Educate—managing patient expectations

When patients move to Vivaglobin^®, the nursing staff will want to ensure that the individuals (or their caregivers) are able to infuse their immunoglobulin (Ig) therapy with ease. However, as with learning any new technique, it takes time and practice to learn how to properly administer Vivaglobin^® and there may be potential problems associated with your patients’ Sub-Q experience.

The most common problems associated with Sub-Q Ig infusions are:

• Injection-site reactions
  – Blanching or erythema
  – Rash or pruritis
  – Discomfort
  – Swelling
• Leaking where the Sub-Q tubing and needle come together
• Needle discomfort/pain
• Long infusion times
• Blood return in the infusion tubing

The following tips may help to resolve common infusion issues:

Injection-site reactions

• Assess for tape allergy; change to paper/hypoallergenic tape
• Assess size of reaction—should be consistent with volume being infused and amount of subcutaneous tissue
• Assess length of catheter—may be too short and fluid may be leaking into the intradermal layer
• Assess site location—may be too close to muscle
• Decrease rate of infusion or decrease volume per site
• Avoid tracking IgG through the intradermal tissue by not allowing drops of IgG on needle tip prior to needle insertion
• Assess appropriateness of rotating sites
• Consider use of topical anesthetic ointment

Leaking at the catheter site

• Assess catheter; ensure it is affixed securely and fully inserted
• Assess placement—may be in a location that is subject to movement; advise regarding selection of site
• Assess length of catheter—if too short, suggest change
• Assess infusion volume—amount per site may be too great; adjust volume
• Assess rate of infusion; adjust rate

Extreme discomfort with needle

• Assess needle length—may be too long and causing irritation of infusion site
• Try catheter that allows introducer needle to be removed, leaving indwelling flexible cannulla catheter
• Try ice or topical anesthetic cream prior to insertion

Long infusion time

• Assess infusion preparation—check to see if Sub-Q Ig was brought to room temperature before infusing
• Assess volume per site, rate of infusion, and number of sites, or adjust infusion regimen
• Check equipment for pump settings, correct selection of tubing size and length to match infusion rates; check pump function, battery function, etc
• Arrange observation of patient technique (by specialty pharmacy provider or during office visit)

Blood return observed

• Remove and discard catheter that demonstrated blood return. Use new set
• Notify your Vivaglobin^® supplier of the need for replacements
• Vivaglobin^® must not be infused into a blood vessel

Next: Referring Patients