Giving Amphotericin B in the Home

Abstract

Carolyn Sipes, RN, MSN, formerly director, patient care services, Harmony Home Health of Mercy Center, Aurora, IL, currently works at RushPresbyterian-St. Luke's Medical Center in Chicago. daily, the patient must be able to hook up his own infusion before discharge from the hospital. If he is unable, a competent caregiver must be available to assume responsibility for the infusion. O The patient and/or his caregivers must show a basic understanding of how to manage the expected side effects. O Physician prescriptions and plans must be obtained for drug dosages, for how often blood specimens need to be drawn, and for specific parameters for withholding treatment based on lab results (such as BUN >40 or creatinine >3.5). D The patient must have had initial infusions of all drugs-meperidine, hydrocortisone, and heparin, as well as amphotericin Bbefore hospital discharge. This reduces the risk of serious adverse effects in the home. Generally, patients will have received at least three doses of amphotericin B before discharge. If you need to draw blood, do so before starting the infusion. After a baseline vital sign check, we monitor vital signs every 15 minutes for the first hour and every 30 minutes thereafter. Our agency policy requires that the nurse stay with the patient throughout the infusion-about six hours for the entire procedure. Our agency does not recommend unsupervised infusions due to the severity of the side effects. Other agencies, however, instruct the patient to premedicate himself onehalf hour before the nurse is scheduled to arrive. The nurse then checks vital signs, examines the patient, starts the infusion, and leaves while the drug is still running. When the infusion is finished, the patient or caregiver stops it and then flushes the central line. l