IMMUNOGLOBULIN (IV)

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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(Best Tag) and ask for Clinical Support.

ALWAYS establish IV access prior to mixing any meds

ALWAYS make sure you have everything you need to complete infusion before you begin

ALWAYS confirm your medication dose against the medication label and orders

ALWAYS reach out to us first (not the Pharmacy) with any questions

NEVER tell a Pt you have not given a particular medication before

MIXING

NOTE: Gammagard SD comes in powder form and needs to be reconstituted. Please see Gammagard SD under specialty medications for this IVIG

Obtain a clear/clean space to prepare IVIG
Be sure all the necessary supplies are available to complete the procedure from beginning to end
- 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
Turn on ambulatory pump
- Check pump is working
- Check batteries
- If issue with pump DO NOT USE gravity tubing until Agency is notified and permission is obtained from Pharmacy to use gravity tubing
Check rate on pump and program if needed
- Rates will be on orders or on a rate sheet sent with the medication or on the medication label
- HHC standard rates are the following:
  - 30ml/hr X 15 minutes
  - 60ml/hr X 15 minutes
  - 90 ml/hr X 15 minutes
  - 120ml/hr X 15 minutes
  - 150ml/hr X 15 minutes (Max rate until infusion ends)
Inspect vials for particulate material and discoloration prior to dilution
Spike IVIG glass vial using Vented spike, connected to pump tubing
- If using pooling bag - transfer IVIG to pooling bag, close all clamps on pooling bag then spike with IV tubing
Prime IV tubing

ADMINISTRATION

Take baseline vitals and document basic assessment
Attach primed IVIG tubing directly into IV line
Begin infusion following rates set by pharmacy on orders or bag label
Assess vital signs at baseline, every 15 minutes for the first hour, hourly and with each rate change, AND 5-10 minutes post infusion
When infusion complete, assess vital signs and patient's response to the infusion.
Flush catheter as ordered
- If infusion is running via peripheral IV, a heparin flush/lock is not necessary, however if patient will remain accessed for subsequent days for infusion and Pharmacy provides heparin, it may be used to increase the longevity of the IV
Discontinue peripheral IV if appropriate
Clean work area and ensure that all trash is disposed of
Document procedure and patient's response to procedure

ADDITIONAL INFO

Video: Home IVIG Infusion

Drip Rate Calculator:

In rare instances, the pharmacy may not preset the infusion pump or provide specific ramp-up rate instructions. When this occurs, the nurse is responsible for calculating appropriate ramp-up rates to ensure safe and accurate administration.

To assist with this process, you may use the following infusion rate calculator:

Drip-Rate-Calculator

Please ensure you double-check all calculations and follow clinical judgment and any provider-specific instructions when setting rates.