UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Managing Patients on Continuous Home Infusion Medications

Keywords: Milrinone, dobutamine, insulin, pumps (PubMed Search)

Posted: 5/4/2019 by Ashley Martinelli (Updated: 6/25/2019)
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Continuous home infusion therapies of medications such as insulin, milrinone, dobutamine, and pulmonary hypertension medication such as treprostinil are becoming more common.  As a result, you may see these patients present to the emergency room and need to know the basics for checking the pump.

  • Is the pump working correctly?
    • Check the infusion lines for leaks or holes
    • Is the screen on, and does it show the correct dose information
  • How long will the current battery last?
  • How long will the current infusion bag last or expire?
    • Also consider the half-life of the medication. Infusions for pulmonary hypertension have a very short half-life and cannot be stopped abruptly.
  • Is the medication carried by the hospital or will the patient need to provide their own medication for pump refills?
  • What is the current dose?
    • Look for doses in weight based increments (i.e. mcg/kg/min, or ng/kg/min)
    • Insulin may have a basal rate and a bolus dose.
  • What is the patient's "dosing weight"?
    • Ensure that the weight used to program the pump is the same weight used to enter a continuation order in the electronic medical record. This may be different from their current weight and can lead to dose changes if not done properly.
  • What is the current bag concentration?

These questions are very important to determine if you will need to order a replacement infusion bag and run it on a hospital infusion pump, or if the patient can safely remain on their pump during the initial medical evaluation.