Discover practical strategies to help minimize reactions and enhance the overall experience for patients and caregivers.
By Candy Finley, RN, IgCN, Clinical Nurse Educator II - June 30, 2025

Providing clear and concise information for patients receiving subcutaneous immune globulin (SCIG) therapy, is of utmost importance. SCIG treatments can be life-changing for people with immune deficiencies and autoimmune conditions; localized site reactions are anticipated and generally well-tolerated and should not be considered a contraindication to treatment continuation. In this blog, I will share some practical strategies to help minimize these reactions and hopefully improve the overall experience for patients and caregivers. Typical localized site reactions include but are not limited to burning, itching, redness, swelling, and pain to injection sites. These reactions should minimize over time once the body gets used to the drug.

Strategies to Minimize Reactions

1. Ig Temperature

Advise patients that SCIG vials or prefilled syringes stored in the refrigerator should be removed 60-90 minutes before a dose is administered to allow immune globulin to warm up to room temperature. Administering cold Ig products may cause discomfort or increase the likelihood of reactions.

2. Proper Site Selection

It is vital to educate patients on proper rotation of sites each infusion to decrease the formation of nodules(temporary) and scar tissue formation (permanent). This will allow the skin to recover and may reduce any irritation that may occur. Avoid placing needles in scars, stretch-marks, visible vessels, boney prominences, tattoos, and irritated skin.

Recommended site(s):

• Independent patients without any caregiver assistance:
  • Entire abdomen-divided into four quadrants (staying 2 inches in circumference away from the umbilicus/belly button).
  • Upper, mid-to-outer-thighs (never the inner-thighs- very vascular and thighs rub together when walking, avoid getting too close to knees).
  • Never use the buttocks.
• Patients with a caregiver available to assist:
  • Backs of upper arms.
  • Lower back adipose tissue (love handles).

3. Preparation of Injection Site

Patients may wash hands or use gloves if preferred, but hand washing is sufficient. If numbing cream is used, it must be completely removed with a paper towel prior to preparing the site to avoid inadvertently injecting into skin. It is important to thoroughly clean the injection site(s) with an alcohol prep pad, do not blow or fan after and allow the skin to air dry. This will reduce risk of infection and help minimize discomfort. Make sure needle sites are at least 2 inches apart, EXCEPT for administration of CUVITRU^® needle sites must be at least 4 inches apart.

4. Needle Insertion

As noted above, clean the injection site and allow to air-dry completely with no fanning or blowing. Ensure appropriate needle length is selected for the infusion site selected. If you are not certain, contact the pharmacy. Remember, if needles are too long you may be terminating in muscle and if the needles are too short you may be infusing into the dermal or epidermal layers. It is imperative you pinch the skin about an inch, to isolate the fatty tissue from the muscle, if possible, and insert needle in a 90-degree angle with a rapid dart-like motion. If NO blood return is noted inside the needle/tubing, cover needle site(s) with occlusive dressing provided with the needle-sets. It is no longer recommended to pull back on plunger to assess blood return. If blood is detected inside the needle set you may not use that site. If this occurs:

• If using a single needle, remove and discard the needle set and use a brand-new needle set.
• If multiple needle sites are used, clamp the affected site and contact the pharmacy to determine if it is safe to proceed with remaining needle sites. This is dependent on the volume per site and the infusion rate. If a new needle set is required, always use a brand-new needle set, do not re-use needles in a different site.
• Note: If you leave the border of the occlusive dressing in place, it’s easier to lift off following the infusion.

5. Post Infusion Care

Once infusion is complete turn the pump off and leave needles in place for several minutes to allow pressure to equalize at the infusion sites and prevent backflow. Consider closing slider clamp(s) to avoid any leakage of drug onto the dermal layers. Once needle(s) are removed, cover the site(s) with a gauze and tape for 1 hour and do not get it wet. Afterwards it is safe to resume all normal activities. For needle site discomfort you may apply a cold pack to aid with discomfort. If itching is noted, a topical antihistamine cream may be applied.

6. Proper Hydration and Skin Care

It is essential to educate patients to stay well hydrated 1-2 days prior to infusion and 1-2 days following the infusion. If patients have fluid restrictions, please adhere to them. It is recommended that adults drink eight 8oz glasses of water per day, adolescents drink six 8oz glasses of water per day, and pediatric patients drink four 8oz glasses of water per day. Always avoid caffeinated products as they can have diuretic effects and may lead to dehydration. Keeping skin moisturized can help keep the skin supple.

7. Education and Support

Providing ongoing education and emotional support is crucial. This will help encourage the patients to feel comfortable with disclosing their site reactions if they arise. It is important to encourage patients to keep a journal for their infusion dates, site reactions experienced, and lot number/expiration date of vials or prefilled syringes used. This information can aid with finding solutions to any potential problems. Also, remember to educate patients to keep the anaphylaxis kit readily available and within reach for every infusion regardless of past tolerability.

Conclusion

With implementation of these strategies, patients and caregivers can work together to minimize reactions to subcutaneous immune globulin (SCIG) therapy. As healthcare providers, our role is to empower our patients with the knowledge and tools to be successful in managing their treatments. This can lead to improved outcomes and better quality of life for most patients. Together we can help healthcare CARE!