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  • TEC13: What kind of training and information is needed for the personnel/carer using IVIG?
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What kind of training and information is needed for the personnel/carer using IVIG?

Authors: Jesús González-Enríquez, Nadine Berndt, Houria Mouas

Internal reviewers: Romana Tandara Haček, Mirjana Huic, Anna-Theresa Renner

Refer to domain search and domain methodology section.

The health professional using IVIG requires specific knowledge and skills in order to be competent to treat patients with IVIGs. A hospital based IVIG program should provide education, training and protocols for staff to ensure the appropriate management and use of IVIGs, including for transport, storage, use of equipment and infusion techniques. The number of training sessions may vary between personnel depending upon their experience. Usually two up to eight sessions, individualized or in groups, are required. The training should include education related to documentation, patient consent, difference among IVIG brands, selection of a brand on the basis of patients’ risk factors, contraindications, needs, action plans for adverse events, rapid infusion protocols, and setup of infusion pumps, tubing and filter equipment {Reid B, 2006}{43}. IVIG can be given in the hospital, doctor’s office, or patient’s home. In any setting, nurses administer 90% of the transfusions {White-Reid K, 2008}{29}. They should complete an accredited blood transfusion education program and be assessed upon their competency {ACT Health, 2013}{33}. Accredited nurses are responsible for checking blood and blood products, administering IVIG, monitoring patients during transfusion, and carrying out the appropriate actions should an adverse effect occur, ensuring adequate documentation in the medical notes, and reporting of transfusion reactions or other incidences related to the transfusion {ACT Health, 2013}{33}. Protocols including a list of recommendations for the administration of IVIGS to help nurses and institutions are valuable. These protocols should list the importance of providing information to patients and their families and obtaining patient consent for IVIG use after outlining its risks and benefits. Other key features should be the verification of the prescription and indications for IVIGs, a list of contraindications to IVIG use, the assessment of the patients’ medical history and health conditions before IVIG infusion, the identification of patients at risk for adverse reactions, the careful choice of IVIG brands and infusion protocols that are appropriate for the patients’ conditions, the equipment needed to perform the infusion and control checks of the product, the necessary preparations before the infusion starts, how the infusion should be carried out, how to deal with adverse reactions and how to complete the infusion, and post-transfusion care, {Reid B, 2006; Malcolmson C, 2014} {43,44}.

Training for administering IVIG {National Blood Authority, 2014}{45}

After having obtained training for administering IVIGs, one should be able to:

- describe the transportation and storage requirements of the specific IVIG

- define IVIG administration and location of site of infusion

- list the appropriate infusion sites and understand the rotation of sites

- demonstrate care of the infusion site

- describe appropriate supplies necessary to complete the procedure

- use the pump and the alternative “push method”

- check the product, prepare the product, and to report wastage or nonuse

- prepare the infusion site and draw up the product from single or multiple vials and prime tubing

- demonstrate insertion of subcutaneous catheter and act appropriately if blood is present

- demonstrate appropriate aseptic techniques

- perform accurate administration the treatment, and remove and dispose the needle safely

- understand potential situations/reactions which could result from the infusion

- manage any reaction to the treatment correctly.

  Whether the nurse is administering an intravenous infusion or teaching patients or caregivers to administer subcutaneous infusions, safety has to be the first priority. Guidelines prior to, during and after administration of IVIG should be carefully followed. In that sense, core pre-infusion assessments may include assessment of the appropriateness of the IVIG for the patient, product integrity and product temperature, and the patients’ health status. An important intra-infusion assessment may include a continuous assessment of the patient for any symptoms to ensure that the infusion is being tolerated {Baxter, 2011; Younger MEM, 2012}{36,37}. Core post-infusion assessments may include an assessment for any irritation or adverse reaction to the infusion and an assessment for pre-medications for future assessments. These guidelines should be offered to help infusion nurses, but also patients and givers to minimize problems and adverse effects, and safely provide a successful infusion experience for the patient {Younger MEM, 2012}{37}.

One needs to be familiar with the complications of IVIG treatment, possible adverse effects and post-infusion reactions, and one needs to know which interventions are effective in case the patient experiences particular adverse effects {Younger MEM, 2012}{37}. IVIG is not a generic drug and IVIG products are not interchangeable, thus a specific IVIG product needs to be tailored to patient characteristics to insure safety {Gelfand EW, 2005; 2006}{40,41}. Communication of potential issues and problems so that they can be proactively addressed is critical {Younger MEM, 2012}{31}. Training and experience is crucial in order to decrease the risk of adverse events. When an IVIG infusion is given the first time, more attention is needed since adverse events may occur. However, if a patient has already received several infusions, it is known how the patient reacts and thus doses etc. are adjusted. Since the manufacture for the individual product is different, individual patients may experience different adverse events to different products and may experience adverse events in some, but not in other products {Gelfand EW, 2005; 2006}{40,41}. Premedication is usually only given if there has been a previous adverse reaction. In case of an adverse reaction, the rate of infusion must either be reduced or infusion stopped. Lower doses may be administered on a more frequent basis. Risk of adverse events can also be reduced by ensuring adequate hydration and by paying attention to particular requirements depending upon the health condition and its associated increased risks. The treatment required depends on the nature and severity of the (risk of the) adverse reaction {Baxter, 2011; NHS Health Scotland, 2012}{36,46}. Lastly, anyone involved with the administration of IVIG to patients must be well informed about the manufacturing and regulation, proper dose and administration, adverse events, appropriate assessments and related patient education {Chipps E, 1994}{47}.

Important
Partially
González-Enríquez J et al. Result Card TEC13 In: González-Enríquez J et al. Description and technical characteristics of technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Use of Intravenous immunoglobulins for Alzeheimer’s disease including Mild Cognitive Impairment [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 24 October 2020]. Available from: http://corehta.info/ViewCover.aspx?id=267

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