Dobutamine Drips at home

[ash12345]

Hello!

I have a patient who may be admitted to our home health with orders for a dobutamine drip at home. This is the first time our agency has had a patient being admitted with a dobutamine drip and it has been a while any of our patients have been on antibiotic treatment as well. So I have a few questions. Would the hospital make sure the patient has the iv pump/meds for the patient to have at home? I know in the hospital patients are on heart monitors, blood pressures are monitored every few hours. Is there any specifics as to how we are to manage this patient at home? Is there any questions I should ask case management before admitting this patient to our home health?

Any insight to anyone who has had patients on dobutamine drips would be helpful.

Thanks (:

[CrunchRN, ADN, RN]

Is it for kidney function?

[Sun0408, ASN, RN]

I've never heard of such gtts used in the home. That doesn't say much since I'm not a HH nurse. Lurking to see other response. I do have concerns about this tho. Who's gonna monitor the pt and how often?? Who's gonna monitor the IV site if this pt doesn't have a PICC??

[offlabel]

Your agency should have a specific policy for the care of patient's getting dobutamine or milrinone at home. Furthermore, it should have specific instructions for teaching the patient's family or home care givers to manage issues with the infusion and recognize problems.

[ash12345]

chf patient

[JustBeachyNurse, LPN]

In my area this would be managed by a home infusion company that would also handle the drugs & supplies. The skilled nursing would be done by the home health agency

[anh06005, MSN, APRN, NP]

In my area this would be managed by a home infusion company that would also handle the drugs & supplies. The skilled nursing would be done by the home health agency

Yes. Anything done IV (other than an occasional IV Lasix) is usually supplied and managed by a home infusion company. I assume they will have a small bag pump and I SURE hope the patient has a PICC or other central line. The home health nurse does go out to check the patient, educate family, etc. but supplies should come from the infusion company.

[KelRN215, BSN, RN]

As others have said, the hospital will set the patient up with a home infusion pharmacy and they will supply the drugs and IV pump for home. I personally have not discharged patients on dobutamine but have sent a few home on continuous milrinone. The patient will be switched from hospital pump to home pump prior to discharge. Monitoring parameters will be in the discharge papers. In general, I have taught patients to weigh themselves and check VS once/day. The patient should have a PICC or some other sort of central access.

[iluvivt, BSN, RN]

You must subcontract with an IV home Health Agency and you should have a protocol in place. They need to send 2 ambulatory pumps in the event of pump failure or problems so the patient never as to stop their medications. What is the diagnosis and I can give you an outline of the care needed. The nurse needs to be familiar with the pump...is is a Curlin or a CADD . What is the CVAD...a PICC or port or tunnelled CVAD?

Your agency should ahve a nurse on call at all times for this type of patient. Youneed a tape measure to measure abd girth and a good scale so patient can weigh daily depending upon the diagnosis.

[Lev, MSN, RN, NP]

I had an ER patient on a milrinone drip at home for CHF. He was not on a portable monitor at home and he had a portable pump which he managed and I think he changed the bags of milrinone too.

What dose of dobutamine are we talking about?

[CrunchRN, ADN, RN]

Interesting. I hadn't heard of this. Do these patients stay on this long term or?

[IVRUS, BSN, RN]

Totally agree with ILUVIVT... And, along with the second pre-programmed pump to be in house, Policies and Procedures MUST be in place which delineate what the patient and/or Caregiver (CG) should do in case the IV catheter should accidentally become dislodged, or come out, or instructions on what to do in case another mishap/complication occurs. The patient MUST be under the care of a CARDIOLOGIST too.

The patient should be "stable" before the acceptance is made to go from hospital to home. That means NO Uncontrolled Arrhythmias and they should not have had a MI in the previous 6 weeks. Stability covers the time frame of the previous 72 hours prior to d/c. Some companies go further and say that they are disqualified if they have Hypertrophic subaortic stenosis or severe obstructive aortic dz, or pulmonary valvular dz.

This can be done safely in home care, but it requires indepth pre-assessment and continued monitoring along with superb education provided to the pt, and CG.