BOSTON _ Two mornings a week, Arthur Jackson clears space on half of his cream-colored sofa. He sets out a few rolls of tape and some gauze, then waits for a knock on his front door.
"This is Brenda's desk," Jackson said with a chuckle.
Brenda Mastricola is his visiting nurse. After she arrives at Jackson's home in Boston, she joins him on the couch and starts by taking his blood pressure. Then she changes the bandages on Jackson's right foot. His big toe was amputated at Brigham and Women's Hospital in November. A bacterial infection, osteomyelitis, had destroyed the bone.
Jackson is still taking intravenous penicillin to stop the infection. He came home from the hospital wearing a small medication pump that delivers a steady dose of penicillin via a PICC line. PICC stands for a "peripherally inserted" or "percutaneous indwelling" central catheter, and it resembles a flexible IV tube, inserted into Jackson's chest.
"This all looks good," Mastricola said, after making sure the line was clean and in place. "You don't need me."
When patients need weeks or months of IV antibiotic treatment but otherwise don't need to be hospitalized, the standard protocol is to discharge them with a PICC line and allow them to finish the medication at home. It saves money and is much more convenient for patients.
But this arrangement is almost never offered to patients with a history of addiction. The fear is that such patients might be tempted to use the PICC line as a fast and easy way to inject drugs like heroin, cocaine or methamphetamine.
Jackson, 69, was addicted to heroin for 40 years. Although he's been sober for years, most U.S. hospitals would force patients like Jackson to stay in the hospital, sometimes for eight weeks or more. But Brigham and Women's in Boston, along with a few others in the U.S., is challenging that protocol, allowing some patients with a history of addiction to go home.
Supporters of the change argue that doing so boosts the chances these patients will stay on their antibiotics and beat the infection.
