By Michelle Greer, RN, IgCN and Cindi Berry, RN, BSN
When working in homecare, preparing to see your patient for intravenous immune globulin (IVIG) therapy can be challenging and requires a good deal of preparation. Many times, it is up to you, the registered nurse, to put together some of the information prior to seeing your patient. This information includes doctor visit notes, current orders prescribed by the doctor, specialty pharmacy orders and supplies, and knowing the type of therapy that will be administered in the home. In addition, since there are many different brands and doses of IG, you should be familiar with both of these prior to seeing your patient in the home.
The following checklist can help to ensure a successful IVIG therapy administration:
1) Be prepared before seeing your patient. Make sure you have the necessary equipment to monitor your patient. Be sure to have a thermometer, blood pressure cuff and stethoscope. Assessing your patient before, during and post IVIG is part of policy and procedure.
2) Contact your patient. Always establish patient contact before your visit. Plan a time and date for your patient’s therapy, and provide your contact information. This is the beginning of your patient relationship.
3) Review important information with your patient prior to therapy. Talk to your patient, and discuss important elements that will help ensure he/she receives therapy with as few side effects as possible. Explain to your patient that premedications should be taken 30 minutes to 60 minutes pre- infusion. Encourage your patient to remain well hydrated and to start hydrating aggressively the day before, day of and the day after therapy is complete. Review patient medications, and educate your patient to take prescribed medications.
4) Know your drug. Not all IVIG products are the same. Review which brand your patient will be receiving, check for compatibility, and review side effects of the specific brand. Remember to infuse IVIG at room temperature.
5) Check your doctor’s and pharmacy’s order. Confirm with the doctor’s order and pharmacy’s order that the titration and drug are correct. Always assess vital signs prior to infusion, 15 minutes into the infusion, every titration and every hour once maximum titration has been established. Confirm with your patient that he or she is comfortable, and assess for any side effects.
6) Know EXPECTED side effects. Review side effects and how to properly manage them. Educate your patient on ways to take part in caring for himself or herself and decreasing potential side effects for better tolerability. Remind your patient that most common side effects include headache, chills, fatigue and malaise.
7) Be familiar with supplies and pump. Find out which pump is used for IVIG administration. Become familiar with how it is programmed.
8) Always have your anaphylactic kit available. Make sure you have your kit out and available at all times. Make sure emergency contact numbers are available. Educate your patient about signs of anaphylaxis. Become familiar with what’s included in the anaphylaxis kit, and know proper administration of epinephrine.
9) Establish IV access prior to setting up the drug. Never set up the drug without confirmation of patent IV. This is very important.
10) Never save any drug that has been spiked. If you need to discontinue a patient’s therapy at any time during his or her infusion, always discard the drug that has been spiked. Any drug that has not been finished cannot be reused. Vials that have not been opened should not need to be wasted.
11) Always assess IV access. IV access can change quickly on a patient receiving chronic therapy. Educate your patient about the potential to have poor peripheral IV access from chronic IV therapy. He or she will appreciate the conversation. This may help prepare him or her for the need for a central line in the future.
12) Never leave your patient home during therapy. It is your responsibility as a nurse to care for your patient throughout the entire infusion. It is NEVER OK to leave your patient. Reactions can occur on the first or 50th infusion. It is never known when a reaction may occur; therefore, careful monitoring is required at every infusion.