• Subcutaneous Immunoglobulin Dose::

  • mg/kg

  • grams
  • (Dose will be rounded to nearest 2.5-gram or 5-gram dose based on product availability)

  • Preferred Product:    
  • .
  • Frequency of Therapy:

  • Every

  • Weeks/Days

  • Duration of Therapy:

  • Weeks/Days
  • .
  • • Needles, syringes, and all ancillary supplies per Geneva Woods Pharmacy protocol, to include infusion pump and other home medical equipment as needed.

  • Pre-Medication Orders:

  • mg PO x 1 dose

  • mg IV x 1 dose


    • For infusions given in the patient’s home, Geneva Woods nurse to educate patient on subcutaneous access, medication administration,
    use of supplies, therapy, and disease state. A nurse may be present during infusions until the patient has demonstrated competency in self-administration. Once competency is achieved and response to therapy is deemed safe by Geneva Woods nursing, the patient will be discharged from nursing services and will continue to infuse at home without a nurse present.
    • For infusions given in a Geneva Woods infusion suite, Geneva Woods nurse to obtain baseline vital signs prior to the start of each
    immunoglobulin infusion and upon completion of each infusion. The patient may be discharged when the infusion is complete if no side effects are noted.
  • Adverse Side Effect Orders:
    • For IG reaction with no significant change in vital signs: Reduce the infusion to previous rate. May increase rate as patient tolerates.
    • Give the following medications: (1) diphenhydramine 25 – 50 mg PO x 1 dose AND (2) acetaminophen 325 – 650 mg PO x 1 dose
      • For IG reaction that is severe, is accompanied by a significant change in vital signs, or does not subside with above interventions:
      Stop infusion, initiate hypersensitivity protocol (below), and contact prescriber.
  • • Acetaminophen 650 mg PO q4 hours PRN fever, chills, headache
    • Diphenhydramine 20 – 50 mg IV q4 hours PRN urticaria, pruritis, SOB
    • Oxygen by nasal cannula at 2 – 4 LPM as needed for chest pain, SOB
  • •Solu-Medrol 125 mg IV x 1 dose PRN urticaria, pruritis, SOB
    • Epinephrine 0.2 mg – 0.5 mg IV or IM x 1 for anaphylaxis
  • Please fax completed form to Geneva Woods Infusion Pharmacy