Unique Plan Description: Immune Globulin Administration
Plan Selection Display: Immune Globulin Administration
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2018-07-30 07:03:03
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2020-03-20 15:40:09
Available at all facilities: No

Immune Globulin Administration
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, PRN, see comment, T;N, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: hypersensitivity reaction
Medications
	immune globulin intravenous - Privigen
		0.4 gm/kg, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		0.5 gm/kg, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		1 gm/kg, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		5 gm, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		10 gm, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		20 gm, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		30 gm, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		35 gm, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
		40 gm, IVPB, Once, Routine
			Comment: 25ml/hr x 30 min, if tolerated increase to 50mL/hr x 30 min, if tolerated increase to 75mL/hr, if tolerated increase to 100mL/hr x 30 min, if tolerated increase to 200mL/hr x30 min, if tolerated until complete.  May increase rate to 400ml/hr until complete if indication for IVIG use is Primary Immunodeficiency.  Decrease infusion rate if patient experiences side effects (headache, flushing, change in vital signs) to the previous rate.  If symptoms subside promptly, the infusion may be resumed at that lower rate. If symptoms continue, stop the infusion and notify the provider.
	Benadryl
		50 mg, Tab, By Mouth, Once, T;N
			Comment: 30 minutes prior to immune globulin administration
		25 mg, Tab, By Mouth, Once, T;N
			Comment: 30 minutes prior to immune globulin administration
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
			Comment: 30 minutes prior to immune globulin administration
	hydrocortisone
		50 mg, Tab, By Mouth, Once, T;N
			Comment: 30 minutes prior to immune globulin administration
	Benadryl
		50 mg, Injection, IV Push, Once, PRN, allergic reaction
		25 mg, Injection, IV Push, Once, PRN, allergic reaction
	dexAMETHasone
		10 mg, Injection, IV Push, Once, PRN, allergic reaction
	SOLU-Medrol
		125 mg, Injection, IV Push, Once, PRN, allergic reaction
	Solu-CORTEF
		100 mg, Injection, IV Push, Once, PRN, allergic reaction
	meperidine
		12.5 mg, Syringe, IV Push, Q30MIN, PRN, shivering, 2 Dose(s)/Time(s)
			Comment: May repeat 12.5mg if shivering continues for total of 25mg.  For shivering associated with immune globulin infusion.
Patient Care
	Vital Signs
		With initiation of immune globulin, and every 30 minutes until infusion ends.  If clinically significant changes in vital signs occur, slow the infusion to the previous rate and reassess.
	Notify MD
		Symptoms of moderate to severe reaction or severe hypersensitivity

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase