**ALWAYS establish patent IV access and flush PRIOR to mixing medication**
Pharmacy specific orders / instructions always supersede the Agency guidance provided below. If in doubt, do not guess, call our office, or tag @TeamHelp-CareCoordination and ask for Clinical Support.
ALWAYSÂ establish IV access prior to mixing any meds
ALWAYSÂ make sure you have everything you need to complete infusion before you begin
ALWAYSÂ confirm your medication dose against the medication label and orders
ALWAYSÂ reach out to us first (not the Pharmacy) with any questions
NEVERÂ tell a Pt you have not given a particular medication before
MIXING
Obtain a clear/clean space to prepare IVIG.
Be sure all the necessary supplies are available to complete the procedure from beginning to end.Â
You will need vented spike or pooling bag (vented spike is preferred method), NS flushes, heparin flushes if needed, alcohol pads, supplies for access (PIV/PICC/Port/CL), alcohol pads, ambulatory pump with tubing and ANA kit (if ordered).
Flush IV access device as needed for access site to assure site is patent prior to spiking medications.
Reconstitute each Fabrazyme vial by slowly injecting the appropriate volume of Sterile Water for Injection, USP to the inside wall of each vial. Gently swirl. Each vial will yield a 5 mg/ml clear, colorless solution.
35 mg vial requires 7.2 ml
5 mg vials require 1.1 ml
 The reconstituted solution should be further diluted with 0.9% Sodium Chloride Injection, USP to a total volume based on patient weight in kg.
< 35 kg                50 ml
35.1 – 70 kg       100 ml
70.1 – 100 kg     250 ml
>100 kg               500 ml
Obtain the appropriate size infusion bag. Prior to adding the volume of reconstituted Fabrazyme required for the patient dose, remove an equal volume of 0.9% Sodium Chloride Injection, USP for the infusion bag. Inject the reconstituted Fabrazyme solution directly into the Sodium Chloride Solution. Do not inject into the air space within the infusion bag. Discard any vial with unused reconstituted solution.
Gently invert bag to mix, do not shake.
Administer Fabrazyme using an in-line low protein-binding 0.2um filter.
ADMINISTRATION
Take baseline vitals and document basic assessment.
Attach primed tubing directly into IV line.Â
Attach the intravenous line to the infusion bag and begin the initial infusion at a rate no more than 0.25 mg/min (15 mg/hr). Slow the infusion rate in the event of infusion-associated reactions. For patients >30 kg, after patient tolerance to the infusion is well established, increase the infusion rate in increments of 0.05 to 0.08 mg/min (increments of 3 to 5 mg/hr) with each subsequent infusion.
For patients weighing < 30 kg, the maximum infusion rate is 0.25 mg/min (15 mg/hr)
For patients weighing > 30 kg,the minimum infusion duration is 1.5 hours (based on individual patient tolerability)
Assess vital signs at baseline, every 15 minutes for the first hour, hourly and with each rate change, and post infusion.
When infusion complete, assess vital signs and patient's response to the infusion.
When the infusion is complete, flush the infusion line with 0.9% Sodium Chloride Injection, USP to ensure the entire dose of Fabrazyme is delivered to the patient. Do not push the flush; rather, infuse at the last infusion rate tolerated by the patient.
Disconnect patient and remove IV
Place a pressure bandage at site.
Clean and dispose of used supplies.
ADDITIONAL INFO
Website:Â Fabrazyme
Preparation-Administration:Â Fabrazyme-Preparation-Administration