Infusion
Nursing Notes
By NuFACTOR

Infusion Nursing Notes by NuFACTOR provides education, resources and support to promote successful patient therapy within the infusion nursing community.

Understanding Titration: IVIG and Infliximab

By Jean McCaslin, RN, IgCN
Nurses in a variety of settings follow an infusion titration (increasing or decreasing the rate of the dose) when infusing many medications. While it is understood that the use of titration is prudent particularly for first-dosing, there are no established uniform standards in the industry for infusing many medications, including intravenous immunoglobulin (IVIG) and infliximab (brands include Remicade®, Inflectra® and Renflexis®). Titration standards may be developed by individual prescribers, hospital systems, nursing agencies, outpatient infusion centers, or specialty pharmacies, yet each may differ from the other. [More]

How to Pool Medications into a Pooling Bag

By Candy Finley, RN, IgCN and Joe DiStefano, RPh

Pooling is the process of transferring the total dose of drug plus overfill into an empty IV bag ("pooling bag"). Although NuFACTOR prefers administering IVIG by spiking vials one at a time sequentially or adding drug directly into a bag of diluent (e.g., infliximab/Remicade®), there are some times when pooling is appropriate. These include lyophilized powder IVIG requiring reconstitution (e.g., Gammagard® SD and Carimmune®), HyQvia® (IG component only) and infliximab doses greater than 1000 mg. The process of pooling medications into a specially designed pooling bag is a relatively simple process. [More]

IV Supply Shortages

By Derrek Blake RN, IgCN - Co Author: Amy Ehlers BS, PharmD, BCPS.

Who knew that Hurricane Maria could lead to such a dramatic shortage of medical products in the United States that all hospitals and pharmacies rely on? Puerto Rico was one of the hardest hit areas by Maria and damaged American manufacturing hubs for medical products. Roughly 43% of the United States IV fluids, IV bags and minibags are manufactured and produced in Puerto Rico. [More]

Psycho-social Considerations of Patients Receiving Home Infusion of Immune Globulin

By Jean McCaslin, RN, IgCN.

In every aspect of medical care, a patient-centric approach is invaluable. Each healthcare discipline must take into consideration each patient’s holistic need when undertaking a plan of care; psycho-social needs are particularly critical. Patients receiving immune globulin (IG) oftentimes are newly diagnosed with a chronic or debilitating disorder and experience adverse feelings. Care partners or family members may be equally affected by the diagnosis and prescribed treatment modalities. [More]

Administration, Common Side Effects and Dosing of INFLIXIMAB (REMICADE®)

By Candy Finley, RN, IgCN.

Infliximab is an intravenously administered genetically engineered monoclonal antibody that neutralizes inflammation caused by a protein called tumor necrosis factor alpha (TNFα) by binding to the soluble and transmembrane forms of TNFα with its receptors. Elevated concentrations of TNFα have been found in the tissues and fluids of patients with the Food and Drug Administration (FDA)-approved diagnoses. Infliximab controls the activity of several inflammatory chemicals. It is FDA-approved to treat rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, plaque psoriasis, psoriatic arthritis and ulcerative colitis. Once established on treatment, symptoms should start to improve over a period of two to twelve weeks. [More]

Home Infusion of Immune Globulin: Navigating the Challenges

By Jean McCaslin, RN, IgCN.

Home health care continues to be the fastest growing segment of the health care industry. Many patients prefer the convenience and comfort of receiving care in the home. While the infusion of immune globulin (IG) requires specialty knowledge and precaution, the home infusion environment itself requires thoughtful consideration and accommodation. [More]