin therapy is used in a variety of different disease states including, but not limited to:

• Primary Immunodeficiency (PID);
• Idiopathic Thrombocytopenia Purpura (ITP);
• Chronic Inflammatory Demyelinating Polyneuropathy (CIDP); and,
• Other autoimmune diseases, including Lupus, Multiple Sclerosis (MS) and Human Immunodeficiency Virus (HIV).

This therapy is generally infused by a medical professional and is typically given every 20-30 days.

Working in conjunction with your medical provider and nurses, the appropriate infusion device and supplies will be provided to make this therapy as easy a process as possible.

Inotropic Infusion Therapy

Inotropic infusion therapy is used to treat the most severe cases of heart failure and for any patient awaiting a heart transplant. Often, a heart patient in this condition can no longer perform daily activities because of the inability of the heart to pump sufficient blood throughout the body.

Dobutamine and Milrinone are the mainstay treatments for inotropic therapy. While there are many criteria that must be met to qualify for this treatment, the knowledgeable staff at Carmichael’s will work closely with your cardiologist to ensure that all tests and documentation required are present in order to qualify for therapy.

An ambulatory pump will be provided so that a patient can enjoy the increase in well-being and everyday life. Most every patient will have a central IV line for this type of infusion therapy. Carmichael’s can provide the supplies necessary to maintain the safety of this central IV line.

Please contact a Carmichael’s representative to discuss any specialized infusion therapy needs, to request additional information or to check your insurance or other available coverage.

Carmichael’s proudly offers state-of-the-art equipment and the latest technology for infusion methods. Our full line of intravenous (IV) pumps and supplies address a wide range of patient needs, leading to the perfect fit for each patient case. In addition, our pumps and supplies are geared toward ease of use for home use.
We offer:

• Stationary pumps
• Ambulatory pumps
• Disposable pumps
• Syringe pumps
• IV catheter care

For many patients who have central IV lines, which also require routine maintenance, Carmichael’s has the largest product line in the region to best suit their needs. If we do not carry a specific product, our customer service representatives will search diligently to locate a product or a source for a product to satisfy the specific need.

Please contact a Carmichael’s representative to discuss any IV pumps and supplies needs, to request additional information or to check your insurance or other available coverage.