UMEM Educational Pearls

Title: Managing Patients on Continuous Home Infusion Medications

Category: Pharmacology & Therapeutics

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

Posted: 5/4/2019 by Ashley Martinelli (Updated: 11/22/2024)
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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.