Human Rabies Immunoglobulin (HRIG)

[antoniodamato]

From time to time, nurses at my New York state institution have been asked to administer a prophylactic dose of the Human Rabies Immunoglobulin (HRIG) by infiltration at the wound site following an animal bite. This is something most of us just did without asking any questions. However, several nurses have begun to openly question whether the nurse or provider should administer HRIG at the wound site, rationalizing that it is a medical procedure. I'm wondering if administering HRIG at the wound site fits under the nursing scope of practice for RNs practicing in New York state, or any state for that matter. Any information you could provide would be most beneficial.

[chare]

When I underwent the rabies series in NC after a feral cat bite several years ago, both the HRIG and vaccination were administered by an RN. I'm curious, what is it about this that concerns your coworkers? And how do you see this as anything other than medication administration?

[antoniodamato]

I'm in your camp. I've been giving both HRIG and the rabies vaccination for years. Some of the newer staff feel that since HRIG is administered in and around the wound, it is a medical procedure rather than a simple vaccine/medication administration. I have written to the New York State Board of Nursing for something more concrete that I could present to them. I am also interested in the experience of my nursing colleagues from around the country, which prompted this posting. Thanks again for your thoughts.

[antoniodamato]

BTW, I wrote to the New York State Nursing Board and this was there reply:

The guidance that we provide in this area is that the technique of infiltrating a wound with rabies immunoglobulin falls within the scope of a provider.

Thank you

Nursing Board Office

New York State Education Department

Office of Professions

89 Washington Avenue

Albany, NY 12234

518- 474-3817 ext 120

[JKL33]

I don't "love" infiltrating around wounds mostly because I feel there are probably particulars that go beyond regular injection technique.

We don't administer local anesthetics by this method of administration, the providers do. That's the closest similar thing I can think of, although admittedly the purpose of local anesthetic wound infiltration is different than what we're talking about here.

I don't know. A totally fleshy wound is one thing, but it just doesn't feel too good to me when it's a grisly wound involving sensitive structures (larger bvs, nerves, tendons, etc.). What particular depths should be used? Where are certain structures in relation to the area that should be infiltrated? In infiltrating this particular wound are there any specifics I should concern myself with? Simple example - the volar wrist.

I'd probably feel slightly more confident if I simply looked into it more, but even in the ED it's not an everyday, every week, or even every month occurrence for the most part so I haven't been overly compelled to take the initiative. Overall though, yes, it's probably something a 30 minute inservice could take care of.

ETA: Oh. I do perform this. I like to talk it through with a provider first, as far as characteristics of the wound/surrounding area, etc.

[antoniodamato]

Thanks for this information, JKL33. I do agree that nurses are capable of handling this task. However, it seems to fall into this gray area and no one seems to have a definitive answer. I have done weeks of research, interviewed dozens of RNs and providers. No one knows the answer conclusively and up until now, no one has been capable of providing any evidence-based data that gives a definitive answer. Thanks again!

[sallyrnrrt, ADN, RN]

Anton:

I really respect and admire av OP, that has done critical thinking and research related to their post question

Good Job