[Tolos]

Does any one of you smart nurses administer Orencia, Remacade,Rituxan and Bonivia IV? How do you administer this according to MD's orders. I am looking forward to working at an outpatient clinic where that is all they do.

[flightnurse2b]

I work in an Endoscopy unit where we do Remicade and Boniva IV. We have about 31 Remicade pts. and here is our protocol: it is ordered per mg/kg (usually starts @ 5mg/kg) and is titrated... the pt. starts @ 2 wks, then 4 wks, then 6 wks, then usually maintenence @ 8-10 wks if no flares. we reconstitute each vial with 10ml NS and let it cook for 10 minutes. Mix in 250 cc NS and it runs over around 2 1/2 hrs. rate is @ 20 for 15 mins, 40 for 15 mins, 80 for 30 mins, 150 for 30 mins and 250 for 30 mins... then watched for another 30 mins.


Boniva is a straight IV push. our docs order a prescription from the pharmacy and the pt. comes in with a little kit. there is a syringe with the Boniva already in it and a butterfly needle. It is a quick stick, push and out the door. Hope this helps a little..good luck

[AMHRN]

I have administered Rituxan 3 times. I have given it for patients with Devic's disease. When I gave it, the patients were medicated with 25 mg IV Benadryl, 125 mg IV Solumedrol, and 500 mg po Tylenol. I gave 500mg/50 cc, diluted in a 500 cc bag of NSS. The patients were monitored very closely. I started out at 1mg/ml and increased to 2mg/ml after I saw the vitals were stable. I checked vitals every 15 minutes for at least the first hour. A dr. was close by in case of an emergency. The first patient took all day about 8 hours, and she had a lot of BP issues, high then low.... then high. And she had one episode of nausea. At one point I had to turn off the IV and she was monitored for about a half hour. Then restarted. She did well and ended up receiving it again once her b cells came back to normal, and that took a while-- because she was completely wiped out. The 3rd time I did it, the patient tolerated it very well and was done within 4 hours. The Rituxan website has good info and a program to obtain auths from insurance! Hope this helps!