Ivig administration in office setting

[Kungpowrao]

Hi, I have been a nurse now for six years working in multiple setting from nursing homes to ICU care. I just picked up a part time job at an infusion clinic where we only administer IVIg. I've administered IVIG many times and feel very comfortable doing so. However recently the doctor running the suite can only have one nurse work per day which is fine. I have only about five to six patients. What I'm worried about is the nurse I've been working with always started the IVIG infusions without the physician there. Now that I will be alone I will be expected to start the infusion without him present. I feel comfortable in theory because I have epi pens, kits, meds available in case of emergency and we are across the street from the hospital. I understand what to do and have had to take care of infusion reactions. What I'd like to know is if it legal to infuse IVIg on patients, not first dose, without the md present at the start of the infusion (he eventually comes in). If this is not an unheard of practice I'm ok with doing it but don't want to be stuck in a bad situation if not. I'd appreciate any input.

[Mom2boysRN]

It's administered at patient's homes by home health nurses all the time.

[Kungpowrao]

Good point

[iluvivt, BSN, RN]

Yes, but I would make certain that the MD office is USP 797-compliant with sterile drug compounding and other rules. Please read these if you have not. For example,I learned that you can have no more than two entries into any one container so If I need to add 4 vials into my IV bag I apply a needless connector to the needle so I comply.

Most IVIG is now given straight from the glass bottle after adding a spike adapter Also always check your ANA kit and make sure you Epi and Diphenhydramine are not expired. Make certain you have given the premeds or the patient took them before the appointment

Most adverse reactions are rate dependent, as you probably know, so if the patient should get some more of the moderate reactions you can lower the rate by half and more severe just stop it for a bit.

So, yes you can be confident that you can administer IVIG without the MD being present as long as you have an ANA kit and you know what to do if the patient should experience an adverse reaction. Review your protocols and make sure that your premedication orders are in place. If you have a patient that consistently is having an adverse reaction be proactive in changing the premeds such as adding in a steroid (prednisone day before and /or day of), IV diphenhydramine,or other.