INTRAVENOUS IMMUNE GLOBULIN (IVIG) INFUSION ORDERS

  • PRESCRIPTION FOR GENEVA WOODS INFUSION PHARMACY

  • Immunoglobulin Dose:


  • mg/kg

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

  • Frequency of Therapy:


  • once weekly

  • Once every

  • weeks

  • days consecutively
  • .

  • every

  • week(s)
  • .
  • Duration of Therapy:


  • months

  • weeks
  • .
  • • Sodium Chloride 0.9% flush, Heparin flush, 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

  • mg PO x 1 dose

  • mg IV x 1 dose
  • NURSING & LABORATORY ORDERS

      • If no central intravenous access, Geneva Woods nurse to insert peripheral IV per Geneva Woods Pharmacy protocol.

    • Geneva Woods nurse to obtain baseline vital signs prior to the start of each immunoglobulin infusion. Additional vital signs will be

    obtained with each rate titration during infusion.

      • Initiate first dose therapy at (1) 0.5 mL/kg/hour x 5 – 15 minutes, (2) increase to 1 mL/kg/hour x 5 – 15 minutes, (3) increase to 2 mL/kg/

    hour x 5 – 15 minutes, (4) increase to 4 mL/kg/hour for the remainder of the infusion. For the second and subsequent intravenous

    infusions, the rate may be increased past 4 mL/kg/hour to a maximum of 8 mL/kg/hour as patient tolerates.

    • For the first infusion, the patient will be monitored for one hour post-infusion. For the second and subsequent infusions, the patient

    may be discharged when the infusion is complete if no side effects are noted.

      • If no central intravenous access, Geneva Woods nurse to insert peripheral IV per Geneva Woods Pharmacy protocol.

    • Geneva Woods nurse to obtain baseline vital signs prior to the start of each immunoglobulin infusion. Additional vital signs will be

    obtained with each rate titration during infusion.

    • Initiate first dose therapy at (1) 0.5 mL/kg/hour x 5 – 15 minutes, (2) increase to 1 mL/kg/hour x 5 – 15 minutes, (3) increase to 2 mL/kg/

    hour x 5 – 15 minutes, (4) increase to 4 mL/kg/hour for the remainder of the infusion. For the second and subsequent intravenous

    infusions, the rate may be increased past 4 mL/kg/hour to a maximum of 8 mL/kg/hour as patient tolerates.

    • For the first infusion, the patient will be monitored for one hour post-infusion. For the second and subsequent infusions, 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 x 1 dose for anaphylaxis
    CALL PRESCRIBER if second dose is needed
  • Please fax completed form to Geneva Woods Infusion Pharmacy
    907.334.8587