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Vera J Jeter
Infusion in the Home Care setting

For Home Care agencies, do any of you have a policy listing drugs that you will NOT infuse in the home? We have been asked to see a patient that will be on a continuous Milronone infusion. From what I've been able to find out, I feel really uncomfortable about taking this patient. Any input would be helpful. If you have a policy outlining what drugs you won't give in the home, that would be VERY helpful.

 

Thanks, Vera

mary ann ferrannini
I have given Milrinone in
I have given Milrinone in the home many times. Generally, these are very ill patients waiting for heart transplants or to prolong life. This is very doable with excellent teaching,good family support anf an Infusion Company with 24 hour nursing on-call service. The pumps are locked in a level where the rate can not be changed. What specifically is your concern so we can be more specific. As you might be aware there are many IV drugs that Medi-Care will not pay for in the home setting . We give all kinds of drugs in the home including TPN, Chemotherapy,IVIG,antibiotics,Blood and Blood products...etc. We often ask that first doses be in a controlled clinical setting. My recent pt on milrinone was so ill I had to hook him up to the drug before he left the hospital b/c he could not be without, even for a few hours.
BJ Emory
I have also given both
I have also given both Dobutamine and Milrinone at home in the past, but it has been some time.  We do have policies to cover different classes of drugs and also request that the first dose been given in a controlled setting.  We have a patient now that is on continuous infusion of Milrinone and the orders state specifically not to flush the lumen between bag changes.  Do you flush between bag changes?  Do you ever check for a blood return?  Just curious as to your policy.

BJ Emory, RN, CRNI

Infusion Education Co

Vera J Jeter
Vera J Jeter, BSN, RN,

Vera J Jeter, BSN, RN, BC

What, if any, monitoring do you do? Would either of you be willing to share your policies?

Vera

IVRN
When I worked at a home
When I worked at a home infusion company, we had a policy for Dobutamine and Milirone adminstration.  The patient had to be stable on it, no titrations needed, and had to have a dual lumen PICC.  That way, when we did the bag change, we swapped lumens, and had one for blood draws, etc.  Daily visits to change the bag, do a through cardiac assessment, distal pulses, standing, lying, sitting BP, lungs, auscultation of heart sounds, s/s of swelling, etc.  Treat them as a CHF pt (which is what they are) with a continuous infusion.
carolsrn
I am the Director of Nursing
I am the Director of Nursing for a home infusion company and we have had a great deal of experience with treating heart failure patients with inotropic agents, both those awaiting transplant, as well as those with end stage cardiomyopathy and not eligible for transplant. At any given time, between our 4 branches we may have 40-50 patients on inotropic therapies-most often milrinone. As everyone has stated, appropriate home environment, family support, education and monitoring are required for successful transition from the hospital to home for these patients. The first weeks of therapy are nursing intense. I have a Clinical Pathway for these patients I am willing to share with you if you will contact me by [email protected]@tpnathome.com.

Carol Sweeney, CRNI; Principal and Vice President of Clinical Operations First Choice Health Care Systems, LLC.

josie631
milirone infusion

Can you give me any information on this infusion? I am scheduled to do this tomorrow

 

ty

 

jo anne

AMParry
Milronone

We do these in the home as well as noted in other posts.  We also send an extra pump that is programmed with the current program, should there be any problems with the pump that is being used there is an immediate back up the patient or caregivers can turn the pump on and begin using with out compromising the therapy and patient health

Ann Marie

Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

infusnman
Milrinone in home setting

Vera,

We do inotropics in the home all the time. I have a very good generic P&P that you can individualize and make your own. If you will email me at [email protected], i will be glaf to forward it to you

Alan Taylor, BSN, CRNI

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