Introduction
Immunoglobulin therapy is a precautionary measure for patients with low immunity. IVIG therapy can be administered as a replacement therapy via IV infusion in greater, more effective doses without painful side effects, and it can safely be given in outpatient as well as inpatient settings.
Definition
IVIG is a product made up of antibodies that can be given intravenously (through a vein). These antibodies are proteins that help the patient to fight infections.
Purposes
- IVIG is used to treat various autoimmune, infectious, and idiopathic diseases.
- It is also used to increase the levels of immunoglobulins.
Indications
- Autoimmune disorder.
- Immunodeficiency.
- Altered immune response.
- Dermatomyositis.
- Kawasaki’s disease.
- Multiple sclerosis.
- Lupus erythematosus.
- Chronic lymphocytic leukemia.
- Idiopathic thrombocytopenic purpura.
Contraindications
- Renal failure.
- Diabetes.
- Osmotic nephropathy
Articles
| Articles | Purpose |
| IV set with tubing | To administer the drug. |
| Infusion pump | To maintain drop factor. |
| Knife dish | To place the injections. |
| Normal saline flush | To prevent blood clots. |
| Wristwatch | To calculate the flow rate. |
| Notebook with pen | For documentation. |
| Immunoglobulin injection 5 g in 5% solution | To improve immunoglobulin levels. |
| Normal saline 500 mL | For dilution. |
| Inj. Hydrocortisone 50-200 mg (IV) | As a premedication. |
| Inj. Enoxaparin 1 mg/kg | As a premedication. |
| Tab. paracetamol | As a premedication (if needed). |
General Instructions
- Document the brand name, lot number, dose, infusion rate, and side reactions.
- Check baseline data such as renal and liver function tests (LFT, RFT), CBC, hepatitis B and C, and HIV tests.
- The recommended dose of infusion is 400-600 mg/kg for 3-4 weeks.
- Very low dose of IVIG 0.3-0.6 mg/kg once a month should be administered.
- The total time of infusion is 5-6 hours.
- The rate of infusion should be monitored.
- The initiated flow rate will be 0.5-1 mg/kg; after 20 minutes, it can be increased to 1.5-2.5 mg/kg/min.
- The usual maintenance dose is 400-500 mg/kg every 4 weeks.
- The vital signs should be monitored every 30 minutes until the infusion is completed.
- Review every 2 months and monitor CBC and immunoglobulin levels.
- Note adverse reactions such as edema, rashes, and scaly skin.
Recording and Reporting
- Record the type of fluid, amount of IV fluid, and drop rate at which the fluid is infused.
- Verify the prescribed dose to be transfused as per the physician’s order.
- Specify the color changes at the IV infusion site.
- Specify if signs and symptoms of fluid overload or fluid deficit are identified.
- Report any pertinent findings to the nurse-in-charge.
Special Considerations
Pre-Infusion
- Hydration is key to reduce side effects like headache.
- Review medications (e.g., hold nephrotoxic drugs).
- Screen for IgA deficiency (risk of anaphylaxis).
During Infusion
- Start slowly, increase rate gradually.
- Monitor for infusion reactions: headache, chills, fever, nausea.
Post-Infusion
- Watch for delayed side effects: fatigue, aseptic meningitis, renal dysfunction.
- Encourage rest and hydration.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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