**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.
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.Â
To assist with this process, you may use the following infusion rate calculator:Â
Please ensure you double-check all calculations and follow clinical judgment and any provider-specific instructions when setting rates.