Rachel Phillips

* Regarding the calculation and the infusion rate mentioned in “the 60 kg” example .
Being infused at 0.1ml/kg body weight/ hour for 10 minutes, means 6 ml/hr and the infusion time is 10 minutes = infusing 1ml over 10 minutes =setting the infusion pump into the following rate: 6 ml/hr and the infusion time is 10 minutes, and it doesn’t mean infusing the whole 6 mls over 10 minutes.

*The second issue, you can then increase gradually the infusion rate to the final infusion rate in order to avoid the side effects of the IgA which is usually responsible in the ADRs that happened with the infusion like the hypotension and allergy like reaction … so these reactions could happen “falsely ” if the products infused very fast and your will be denying the patient from getting the product.

In IgG infusion most of the ADRs are related to the infusion rate, so there should be a plan for the nurse what to do if she see these ADRs : headache, backache, myalgia, elevation in body temperature, chills abdominal pain, chest tightness, hypotension or hypertension, flushing, & N/V.
So, the safest way to handle this issue is to gradually double the rate after the first infusion q 15 for half an hour after that infuse the remaining over 60 minutes. Some patients could tolerate the product very well if infused very slowly.

*Third, it is always recommended to pre-medicate with acetaminophen and diphenhydramine . Also, don not infuse the product above 4 hrs as this a blood product, i.e. the minimum infusion time is 2 hrs and the maximum time 4 hrs.

*Fourth, Closely monitor the patient for the first 10 minutes and each time the rate is increased. The most of the infusion reactions occur is 30 to 60 minutes after the initiation and each time the rate is increased. Continue to monitor the patient as appropriate throughout the transfusion for changes in vital signs and symptoms of adverse reactions and for at least 20 minutes after the finish of the infusion.

* Finally… in general having printed infusion instructions ( or form) for IV immunoglobulin available to the nurse with instructions of what to do if she suspect an infusion reaction ; will contribute a lot to the safe infusion practice and will identify true allergy from just an infusion reaction that can be managed by decreasing the rate.

One more thing , when you want to select an IgG product to add it to the formulary always consider the IgA content of each product available in the market because this will relief you from a lot of infusion rate related problems.

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