Key safety steps to recognize and respond quickly.
Marianna Herrera, RN, BSN, IgCN, Clinical Nurse Educator II - November 11, 2025
Home infusion nursing brings the unique responsibility of providing high-quality care outside the traditional clinical environment. In the home setting nurses are a "One Man Team", unlike the hospitals that provide rapid response teams at a push of a button. While serious adverse drug reactions (ADRs) are rare, anaphylaxis can occur suddenly and without warning, requiring immediate recognition and decisive action. Nufactor patients are staffed with nurses who must undergo vetting and skills assessment prior to providing care to patients. This is done to ensure they are fully prepared to not only safely and effectively complete the infusion but also recognize any adverse drug reactions and be prepared to intervene accordingly.
Pre-Infusion Preparation
Upon arrival at the patient's home the very first thing that must be done is to check for an anaphylaxis kit to be readily available, within date, and not damaged. Review the protocol and familiarize yourself with supplies available. Unless ordered differently by the prescriber, Nufactor's anaphylaxis kits consist of the following:
- Rescue Medication
- Epinephrine Auto-Injector – intramuscular use
- Junior strength
- Adult strength
- Epinephrine vials- SubQ use
- Diphenhydramine – oral
- 9% Normal Saline- 250mLs
If an anaphylaxis kit is not intact, is missing, expired, or damaged, the infusion will not take place. Notify Nufactor to replace missing item and reschedule appointment accordingly.
Nufactor's Management of Anaphylaxis for Intravenous medication is as follows:
"MILD" allergic reactions such as itching, hives, rash, nausea and/or vomiting:
- STOP the infusion of the drug IMMEDIATELY. Completely remove the source of the infusate while maintaining venous access, if applicable.
- Administer Benadryl (diphenhydramine) orally if able to swallow:
- Adults: 50 mg orally every 6 hours as needed.
- Children: 1.25 mg/kg orally every 6 hours as needed. *See chart below.
- Call Nufactor at (800) 323-6832 to report the reaction and reorder anaphylaxis kit medications.
"SEVERE" reactions such as angioedema, wheezing, difficulty breathing, swelling of eyelids or lips:
- STOP the infusion of the drug IMMEDIATELY. Completely remove the source of the infusate while maintaining venous access, if applicable.
- Administer epinephrine:
- Adults and children weighing greater than 30 kg (66 pounds): 0.3 mg intramuscularly if using an auto injector or 0.3 mg/0.3 mL subcutaneously if using a 1 mg/mL vial/ampule.
- May repeat dose in 5 - 15 minutes as needed.
- Children weighing 15 – 30 kg (33 to 66 lbs.): 0.15 mg intramuscularly if using an auto injector or 0.15 mg/0.15 mL subcutaneously if using a 1 mg/mL vial/ampule.
- May repeat dose in 5 - 15 minutes as needed.
- Children weighing less than 15 kg (33 lbs.): 0.01mL (0.01mg)/kg subcutaneously from a 1 mg/mL vial/ampule.
- May repeat dose in 5 - 15 minutes as needed. *See chart below.
| Weight (lb) |
Weight (kg) |
Epinephrine Dose (1 mg/ml strength) |
| 5 lb |
2.3 kg |
0.02 ml |
| 10 lb |
4.5 kg |
0.05 ml |
| 15 lb |
6.8 kg |
0.07 ml |
| 20 lb |
9.1 kg |
0.09 ml |
| 25 lb |
11.4 kg |
0.11 ml |
| 30 lb |
13.6 kg |
0.14 ml |
| 32 lb |
14.5 kg |
0.15 ml |
- Contact or have caregiver call 911.
- Place the patient in supine position with the lower extremities elevated, unless there is prominent upper airway swelling prompting the patient to remain upright (and often leaning forward). If the patient is vomiting, placement of the patient semi-recumbent with lower extremities elevated may be preferable. Place pregnant patients on their left side.
- Tilt patient’s head or thrust jaw to relieve airway obstruction if patient has problem breathing.
- Administer Benadryl (diphenhydramine) if able to swallow:
- Adults: 50 mg orally every 6 hours as needed.
- Children: 1.25 mg/kg orally every 6 hours as needed. Maximum individual dose is 50mg. *See chart below
| Weight (lb) |
Weight (kg) |
Diphenhydramine Dose (mg) |
Diphenhydramine ORAL Dose (ml)
(12.5 mg/5 ml strength) |
| 5 lb |
2.3 kg |
2.8 mg |
1.1 ml |
| 10 lb |
4.5 kg |
5.7 mg |
2.3 ml |
| 15 lb |
6.8 kg |
8.5 mg |
3.4 ml |
| 20 lb |
9.1 kg |
11.4 mg |
4.5 ml |
| 25 lb |
11.4 kg |
14.2 mg |
5.7 ml |
| 30 lb |
13.6 kg |
17.0 mg |
6.8 ml |
| 35 lb |
15.9 kg |
19.9 mg |
8.0 ml |
| 40 lb |
18.2 kg |
22.7 mg |
9.1 ml |
| 45 lb |
20.5 kg |
25.6 mg |
10.2 ml |
| 50 lb |
22.7 kg |
28.4 mg |
11.4 ml |
| 55 lb |
25.0 kg |
31.3 mg |
12.5 ml |
| 60 lb |
27.3 kg |
34.1 mg |
13.6 ml |
| 65 lb |
29.5 kg |
36.9 mg |
14.8 ml |
| 70 lb |
31.8 kg |
39.8 mg |
15.9 ml |
| 75 lb |
34.1 kg |
42.6 mg |
17.0 ml |
| 80 lb |
36.4 kg |
45.5 mg |
18.2 ml |
| 85 lb |
38.6 kg |
48.3 mg |
19.3 ml |
| >90 lb |
40.9 kg |
50.0 mg |
20.0 ml |
- Monitor patient’s vital signs. If hypotensive, elevate the patient’s legs.
- Maintain IV line with normal saline to keep vein open.
- If cardiopulmonary arrest occurs, begin CPR.
- Remain with patient until paramedics arrive.
- Arrange for rapid transport to an emergency department. Since 20% of anaphylaxis episodes follow a biphasic course with recurrence of the reaction after a 2 - 9-hour asymptomatic period, hospitalization or a long period of observation is recommended for monitoring.
- As soon as possible, inform physician.
- Call Nufactor at (800) 323-6832 as soon as reasonably possible to report the reaction and reorder anaphylaxis kit medications.
Nufactor's Management of Anaphylaxis for Subcutaneous Medications is the same as intravenous medication except the kit for subcutaneous therapy does not include 250 mLs of Normal Saline to keep the vein open, as there is no venous access established for infusion.
