Parenteral Manual

Immune globulin, human (BLOOD PRODUCT from TML)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
GAMUNEX, GAMMAGARD LIQUID,GAMMAGARD S/D, IGIVnex , IGIV, IVIG
Classification: 
Gamma globulin
Original Date: 
August 2005
Revised Date: 
June 2014
Indications: 
  • Immunodeficiency syndrome (immunoglobulin deficiency syndromes)
  • Idiopathic thrombocytopenic purpura
  • Kawasaki disease
  • Prophylaxis of bacterial or viral infections (in combination with appropriate anti-infective therapy) in patients with immune deficiencies
  • Invasive group A streptococcal disease
  • Polymyositis/Dermatomyositis
  • Guillain Barre Syndrome

 

Reconstitution and Stability: 

- If provided with powder, reconstitute with diluent provided or sterile water for injection as directed by manufacturer.  DO NOT further dilute

Drug Concentration Stability in PVC bags
Gammagard Liquid 100 mg/mL 24 hours
Gammagard S/D 50 mg/mL or 100 mg/mL 24 hours
Gamunex , IGIVnex 100 mg/mL 8  hours

 

Compatibility: 

- Solutions Compatible: Gamunex®, IGIV, and Gammagard® with D5W ONLY

Incompatible: NS
                      

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES.   
Start all IVIG infusions slowly according to the following guidelines:
__________ mL/hr x 15 minutes (0.3 mL/kg/hr)
__________ mL/hr x 15 minutes (1 mL/kg/hr)
__________ mL/hr until done (3 mL/kg/hr) 
may increase to  __________ mL/hr  (MAX 7.2 mL/kg/hr)  until total volume finished for patients who receive regular infusions and have no history of reactions

Flush IV with 20 mL D5W after infusion complete

 
IV Continuous Infusion NO

 

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

- Immunodeficiency syndrome : 300 - 600 mgkg/dose IV once a month

- Idiopathic thrombocytopenic purpura: 800-1,000 mg/kg/day x 1 -  second dose given within 48 hours if needed

- Kawasaki disease: 2 g/kg as a single dose   Maximum 70 g

- Invasive group A streptococcal disease: 1 g/kg/dose on day 1 then 0.5 g/kg/dose day 2 & 3

- Dermatomyositis:  1 g/kg/dose daily x 2 days

- Viral myocarditis: 2 g/kg over 24 hours

- Guillain Barre Syndrome:  1 g/kg/dose  IV daily x 2 days

 

Potential hazards of parenteral administration: 
  • Fever, chills, hypotension, headache, nausea, vomiting, lethargy
  • tachycardia,  dyspnea, bronchospasm
  • Hypersensitivity reactions
  • Many of the adverse reactions are associated with the rate of infusion, therefore slowing or temporarily stopping the infusion may ameliorate the reaction
  • Thromboembolic events related to fast rate of infusion

IF PRE-MEDICATION REQUIRED:
Give 30 minutes prior to immunoglobulin infusion:

  • Diphenhydramine (Benadryl)  - 1 mg/kg, (Max. 50 mg) x 1 dose
  • Acetaminophen (Tylenol)   - 10-15 mg/kg, (Max. 975 mg) x 1 dose
  • Hydrocortisone (Solu-Cortef)  - 2.5 - 5 mg/kg/dose  I.V. x 1 dose

 

Notes: 

This medication contains albumin or human blood products.  Consent (Informed Consent for Transfusion of Blood/Blood Products - form #1084) is required prior to administration to the patient.                      

  • IVIG products with high IgA content are contraindicated in IgA deficiency
  • May interfere with immune response to live vaccines
  • Monitor:  VS,TPR,& BP pre infusion, q15min x 4 , then q hourly during infusion
  •  10% = 100 mg/ml
  • Notify MD and hold infusion if:   HR > 30 /min above baseline   RR> 10/min above baseline  - T > 1.5° C above  baseline    BP changes: increased or decreased >10 mm Hg from baseline       Wheezing, chills, rash, urticaria, flushing, myalgias, CNS or behavior change, headache or any unusual symptoms

ANAPHYLAXIS PRECAUTIONS:
- Have epinephrine, diphenhydramine and hydrocortisone available at bedside and in portable kit for patient transport off unit. 
- Dosage guidelines (Administer in sequence listed):

  • Epinephrine (Adrenalin)_____ mg = _______mL (0.01 mg/kg = 0.01 mL/kg of 1:1000 solution , Max. 0.5 mg = 0.5 mL) IM  Q 15 minutes x 2, then Q4H PRN.
  • Diphenhydramine (Benadryl)_______ mg (1 mg/kg/dose, Max. 50 mg) I.V. stat , then Q6H PRN.
  • Hydrocortisone (Solu-cortef)________ mg (2.5  - 5 mg/kg/dose) I.V. stat , then Q4H PRN.

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