Management of SCIG Side effects
By Nufactor - June 3, 2022
The greatest advantage of subcutaneous immunoglobulin (SCIG) is that it provides the patient with autonomy, which helps them feel empowered to live a normal life. Nurses are responsible for teaching patients how to manage the expected side effects. Most patients do not require premeds; if they are ordered, advise your patient to be compliant with them. Always ensure the anaphylaxis kit is readily available for each infusion regardless of past tolerability. It should consist of a double pack epinephrine autoinjector and oral Benadryl. Please instruct the patient how to use it properly before leaving their home.
SCIG infusions first entered the U.S. market in 2006 and are safe and well-tolerated by most patients. There is less chance of blood-borne viruses being transmitted to the patients when compared to intravenous immunoglobulin (IVIG). Most site reactions subside after the second or third infusion. You can help to minimize SCIG site reactions by following a few key techniques:
- Pre-infusion - apply a numbing cream or ice pack before needle insertion
- Proper site selection — the abdomen minus 2 inches in circumference of the umbilicus, tops of thighs, backs of arms, and flank area “love handles.” Avoid scars, fresh stretch marks, bony prominences, tattoos, visible vessels and inflamed areas. It is important to evaluate the skin for areas with adequate fat distribution.
- Proper needle insertion — pinch the skin 1 inch and insert with a rapid dart-like motion and use a 90-degree angle. Bruising may occur from nicking capillaries while inserting the needles.
- Post-infusion — turn off the pump and leave the needles in place for two to three minutes to stop the fluid flow and cover the sites with a 2x2 gauge and a band-aid for one hour to help clot formation. We primarily expect to see localized site reactions, such as burning, itching, discomfort, pain, swelling and redness to the sites.
When prepping your work area, the first step is to ensure it is cleaned with disinfectant and use a sterile drape to place your supplies on top to prevent infection. The next step is to prime the SCIG flow rate and tubing with Ig and stop 2 to 3 inches from the tip of the needle sets to ensure a dry stick. This is a crucial step and the best way to minimize localized site reactions.
If your patient experiences any localized site reactions, explain that some side effects are expected and will improve over time. The most common side effect is site reactions following traditional SCIG and fSCIG infusions. SCIG infusions may result in subcutaneous injection sites that may range in size from a quarter to a golf ball. fSCIG infusions may result in larger, more widespread subcutaneous injection sites and interfere with certain clothing. As fSCIG volume increases during ramp-up, phase two sites may be preferred by patients. Advise them to apply a warm or a cool compress to the affected areas for 15-20 minutes every four to five hours for comfort. If their complaint is site itchiness, only use a cool compress. Other post-infusion options include gently massaging the affected area, applying topical hydrocortisone cream, and wearing loose-fit clothing for one to two days. Most reactions will subside within 72 hours.
Since SCIG is given more frequently with shorter infusion times than IVIG, we do not expect systemic side effects, but there is still a possibility they can occur. If they occur, they typically improve over time. Unexpected reactions include headache, general flu-like symptoms, chills, low-grade fever, fatigue, rash/itching, nausea, diarrhea, lightheadedness, myalgia, arthralgia and cough. Please contact the pharmacy immediately and they will get in touch with the prescribing physician to develop a plan that seeks to minimize or eliminate reactions.
Side Effect Signs and Symptoms:
- Mild: itching, hives, rash, nausea and/or vomiting
- Serious: thrombosis (boxed warning), renal dysfunction/failure, anaphylaxis, aseptic meningitis, hemolytic anemia and transfusion-related acute lung injury (TRALI)
- Severe: angioedema, wheezing, difficulty breathing, swelling of eyelids or lips
Anaphylaxis can occur at any time during the first and/or subsequent infusions. That is why we always have the anaphylaxis kit readily available. Monitor the patient for symptoms of anaphylaxis which include difficulty breathing or choking. Follow the orders or organization’s protocol. Review anaphylaxis symptoms and kit medication use with the patient on the first visit.
If anaphylaxis is suspected, STOP THE INFUSION. Follow the anaphylaxis protocol. Call 911 if symptoms are life-threatening. Side effects are expected, but they can be managed.