SCIG and Blood Return
By Nufactor - August 26, 2024
With Hizentra® 10 gm/50 mL prefilled syringes now commercially available, we have learned of some patients accidentally pulling out the syringe plunger when checking for blood return before administration. This may be related to the design and need for better dexterity and has resulted in wasted medication and delayed doses.
In the subcutaneous immune globulin (SCIG) administration labeling of some SCIG products, instruction includes checking for blood return before infusing SCIG. In other product labeling, no such instruction is made. Differences in guidance is likely based on how studies were designed for FDA approval and not because of inherent difference in actual SCIG product.
Per the Immunoglobulin National Society (IgNS) Standards of Practice, the likelihood of injecting SCIG into a small blood vessel is minimal, and many drugs administered subcutaneously, such as heparin and insulin, do not require aspiration for blood return. The 2021 Infusion Nurses Society (INS) Infusion Therapy Standards of Practice recommendation for SCIG is to “remove and insert a new device at a new site if blood return is present during device placement.”
Based on this information collectively, for new patients, Nufactor now recommends omitting checking for blood return before SCIG administration (any brand), including HYQVIA®. Regarding the HYQVIA® component hyaluronidase, administered before the immunoglobulin component, if it gets injected intravenously, it immediately degrades, and enzymatic activity halts.
References
- SCIG product labeling
- IgNS Immunoglobulin Therapy Standards of Practice Edition 3.1. October 2023.
- Infusion Nurses Society, Infusion Therapy Standards of Practice [2021], Section Eight: Other Infusion Devices; 58. Subcutaneous Infusion and Access Devices.
- Murray RL, Zafar Gondal A. Hyaluronidase. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545163/
