Question

1. IVIG infusion: the ordered dose is 2 gm/kg/dose. (IVIG concentration is 2 gm/10 ml 0.9 NS). The nurse runs the IVIG over 6 hours, discuss the drug class, side effects, patient and family education and nursing considerations
   1. Calculate the correct dose for this patient: ____________
   2. The first ½ hour: run infusion at ¼ rate for 30 minutes – what is that rate? ___________/hr
   3. The second ½ hour: run infusion at ½ rate for 30 minutes – what is that rate? ___________/hr
   4. If the infusion is tolerated increase to the rate of 2 ml/kg/hour until complete. What is that rate: ______ / hour

Answer 1

IVIG stands for Intravenous Immunoglobulin, IVIG is now considered effective therapy for various autoimmune disorders including idiopathic thrombocytopenic purpura (ITP), Guillain-Barre syndrome, various neuropathies, myasthenia gravis,
dermatomyositis and Kawasaki's syndrome, and others.

Intravenous immune globulin ("IVIG") is a product made up of antibodies that can be given intravenously (through a vein).

Mechanism of action of INTRAVENOUS IMMUNOGLOBULIN:

-blockade of Fc receptors
-Auto-antibody neutralization and inhibition of autoantibody production
-Complement inhibition
-Modulation of cytokine and cytokine antagonist production
-Activation or functional blockade of the death receptor Fas
-Modulation of dendritic cell properties
-Signaling through the inhibitory Fc receptor, Fc-gamma RIIB
-Enhanced steroid sensitivity

Intragam (immune globulin intravenous (IGIV)) is a sterilized solution made from human plasma. It contains the antibodies to help the body protect itself against infection from various diseases.

Many people do not have side effects from IVIG, but there are a lot of possible side effects, especially if you are not receiving the IVIG on a regular basis and/or if you are receiving larger doses of IVIG. However, over the course of their treatment, up to half of the people may experience one side effect, usually minor or bothersome but not dangerous. Very rarely, more serious side effects like allergic reactions or blood clots can occur.

Unwanted effects which may occur include :

• stomach pain
• headache,
• chest tightness
• flushed or pale face
• feeling hot or unwell, shortness of breath or breathing difficulty
• skin rash
• itching
• general redness
• swelling
• faintness
• dizziness
• nausea or vomiting
• a hot feeling or redness at the site of the injection.

Inform the patient of:

• The reason why they need IVIg
• The risks and benefits of the treatment
• The risks of not receiving IVIg

Kawasaki disease is an uncommon but important cause of fever in children. It most often occurs in children 6 months to 5 years of age. Kawasaki disease belongs to a family of illnesses where vasculitis or inflammation of the blood vessels can occur.

The dose (grams) of IVIg prescribed will vary according to the indication. A typical dose for Kawasaki Disease is 2g/kg/dose. The nurse runs the IVIG for over 6 hours :

1. Suppose if the patient is weighing 15 kg the correct dose for the patient is 30g

2.The first ½ hour: run infusion at the ¼ rate for 30 minutes – The rate is 50ml/hr

3.The second ½ hour: run infusion at the ½ rate for 30 minutes – The rate is 40 ml/hr

4.If the infusion is tolerated increase to the rate of 2 ml/kg/hour until complete. Then the rate is 19ml / hour