Result card

  • TEC4: Who performs or administers IVIG?
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Who performs or administers IVIG?

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

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

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IVIG is usually administered in an infusion center or health care facility, indicated by specialized medical staff and supervised by health professionals. IVIG can be given in the hospital, doctor’s office, or patients’ 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. 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. (See TEC13. B0013). IVIG may be infused in the home setting, usually by an experienced infusion nurse. In some situations, this practice has been found to be more cost effective and result in improved quality of life measures. The first few infusions should be administered with medical supervision, regardless of the longer-term plan.

Many institutions require signed consent before any blood product is administered, and they document in the records of all of the patients that potential risks have been explained and that the patient/parent has received this information, has been given the opportunity to ask questions, and has given consent to receiving IGIV before initiating therapy.

The risk of transmission of viruses and prions from IVIG treatment is felt to be extremely low. Nevertheless, patients should be tested for exposure to known blood borne pathogens before starting IVIG therapy. Serologic tests for exposure to or infection with common pathogens such as Epstein-Barr virus, CMV and Hepatitis B will become positive in recipients of immune globulin therapy because of the passively transferred antibody. Therefore, if it is important to know if a patient has been infected with one of these organisms, antigen tests, such as PCR, should be done before IgG is administered.

It is recommended to perform testing for HIV and hepatitis A, B, and C, and measure complete blood count, hepatic transaminases and renal function before initiating immune globulin therapy by any route. In hematologic disease, Coombs’ testing should be done prior to IVIG therapy. This may identify preexisting infection or Coombs’ positivity before the immune globulin was administered and not transmitted iatrogenically. (See TEC10, B0010).

Solution products and reconstituted solutions of lyophilized products that have been stored in refrigerators should be allowed to reach room temperature before administration, to minimize adverse events. However, immune globulin solutions should not be microwaved or otherwise heated because the immunoglobulin protein could become denatured. Reconstituted lyophilized products should be inspected before administration to assure that the product has been completely dissolved and that the solution is uniform, although vigorous mixing causing excessive foaming should be avoided. All products should be inspected for the presence of particulates and evidence of tampering before pooling or administration to the patient.

(See TEC13, B0013)

Important
Partially
González-Enríquez J et al. Result Card TEC4 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

References