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IVIG INFUSION PHARMACY PROTOCOL - 2
PREPARATION / ADMINISTRATION of
IVIG:
A. Intravenous immune globulin products
are either already in solution (recommend this formulation when
possible to
avoid issues with reconstitution) or require
reconstitution with provided diluent. Administration
concentrations range
from 5% to 12%. If concentration is not
specified on the physician order, the pharmacist will evaluate
the patient's
fluid status and prepare the IVIG in an
appropriate concentration. IVIG standard order sheets are
available for
physicians to use when ordering IVIG.
B.
Inspect Immune Globulin for particles. If particles are seen, do
not shake solution as this will cause foaming, and
will
inactivate the proteins in solution. The solution should be
colorless, particle-free and non-turbid. If the solution
contains particles, contact pharmacy for assistance.
C.
Immune Globulins should be infused separately from all other
products/solutions and at room temperature. Do not
infuse
Immune Globulin into other IV medication lines. Do not inject
medications into the Immune Globulin infusion.
Immune
Globulins should generally be infused without a filter (i.e. no
blood filters, IV filter, etc.); however, some do
require an
in-line filter. If filtration is required (product-specific),
the filter will be provided by pharmacy.
1. Depending on
the type of Immune Globulin currently stocked in the pharmacy,
the product flush solution
recommendations may be either
normal saline or D5W. Only flush the Immune Globulin with the
flush solution
noted on the medication label and on the MAR/eMAR
comment.
2. Initiate venous access with 250 ml normal
saline or D5W as recommended by pharmacy and unfiltered IV
tubing using filter only if provided by pharmacy. Initiate IV
Immune Globulin administration using a Secondary
Medication
IV infusion set, or switch bags on the primary infusion tubing
and utilize an IV infusion pump. Do not
infuse normal saline
or D5W simultaneously with the Immune Globulin product.
3. Have second maintenance IV with same solution set up
available in the room in case of an adverse reaction.
D. PEDIATRICS:
If rate of administration is not indicated, the following rates
of administration should be utilized:
1. Routine
Infusion Rates for 5% - 6% IVIG:
0-15 minutes
0.5 mL/kg/hour
15-45 minutes
1 mL/kg/hour
45-75 minutes
2 mL/kg/hour
Remainder of infusion 4 mL/kg/hour
2. For 10% - 12%
Concentration Divide the Infusion Rates Above (#1) by One-Half.
E. ADULTS: The following rates are independent of total dose or
volume or concentration:
10ml/hr for 10 min
20 ml/hr for
20 min
50 ml/hr for 20 min
100 ml/hr for 1 hour
200
ml/hr until the infusion is completed
F.
ADULTS—OUTPATIENT INFUSION CENTER
1. FOR INITIAL
IVIG TREATMENT (new brand, changing renal function or
experiencing new side effects): follow
the adult titration
rate schedule as above.
2. FOR SUBSEQUENT / REPEAT IVIG
treatment: titration of the dose is not necessary if the patient
receives the
same IVIG brand as on previous visit, the
infusion rate has stayed constant as on previous visit (with no
side
effects), and the patient's renal function has not
decreased significantly since the previous visit.
G.
MONITORING REQUIREMENTS:
Obtain and document vital signs
every 30 minutes for 2 hours, then every 2 hours until infusion
is completed
or as ordered by the physician. All patients
should have continuous electronic monitoring of heart rate,
respiratory rate, and oxygen saturation throughout the infusion.
2. Adults: All patients have vital signs taken pre-IVIG, then
roughly halfway through the infusion and again upon
completion of infusion.
H. ADVERSE REACTIONS /
CONTRAINDICATIONS / WARNINGS PRECAUTIONS:
1. Observe
and assess for adverse drug effects / reactions when collecting
and documenting vital sign information.
2. Based on the
adverse drug effects / reactions observed:
Notify
physician immediately.
If necessary discontinue the IVIG.
o Adult and Pediatric Units: Begin infusion of normal saline or
D5W as indicated by pharmacy at a
keep open rate or flush
with 10 to 20 mL of the appropriate solution as above.
o NICU
/ Nursery: heparin lock the IV cannula.
Report any observed
Adverse Drug Reactions to the ADR Hotline.
3. Adverse
drug effects / reactions include the following:
•
Cardiovascular System: Flushing of the face, hypotension,
tachycardia
• Central Nervous System: Dizziness, fever,
headache, chills
• Gastrointestinal: Nausea
• Respiratory:
Chest tightness, difficulty breathing
• Miscellaneous:
Hypersensitivity reactions, sweating
4. CONTRAINDICATIONS:
Selective IgA deficiency (except with Polygam)
History of anaphylactic episode following previous IVIG infusion
Severe thrombocytopenia or other contraindication to IM or IV
injections
5. WARNINGS / PRECAUTIONS: Anaphylactic type
reactions may occur and proper monitoring for these reactions
concomitant nephrotoxic drugs
human plasma products may
contain infectious agents
pre-existing renal
insufficiency
cardiovascular risk factors- Patients
receiving large volumes of fluid due to 5% IVIG concentration
and
large dosage requirements should be observed for signs of
fluid overload. Infusion rate should be
decreased if
necessary.
decreased cardiac output
sucrose-containing products increase risk of renal dysfunction
increased risk of inflammatory reactions in patients with
agammaglobulinemia or extreme
hypogammaglobulinemia receiving
first doses or after 8 weeks
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