IgG Therapy for the Home-Based Patient: Administration and ... - NHIA

The primary driver in the success of that educational effort is
being sure that the patient knows what to expect. The home
infusion care team should create a care plan that details the
number of infusions per week/month the patient will have, an
estimated time for each infusion, the volume being infused, and
the number of sites accessed. This information—along with a
set of supplies, written instructions, and pharmacy contact information—should
be supplied prior to the teaching visit.
Typically, patients and/or caregivers can become independent
in as few as two or three teaching visits (see Exhibit
5). During the first visit, the nurse performs the entire administration,
explaining each step as the patient observes.
There should be time for the patient to ask questions and
get acquainted with the many various supplies. The second
visit is a tandem administration with the patient performing
the majority of the tasks with verbal cues from the nurse.
The nurse may perform certain tasks, such as the needlestick.
By the third visit, the patient should be able to perform
all of the tasks with only minimal cuing from the nurse. If
the patient or caregiver is not fully independent, more visits
may be offered. Additional support, such as phone assistance
and access to manufacturer teaching materials, may
also be offered.
Another critical element for success is regular follow­up.
Phone calls to check on patient progress and answer questions
aid in compliance and help patients avoid complications
that can sometimes arise from lapses in technique.
Patients should be made aware of what to expect during
SCIG administration. Typically, the first several infusions result
in a stretching, burning, tingling feeling at the injection site.
This sensation usually disappears after the tissue in and around
subcutaneous space becomes sensitized. Patients may continue
to experience sunburn­like redness and swelling at the
injection site and a “goose egg” reservoir of fluid in the subcutaneous
space, due to the volume of infusion. These fluid pockets
generally disappear within 6 ­ 24 hours as the fluid is
absorbed into the body. It’s common for patients to feel tenderness
and/or discomfort at the infusion site 12 ­ 24 hours following
administration; counsel them to choose activities and
even clothing appropriately. Patients may also experience
bruising 5 ­ 10 days after an infusion, and should know not to
be alarmed by the delayed appearance of bruising.
Exhibit 5
Core Elements of Patient Education
• Therapy regimen. The patient’s lifestyle must accommodate more frequent (weekly vs. monthly) administrations.
Patients must also understand that compliance with an independent self administration schedule is essential to
good outcomes.
• Anaphylaxis procedures. Review epinephrine auto­injector use and storage procedures in the event of an anaphylactic
reaction.
• Hand hygiene. Proper hand hygiene is a core element in all effective infection control programs, including in the patient’s
home.
• Site selection and preparation. Patients should be involved in determining which site(s) to use for infusion based
on comfort, body mass, convenience, etc. They should also be counseled on how to recognize improper needle
length for the site used (i.e. A needle that is too long may brush muscle wall causing bruising and discomfort, or a
needle that is too short can infuse intradermally, increasing the severity of local infusion site reactions.)
• Supplies. Patients should receive a list with all the supplies needed for their care along with storage/handling instructions.
Inventory awareness and appropriateness should also be stressed with patients during the training
phase, as they will be expected to assist their pharmacy with their supply needs and should know how to communicate
supply and usage needs.
• Priming needles. Patients should be instructed that all effort should be taken to insert a dry needle so that IgG is
not being tracked through the dermis, triggering a possible histamine release and increasing the probability of a
local site reaction.
• Needlestick procedure. Teach patients to insert the needle into the subcutaneous space and how to avoid intradermal
injection. Proper placement of the needles limits leaking, discomfort, and localized site reactions. Also teach
90­degree angle insertion, avoiding scars, skin folds, or keloids.
• Needle Securement: Apply tape over the needle in a chevron pattern to hold it securely in place during the infusion,
minimizing the risk of dislodgement and subsequent intradermal infusion.
• Disposal of trash and medical waste. Instruct patients on state and local regulations and to have appropriate
garbage receptacle ready before the administration procedure begins.
• Adverse reactions. While local site reactions are the most common, patients should also be educated regarding the
rare risks of aseptic meningitis, renal compromise, and cardiac compromise – particularly if there is comorbidity.
• Troubleshooting. Caution patients that the use of heating pads may increase a histamine response. Icing with a
cold water bottle before needle placement minimizes pain and can enhance comfort. Chronic leaking or redness at
the site should be a sign for the patient to discuss the needle length and/or pretreatment with their clinician.
IgG Therapy for the Home­Based Patient: Administration and Delivery Method Considerations 7