Pre and post transplant home infusions

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Specializes in ICU/CCU, Home Health, Case Management.

Hi you all,

I hope you all great holidays! Now, business at hand. Have you ever heard of home infusion therapy for pre and post transplant pts. They wiill come out with PICC line and my company wants to train me for this. They tell me I'll be "safe" in the home, I mean safe as in delivering safe care. I know transplant pts can do a dixie in a NY minute on the transplant unit. The pts will be given Dobutamine and other IV meds by me. I am in Florida and was just wondering how you all would feel doing this. They want to trrain me in one day 1/12/2010, surely they don't want me to tour the transplant unit! HELP, please.

Thankyou in advance.

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One time my hh agency wanted me to work with a patient with an IV and I refused the case because I'm only an LVN and although I am IV certified I told them that I was not competent to deal with IV therapy in the home and refused to jeopardize my career. They tried to browbeat me into it as if the piece of paper from the IV certification course magically made me qualified. I certainly hope that your one day of training gives you the background you feel you need for this assignment.

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Specializes in ICU/CCU, Home Health, Case Management.

Hi Calli,

YES, I am feeling like this would not be good for my license> RN in 2 states MA and FL. Even, the Cardiac coordinator said she would not do it! My specialty is Cardio-pulmonary, not transplant pts! Plus, they still have me as per-diem, even with an excellent 90 day review! With OASIS C, Palm training planned for Jan. is enough for me! They didn't bring me on FT, so I still get 35. visit and 4 hrs of paperwork. Both teams have advocated for me to be FT, but, I think upper management thinks I am a "Mikey". I am the only RN who is ACLS certified. Transplant pts have so many co=morbities, the admission alone will be a nightmare, let alone all the teaching!

Thankyou for your input, it is greatly appreciated!:tku:

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Tampa, if I were you I would not do this.

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Specializes in COS-C, Risk Management.

I am PICC certified and depending on the situation, I probably would do it. I have previous experience with Dobutamine infusion in the hospital as well as home infusion experience. Some of what I would insist on would be cardiac monitoring capability (preferably a Lifepak or similar) and would want to know the response time for local EMS--no way would I do it in a rural area with a response time of 20-30 minutes. Would also insist on a ACLS kit with a bag and never being alone in the home with the patient, always someone else there who is CPR qualified. I'd also insist on premium pay, since this is a really big deal to do in the home. This would be beyond the scope of practice of most home health nurses and pay should reflect that. I'd also make sure my is up to date. Oh, and they need to have a contingency plan if something happens to you and you're not able to see the patient.

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Specializes in ICU/CCU, Home Health, Case Management.

Dear Kate,

As far as I know, none of this is going to be provided for me. I am not PICC Certified. I'm told "It's homecare,Kathy, not an ICU". Yes, I am the only RN who is ACLS at my agency. My malpractice is up to date. I've administerd multiple drips, including Dopamine, Dobutrex, via PICC's, Midlines, etc at Pepin Heart Institute, in Tampa. IV Hi tech pay is 40.00 wkday and 45.00 wkends. The pts will be coming out of a major teaching hospital in Tampa, BUT, where they live is another story, could be rural. It truly sounds very unsafe to me. I'll go to their one day in-service to hear what they have to say. I'll keep you posted.

Thankyou for caring and for your advice.

Kathy

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Specializes in COS-C, Risk Management.

Ummm . . . . then no. You should be PICC certified to care for them in the home since you won't have a hospital IV/PICC team to back you up. ACLS doesn't mean crap if you don't have the equipment and the drugs. Fat lot of good it does you to know protocols if you don't have the drugs or monitoring capability. And no way would I mess with those drugs in the home for the same pay rate as for a regular IV infusion. I can see *maybe* doing a stable CHFer on an intermittent Dobutrex gtt, but add in all the transplant meds and it's a whole 'nother ball of wax. Good luck.

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Specializes in ICU/CCU, Home Health, Case Management.

Thanks Kate, I'll stick with my Cardiacs, they are all decomping now! Must be the Holidays and the cold weather!

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Ummm . . . . then no. You should be PICC certified to care for them in the home since you won't have a hospital IV/PICC team to back you up. ACLS doesn't mean crap if you don't have the equipment and the drugs. Fat lot of good it does you to know protocols if you don't have the drugs or monitoring capability. And no way would I mess with those drugs in the home for the same pay rate as for a regular IV infusion. I can see *maybe* doing a stable CHFer on an intermittent Dobutrex gtt, but add in all the transplant meds and it's a whole 'nother ball of wax. Good luck.

I don't feel it's necessary to be PICC certified (though I was at one time) in order to infuse via PICC in the home. Use of a PICC is very common in HH. PICC certification is only required for insertion, not use or maintenance. However, I am not familiar enough with the particular med you mentioned to advise specific to that situation.

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Specializes in ICU/CCU, Home Health, Case Management.

Hi all,

I went to the inservice--3 hrs!! No way am I doing this--Dobutrex cont infusion in home, AND some of them will be coming out with Left Ventricular Assistive Device!! Too much to go wrong for me. Currently sending out resumes. Thank you for your advice.

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Specializes in COS-C, Risk Management.

Holy moly! And I thought we had some sick ones on our service. I wouldn't do it either. Good luck with your search.

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