Administering Home Milrinone: Evaluating Safety and Efficacy.

HOME environment; DRUG efficacy; OCCUPATIONAL roles; NURSING; CHILD development; SOCIAL services case management; MEDICAL care costs; FAMILIES; SATISFACTION; COST control; MILRINONE; HEALTH care teams; NURSES; PATIENT education; PSYCHOLOGICAL adaptation; PATIENT safety; HEART failure; SOCIAL case work

Pediatric patients with refractory heart failure use continuous intravenous inotropic support as a treatment intervention. Inpatient milrinone use is ubiquitous in pediatric patients with heart failure, with some children eligible for home milrinone therapy. Data are limited within pediatrics on the safe administration of home milrinone. Heart failure in pediatrics has varying etiologies, from congenital to acquired, and the use of milrinone as inotropic support for treatment varies based on the mechanism of heart failure. Milrinone's properties that support heart function allow for myocardial stabilization for children in the interim of other treatment interventions. Long-term milrinone use at home provides patients and their families time outside of the hospital before heart transplantation, palliation if ineligible for transplantation, and time for myocardial recovery. Patients that receive home milrinone face risks related to arrhythmias, central line infections, and readmissions. Education on the risks of home milrinone, home monitoring programs, and timely follow up allow families the capacity to advocate for their children while normalizing home life out of the hospital for their child with a chronic illness. Benefits to pediatric patients at home on inotropic therapy include decreasing health care costs, promoting child development, and increasing family satisfaction. A multidisciplinary team approach is imperative and consists of providers, pharmacists, case managers and social workers, and nurses of inpatient and infusion specialties. Home milrinone proves a viable safe option for pediatric patients in heart failure, with nurses in a unique position to prepare families by helping them transition safely from an acute care setting to home. [ABSTRACT FROM AUTHOR]

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