Primacor drip

[Genista, BSN, RN]

Had a new order for Primacor IV drip today (milrinone). This is the first time I have ever heard of the drug, or given it to a pt. Cardiologist wrote order for med, but no parameters for monitoring (pt already on tele floor w/ routine tele orders). Primary MD was on floor shortly thereafter, and we asked for parameters to monitor. I think he was going to write for Q2H vs. I am curious what is standard monitoring, if you have given this drug? This was not titrated, but just a maintenance infusion rate. I've read my drug books, so I know we are watching pt's electrolytes, creat clearance, vs and tele. Just wondering what your protocol is. Thanks for your input.

[samrn32]

It has been over a yr. since I have given this drug. So just from

memory we monitored heart rate continuous and bp every 15

minutes. In our experience it can really affect blood pressure

We now give this drug to a group of chf patients in our heart

failure clinic, but I don't work there so my memory is a little

poor. We do give 1st doses sometimes to inpatients who will

be going to outpatient clinic or to a member of the clinic who

has been admitted for some reason, but all those have been on

my days off. If I get a chance I'll talk to our arnp who does the

clinic and get back to you but I don't work this week , so it may

be awhile.

[P_RN, ADN, RN]

From what LITTLE I know you need to watch carefully for BP drop, so wouldnt vs be a little more often than q2?

[ICUBecky]

i work in the CCU/heart failure/pre-heart transplant unit and give this gtt all of the time!! if the person is brand new to this drug and we just start it we monitor q15x4, q30X2, and then hourly after that. if we are titrating after that then we just use our nursing judgement...but if they have swan ganz we have to do a reading one hour after each titration. we get a lot of ppl on home milronone thru a pump, and have been on it forever...so we don't really worry about them as much as someone brand new. but you should at least monitor them hourly...which would be pretty hard on a tele unit...

[ICUBecky]

oh yeah...i forgot. you should post this thread on the CCU BB. i'm sure lots of ppl can give you advice!!

[Genista, BSN, RN]

Thanks for the replies. This drip was started just at the change of shift, as I was leaving for the "weekend," so I don't know what the primary MD decided for monitoring orders. Next time this comes up @ work, I'm going to ask cardiologist for freq. vs orders (like post op vs...q15x4,q30x2, etc). We'll have to discuss this @ our next unit mtg, too.

[slapper]

I am a home health nurse and director of the education department. We get an occasional Primacor that will be monitored at home. We go to the hospital before the patient leaves and hook them up to our pump (usually a CADD prizim) Any suggestions how I can reassure my nurses that this drug in the home is safe, otherwise the patient would not be sent home. All of our patients have been in the hospital for several weeks and have been titrated. What is the best way to monitor these patients in the home setting? Any information would be greatly appreciated. I have read up on the drug and I have transitioned a patient from the hospital pump to ours and I have done weekly visit on a patient on primacor, just need to reassure others that it is like any other home drug, or am I mistaken?

Slapper

[Virgo_RN, BSN, RN]

Oops, didn't notice this thread was six years old. I don't know the answer to your question, slapper. Good luck.

[P_RN, ADN, RN]

Oh my this thread is SIX years old! However if there is new information please feel free to add;

[joeyzstj, LPN]

In my opinion, Primacor is really something that needs to be monitored in a unit with an arterial line. We commonly use this drug in addition to IABP's. The problem is, you often need a pressor with primacor due to the vasodilatory effects of the drug, so subsequently they should be monitored frequently and closely.

[ghillbert, MSN, NP]

I have to disagree - home milrinone is very common and has been shown to be safe. A quick Medline search shows several articles about milrinone use in the home care setting - slapper perhaps you could come up with a protocol for your staff.

[Wile E Coyote, ASN, RN]

I have to disagree - home milrinone is very common and has been shown to be safe. A quick Medline search shows several articles about milrinone use in the home care setting - slapper perhaps you could come up with a protocol for your staff.

The way milrinone/primacor behaves in the settings of recent post open heart, cardiogenic shocky pt, or even a milrinone-naive pt, should not be applied to that of a chronic pt set to go home on a maint gtt. I feel much of the 'bad stuff' is biased towards the acute stages in it's use.