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Vera J Jeter
Dobutamine infusion in the home
For those of you in the Home Care setting. Do you do continuous infusions of renal dose levels of dobutamine in the home? Is not, why not. If so, do you have any policies/procedures you would be willing to share? What are your monitoring parameters? How long do you allow the bag to hang and can you teach family members to change the bag? Is this an RN only type of patient? (We have LPNs in our agencies) We have a procedure from an infusion company but it is failry dated and we'd like to create one based on recent evidence. How about other inotropic agents like Dopamine and Amrinone?
Vasular Nurse
I do consult with home care

I do consult with home care agencies. For many agencies, it depends on the reimbursement. Private insurance companies pay for the nurse to stay with the patient. But, if it is a Medicare patient, all we get is the PPS payment. So, You can teach the family to monitor the patient and disconnect the dobutamin.  Family/caregiver teaching, including monitoring B, emergency measures. A RN must be available for emergencies. Dobutamin half life is 3 minutes. Start the infusion, RN stay with the patient for 60 minutes, if there is no variations in the patient's staus,  you may leave. If there is a problem, caregiver must stop the infusion and contact the RN immediatly.

Dopamin and Amrinone needs closer monitoring. I suggest a RN being with the patient during the infusion. You can not work with the companies policy, unless you have a contract with the infusion company. According to the agreement, if your agency is responsible for administering and monitoring the patient, it must be according to your agencies policy and procedure. Refer to JCAHO standards. 

Regarding LPN, you must review your state's professional regulations. LPN also works under the supervision of a RN. When a job is deligated to a LPN, it is the responsibilty of the delegating RN's responsibilty to ensure the LPN is competent andthere is documented education.


Laura Lenihan
Vera - our hospital

Vera - our hospital affliated home care agency provides both dobutamine and milrinone infusions to home care patients routinelly. These are continous infusions for late stage CHF patients. Patients are often pre-heart transplant, may be on a LVAD, or may not be a transplant candidate. Some patients are on both dobutamine and milrinone. Nurses make 2-3 visits weekly depending on the current clinical status. Patients are taught to maintain their ambulatory infusion pumps, taught how to use their back -up pumps, understand emergency procedures related to pump malfunction. They never are without a constant infusion, no flushing is allowed of the inotropic catheter port although the line is usually double lumen.

Laura Lenihan, RN

Clinical Specialty Coordinator

Henry Ford Home Health Care

(313) 874-6572

fax (313) 874-6501


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