Updated IVIG Education PPT for Nurses

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6. What is Gradual?
The infusion rate can be increased every 15 or 30 minutes,
providing the patient is tolerating, until the recommended or
ordered maximum rate of infusion is reached.
What Do I Increase the Rate TO?
The infusion RATE INCREASE is DETERMINED BY:
Patient’s tolerance, recommendation by the manufacturer,
Provider, and/or Pharmacist.
See manufacturers recommended Titration Rates/ Titration Tables
listed at the end of this Power Point).
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9. Mild to Moderate
1. Headache
2. Nausea and Vomiting
3. Chills/Rigors
4. Flushing
5. Dizziness
Management
1. Slow or stop infusion
2. Medicate for
reaction(as prescribed)
3. Restart the infusion at a
slower rate once the
symptoms have
subsided.
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Infusion Problem Assessment/Cause Nursing Response
Fevers, chills, rigors Solution is not at room
temperature.
Infusion rate may be too fast.
Stop infusion
Administer prescribed
medications
When symptoms resolve,
restart the infusion at the
previously tolerated rate
Infusion headache Solution is not at room
temperature.
Infusion rate may be too fast.
Patient may not be
adequately hydrated.
Administer analgesia, if
prescribed
Slow the rate
Nonpharmacologic
comfort measures
Instruct the patient about
the importance of
adequate hydration before
the next infusion

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Post infusion headache,
malaise, arthralgia, myalgia
May be an inflammatory
response indicating
intolerance to specific
product of IVIG in general
Symptomatic pharmacologic
(analgesics) and
nonpharmacologic measures
(rest, heating pad, etc.)
Consult provider; a short
course of steroids may be
necessary; premedication
before the next infusion is
indicated
If problem persists, consider
change in product or route or
administration.
Infusion Problem Assessment/Cause Nursing Response

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Urticaria May indicate intolerance to
product or a specific lot
number of a product
Stop the infusion and
contact provider
Administer
antihistamines and/or
steroids, if ordered.
Observe for signs of true
anaphylaxis, and, if they
occur, initiate emergency
interventions (administer
epinephrine and call 911).
Infusion Problem Assessment/Cause Nursing Response

13. Vasomotor symptoms
(blood pressure changes,
flushing, increased heart
rate)
• Product is not at room
temperature.
• Infusion rate may be too
fast.
• May indicate intolerance
to product.
Stop infusion
Consult provider and/or
call 911
Nausea, vomiting • Infusion rate may be too
fast.
• Product is not at room
temperature.
• May indicate intolerance
to product.
Stop infusion and call
provider
Provide symptomatic
comfort measures
Administer antiemetic, if
prescribed.
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Infusion Problem Assessment/Cause Nursing Response

14.  Once the infusion has been restarted, (after
symptoms have resolved), rate increases must be done
slowly and incrementally as indicated by the
patient’s tolerance.
 Once the patient experience a infusion reaction, the
provider may consider routine premedication for
future infusions.
 If reactions persist despite premedication, the provider
may consider a product or route change.
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22. 1. What was your infusion start time?
2. What was your infusion start rate?
3. What were you infusing through…PIV, IVAD,PICC?
4. Was your vascular access device patent, with good
blood return before you started infusing?
5. What were your patient’s vital signs prior to starting
the infusion?
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23. Each time the rate was increased or
decreased:
1. What was the time?
2. What was the rate?
3. What were the vital signs?
4. If PIV, was the site assessed for
infusion related complications?
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24. 1. What time did the infusion end?
2. What were the patient’s vital signs following the infusion?
3. How did the patient tolerate the infusion?
4. If PIV, did you remove? If so, catheter intact? Dressing
applied?
5. Is Site w/o device or infusion related complications?
6. If CVC; Did you flush per protocol & w/o resistance?
7. Was there brisk blood return?
8. Any s/sx of infusion of device related complications?
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26. Weight Based Titration Table
50kg VTBI Rate ml/hr
Time
Start@ 12.5 ml 25 ml/hr
@ 30 min 25 ml 50 ml/hr
@ 60 min 50 ml 150 ml/hr
@ 90 min 75 ml 150 ml/hr
@ 120 min 100 ml 200 ml/hr
Max Rate 250 ml/hr
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27. Weight Based Titration Table
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60kg VTBI Rate ml/hr
Time
Start@ 15 ml 30 ml/hr
@ 30 min 30 ml 60 ml/hr
@ 60 min 60 ml 120 ml/hr
@ 90 min 90 ml 180 ml/hr
@ 120 min 120 ml 240 ml/hr
Max Rate 300 ml/hr

28. Weight Based Titration Table
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70kg VTBI Rate ml/hr
Time
Start@ 17.5 ml 35 ml/hr
@ 30 min 35 ml 70 ml/hr
@ 60 min 70 ml 140 ml/hr
@ 90 min 125 ml 250 ml/hr
@ 120 min 140 ml 280 ml/hr
Max Rate 350 ml/hr

29. Weight Based Titration Table
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80kg VTBI Rate ml/hr
Time
Start@ 20 ml 40 ml/hr
@ 30 min 40 ml 80 ml/hr
@ 60 min 80 ml 160 ml/hr
@ 90 min 120 ml 240 ml/hr
@ 120 min 160 ml 320 ml/hr
Max Rate 400 ml/hr

30. Weight Based Titration Table
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90kg VTBI Rate ml/hr
Time
Start@ 22.5 ml 45 ml/hr
30 min 45 90
60 90 180
90 135 270
120 180 360
Max Rate 450

31. Weight Based Titration Table
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100kg VTBI Rate ml/hr
Time
Start @ 25 ml 50 ml/hr
30 min 50 100
60 100 200
90 150 300
120 200 400
Max Rate 500

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