Administering Orencia, Remacade,Rituxan and Bonivia

flightnurse2b, LPN · Nov 7, 2007

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 · Nov 8, 2007

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!

readyforanap · Jun 10, 2009

Are there guidelines somewhere for care of pt's getting rituxin , remicade, etc?

I am floating up to an infusion center and they don't do any vitals until pt. is done and ready to go home. Does pt. getting rituxin need to be on heart monitor or have one available? How often should b/p be checked?

Thanks for any info..