Subcutaneous Immune Globulin Supplies and Equipment

By Candy Finley, RN, IgCN

Subcutaneous immune globulin (SCIG) administration allows the patient more freedom and control by eliminating the complexity of the process, when compared to intravenous immune globulin (IVIG) administration. Training patients to become independent requires expert skills and experience. Nurses are responsible for ensuring patients are fully trained to administer drugs correctly, order supplies accurately and monitor for localized site reactions such as burning, itching, pain, redness and swelling at the injection site. Compared to IVIG, systemic side effects such as headache, flu-like symptoms and fatigue occur less frequently with SCIG. Premedication may not be necessary, but they may be appropriate for a patient transitioning from IVIG who has experienced side effects. Prior to each infusion, ensure all necessary supplies as well as the waste receptacle, are within the patient's reach to allow for a continuous SCIG preparation and administration process once started, avoiding interruptions.

Note:

During this COVID-19 pandemic, SCIG is a great option for patients not willing to risk exposure in the clinic setting, or the home with nursing for IVIG/SCIG. There has been an increase in patients requesting virtual training. It has been a great opportunity to avoid delays in their therapy and has helped lessen exposure to the virus.

Equipment:

Freedom 60 pump or Freedom Edge pump are mechanical syringe pumps that do not require batteries or electricity to operate and have basic alarms and features. They are easy-to-use, require drawing SCIG into a syringe, loading the syringe into the pump and a few other simple steps.

Supplies required include:

• Sharps container
• Sterile drape
• Transparent occlusive dressing
• Mini-spike dispensing pen
• Appropriate sized syringes (based on the pump type)
• Alcohol pads
• Syringe caps
• Flow rate pump tubing
• SCIG needle set
• Paper tape
• Gauze and adhesive bandage strips.

If ordered, topical anesthetic cream is used to numb the SC administration sites. It should be applied about 1 hour before SCIG administration and wiped from the skin before needle insertion. The Nufactor Anaphylaxis Kit contains an epinephrine autoinjector (e.g., EpiPen) and oral diphenhydramine.

Tips for successful SCIG infusions:

1. If weight gain or loss of +/-10% from baseline, notify Nufactor.
2. Use the proper needle length. Available sizes are 4mm, 6mm, 9mm, 12mm and 14mm. Nufactor sends two SCIG needle sizes for adjustments based on adipose tissue and location. Sites for injection are the abdomen and upper- to outer-thighs for patients who will self-administer SCIG. If a caregiver administers SCIG, additional sites include the side of the upper hips and back of arms.
3. Flow rate pump tubing is numbered from F 35 to F 2400. The lower the number, the slower the rate of the infusion; the higher the number, the faster the rate of the infusion. Nufactor sends the entire months' supply of drug and ancillary supplies. Select the slowest flow rate pump tubing for the initial infusion.
4. Utilize a "dry stick" method by stopping the flow of SCIG two inches from the tip of the SCIG needle set. This helps decrease the incidence of localized site reactions.
5. Always check for blood return. If positive on 2 or more needles, it may be necessary select a different site and start over with a new needle-set.
6. The best injection site locations, number of sites and speed of infusion should be determined as ordered and tolerated by the patient. Communicate what works best to Nufactor so the right supplies can be sent with subsequent deliveries.
7. Have the patient take great notes in their own writing or they may not understand later.

Now you're ready to go! Whenever you need assistance, call us! (800) 323-6832