**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.
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
Rituxan comes in a sterile, ready-to-use solution for intravenous (IV) infusion at a concentration of either 500mg per 50 mL or 100mg per 10 ml. Determine the number of vials needed to make up the dose per the Orders. Always be sure you read your orders and are clear about the dosage before spiking any vials
Obtain a clear/clean space to prepare the medication. Be sure all the necessary supplies are available to complete infusion from beginning to end. You will need IV start/ port access supplies, a syringe and needle, 250 ml bag of Normal Saline for dilution, and tubing (gravity tubing or pump tubing if using a pump).
Draw up the prescribed dose in a syringe. The medication will need to be diluted with Normal Saline.
Remove the volume of Normal Saline from the 250 ml infusion bag equal to the volume of the total volume of Rituxan. The total volume of Normal Saline and the medication will equal 250 ml.
Inject the medication into the bag of Normal Saline. Gently mix. DO NOT shake.
Spike the IV bag with the proper pump or gravity tubing.
ADMINISTRATION
Take baseline vitals and document basic assessment.
Infuse Rituxan beginning at a rate of 25ml/hr, titrating up every 30 minutes to a max of 400ml/hr unless orders specify otherwise. Titration should progress as follows unless otherwise specified in the orders:
25ml/hr x 30, 50ml/hr x 30 min, 100ml/hr x 30 min, 150ml/hr x 30 min, 200ml/hr x 30 min, 300ml/hr x 30 min, max rate = 400ml/hr
Record vitals at baseline, with each titration, hourly, and at infusion end.
Please remember to record lot numbers and expiration dates for vials used.
Disconnect patient, flush line, and remove IV, placing a pressure bandage at site. Clean and dispose of used supplies.