IVIG Therapy

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The following course content

Introduction   

When hearing the phrase intravenous immunoglobulin (IVIG) therapy, what comes to mind? What do you think of when a client receives regular IV infusions? If you’re a nurse, you’ve definitely heard about IVIG therapy at some point in your nursing studies and career. Maybe even before nursing school, you might have overheard some people talk about going to clinics for infusion therapies or saw people with IV ports. Presently, clients seek guidance and information on various health topics from nurses, including the use of IVIG therapy. The information in this course will serve as a valuable resource for nurses of all specialties, education levels, and backgrounds to learn more about IVIG therapy. 

Intravenous Immunoglobulin (IVIG) Therapy 

Intravenous immunoglobulin (IVIG) therapy is a medical intervention that involves immunoglobulin medications to be given to a client via IV. IVIG is a type of antibody medication fluid that can be used for several health conditions, such as infections, inflammation states, and autoimmune conditions. The ideal target outcome for a client on IVIG is to stabilize the client’s immune system since the client most likely has a compromised immune system. IVIG therapy is not a new form of medication; in fact, IVIG therapy has existed in the United States for several decades. Since the 1970s, nurses, health care providers, scientists, and clients have all experienced novel innovations with IVIG therapy. Truly, IVIG therapy is often a life-saving medication option for several people who have not responded well to other medical interventions. IVIG therapy is often used for clients with autoimmune conditions, such as cancer or blood disorders, or for clients experiencing a chronic or severe infection. Some clients with severe inflammatory responses also receive IVIG therapy.  

Over the past several years, there have been hundreds of IVIG therapy options on the market for several health conditions. Some clients received a single IVIG therapy infusion for a single infection and never receive IVIG therapy again. Some clients have been on various IVIG therapies their whole life as a result of chronic autoimmune conditions. Because of the wide range of IVIG therapies, uses, dosages, client populations, IVIG therapy administration settings, and more, the world of IVIG therapy is no longer limited to high-risk, acute, or chronically ill clients. Clients of several varied health histories and with unique health needs seek IVIG therapy daily. For instance, a client with ulcerative colitis can receive IVIG every few months to manage their intestinal flareups at the local IV infusion center. Another client can receive IVIG therapy a single time after a severe pneumonia infection in the med-surg unit at a major hospital (1,2,3,4,5,6,7).  

IVIG therapy is used in a variety of clinical settings for various client needs, such as in oncology nursing wards, rheumatology clinics, intensive care units, and rehabilitation care centers. With the rise of technology, telehealth, home health nurses, and remote client monitoring, thousands of clients receive IVIG therapy from their own home as well with a routine IVIG infusion or through an IV port (depending on the type of IVIG therapy and port). While many clients receiving IVIG therapy receive this therapy in an outpatient setting, as the demands for home health nursing and medical interventions shift, the reality is that many clients receive IVIG therapy in non-clinical settings as well. Because IVIG therapy can be used for short or long durations (as little as a few days to a lifetime), nursing care and client monitoring must be followed to ensure that clients are receiving appropriate nutrition, maintaining client IV access, tolerating the procedure well, and showing improvements in health and quality of life.  

In particular, IVIG therapy, like all other medical interventions, is not guaranteed to have the same outcome on every client’s health. Some clients can have more severe IVIG therapy reactions, such as anaphylaxis, IV site irritation, and worsening of client health status. Because there are several types of IVIG therapies, doses, frequencies, concentrations, and durations, it is important to consider all these factors, in addition to the client response and health status, when assessing for response to IVIG therapy (1,2,3,8,9,10).  

A client’s clinical condition, response to IVIG therapy, age, insurance, health status, and other factors determine the need and length for IVIG therapy. Because of various factors influencing IVIG therapy duration, dosage, and type, monitoring and adequate assessment of clients on IVIG therapy is essential. This is especially true since the majority of clients receiving IVIG therapy are immunocompromised, have at least one chronic health condition, and have had several medical interventions prior to IVIG therapy. Because of each client’s situation, it is important to make sure they are aware of the role of IVIG therapy and educated on the risks and benefits (1,2,3,9,10,11,12).  

Prevalence 

The exact prevalence of IVIG therapy use is not known, as IVIG therapy usage can vary widely in several health care settings. In fact, no longer are days when IVIG therapy is limited to emergency or acute care settings. Several clients use these devices at home, at outpatient IV infusion centers, in outpatient health care centers, nursing homes, and more. It is estimated that at least a million adults have either tried or currently use some type of IVIG therapy. IVIG therapy is also used by all age groups, from neonatal to pediatric and geriatric populations. Even pregnant people use IVIG therapy during their pregnancy. While IVIG therapy is often administered by a registered nurse (RN), some states and places of work also permit licensed practical/vocational nurses (LPN/LVNs) to administer IVIG therapy as well.  

IVIG therapy can be given at home as well, depending on the type of infusion, client condition, and home health nurse availability. As a result, for many clients, the role of caregivers, such as a parent or spouse, who can assist with monitoring a client’s condition can be helpful as well. In general, most acute care settings, hospitals, rehabilitation care centers, and long-term care facilities use some form of IVIG therapy in at least one client at any given time. It is important to note that IVIG therapy is available via prescription only, which can also cause discrepancies in true prevalence in various inpatient and outpatient settings (1,2,3,4,5,6).  

Indications 

Clients can receive IVIG therapy for many reasons. Some people receive IVIG therapy to manage chronic health condition, such as cancer remission or thrombocytopenia. Some people receive IVIG therapy to manage the severity of an infection, such as COVID-19 or more virulent systemic infections. The majority of people who receive IVIG therapy do so as a result of an existing weakened immune state as a result of an autoimmune condition, infection, or other inflammatory predisposition. For instance, neonates might be on IVIG therapy if they are born prematurely and unable to bolster their own immune system naturally. An adolescent client might be on IVIG therapy if they have a blood cancer. A geriatric client might be on IVIG therapy if they have cognitive impairment, such as Alzheimer’s.  

There is no one-size fits all criteria for IVIG therapy, but IVIG therapy is often not considered a first-line therapy given that it is often expensive, invasive, and can have severe side effects. Prior to initiating IVIG therapy, many clients receive other types of pharmacological and non-pharmacological interventions to determine if there is an improved status in client health.  It is important to note that the rise of IVIG therapy have allowed for possibly less drug-drug interactions and possible improvement in quality of life and care for several clients. It is also important to note that for many people receiving IVIG therapy, they will often be in an immunocompromised state for several months, if not the rest of their lives, which can make these clients more susceptible to other infections. As a result, education on infection prevention for clients on IVIG therapy is essential (1,2,8,13,14,15). 

While many clients can be on IVIG therapy for many reasons, there is often no strict contraindication for IVIG therapy. That said, there are hundreds of types of IVIG formulations on the market, so ensuring a client is well-hydrated, has completed baseline blood work prior, and is aware of the possible risks and benefits of their particular IVIG therapy regimen is paramount. All clients receiving IVIG therapy also need a patent IV access site, often in the arm or through an IV port (1,2,3,4,5,6,7).  

IVIG Therapy Options 

There are several Food and Drug Administration (FDA) approved IVIG therapies on the U.S. market and more being researched and funded every day. That said, many health care organizations contract with manufacturers and pharmaceutical companies. So, at your workplace, it is important to familiarize yourself with the types of IVIG therapies you will encounter. In addition, certain IVIG therapies use specific tubing and might need to be primed with normal saline before administering. Tubes and adhesives can influence client skin sensitivities or trigger allergic reactions in addition to the IVIG therapy itself.  

As a nurse, it is important to understand the materials the tubes use and the materials in each IVIG therapy, as every formula can vary widely in ingredients used and concentrations administered. Some IVIG infusions last an hour without the need for an infusion pump, whereas some other infusions last several hours with the use of an IV infusion pump. Ensuring the pump, IVIG therapy, concentration, dosage, duration, and other client rights, in addition to the client’s allergy history as well, is part of IVIG therapy administration. Consider your client needs, allergies, facility protocols, client condition, IV patency status, medication history, IV pump settings (if applicable), and overall client progress when assessing for IVIG therapy use and progress (1,2,10,13,14). 

IVIG Usage 

As mentioned above, IVIG therapy is used in several inpatient and outpatient settings presently. While many people can initially start using IVIG therapy in an acute care setting, many times, clients can also start using IVIG therapy in an outpatient setting after clinical evaluation. IVIG therapy can be used wherever someone has access to immunoglobulin therapy, IV supplies, and health care professionals who can monitor client response to therapy. In emergency situations, IVIG therapy can be administered if an IV pump is needed with a generator or large portable battery. Typically, if a client is scheduled for IVIG therapy, they will either complete an evaluation with a health care provider before, which can include vital signs, blood work, and overall health assessment. Then, at the IVIG therapy appointment, the client often arrives, completes paperwork, and receives the infusion over the course of the pre-set duration for that IVIG therapy.  

During the infusion, the client should be carefully monitored for any urgent side effects or allergic reactions. After the infusion, the nurse should examine the IV access site or port and ask the client how they are feeling and schedule a follow up as indicated per workplace protocol. Many times, when a client is receiving IVIG therapy, they can watch TV, use their phones, rest, knit, or talk to their caregiver. Everyone’s response to IVIG therapy can vary, so that is something to keep in mind as well. With the rise of home health and telehealth interventions, many clients can receive IVIG therapy in a hospital setting then transition to administering IVIG therapy at home with a home health nurse and follow up with health care services as needed. Because of the growing prevalence of at-home nursing care and IVIG therapy outside of clinical settings, it is important to keep in mind the role of client education and nursing care in IVIG therapy administration and client care management (1,2,3,4,5,6,7).  

Clinical Criterium 

Clinical criterium for being on IVIG therapy can vary depending on facility protocol, client response to prior medical interventions, client age, and other demographics. Overall, clinician judgment and client response consider should guide the need for IVIG therapy, as IVIG therapy is often used for various clinical indications and for varied durations. While IVIG therapy is becoming more popular, IVIG therapy is rarely, if ever, the first-line intervention for a client and is not often a routine medical intervention, as IVIG therapy is a costly medical intervention that requires client education, monitoring, and assessment. In addition, being on IVIG therapy presents several risks, and risks versus benefits must be considered for the client.  

Clinical criterium for being on IVIG therapy would be to ensure the client is willing and able to try IVIG therapy and to have patent IV access during the duration of IVIG therapy, especially for the first session. In addition, education and monitoring of severe side effects, such as anaphylaxis and breathing complications, and possibly not working as effectively as indicated are things to consider for IVIG therapy. While there is no set guideline for IVIG therapy protocol, there are hundreds of IVIG therapy products approved by the FDA for their own clinical indications that can possibly be a good fit for a client given their health history and condition (1,2,3,10,12,13).  

Side Effects and Complications 

While IVIG therapy has grown in popularity over the past decade, IVIG therapy has several possible side effects and complications. The most immediate complication of IVIG therapy is anaphylaxis reaction, in which the infusion would need to be stopped immediately and emergency medical intervention would be needed. Other complications of IVIG therapy can include IV site infiltration, IV site swelling, IV tubing issues, and issues with IV insertion. As for IVIG therapy itself, the most common side effects are fatigue, fever, headache, and chills, all of which can occur during the infusion, after the infusion, and last for a few days or up to a week after the infusion depending on the client’s response. Other rare, but still possible, side effects include chest pain, GI upset, changes in heart rate, changes in blood pressure, trouble breathing, kidney injury, arrythmias, hematological impairment, or neurological impairment.  

Given that there are several types of IVIG therapies, some might have more specific severe adverse reactions, which are important to counsel and educate clients on. Given the wide range of possible and severe side effects and complications of IVIG therapy, careful monitoring of a client’s health and condition is essential. While some clients will have no symptoms initially, others can develop symptoms over time, especially if they have complex health histories or several medications being administered. While there are no established protocols on serum lab values or imaging to monitor for clients receiving IVIG therapy, it is essential to check with your facility’s protocol regarding frequency of assessments and monitoring for clients receiving IVIG therapy (1,3,4,5,6,7,10,11,14).  

Average Cost 

Cost for IVIG therapy can significantly vary depending on the type of IVIG therapy, concentration, dosage, frequency, client age, insurance, duration, and other factors. IVIG therapy is often an expensive medical intervention, but for many clients, it is essential care and possibly the only way for some clients to improve their health and quality of life given their health situation. Cost is among a leading reason why many clients cannot maintain their medication and health care regime, especially if IVIG therapy is recommended in an outpatient setting. If cost is a concern for your client, consider reaching out to your local client care teams to find cost effective solutions for your clients (1,12,14,15).  

Self-Management 

Depending on the nature of IVIG therapy, clients may have either started IVIG therapy in an acute setting, such as an oncology nursing unit, and then be discharged to home care or outpatient care for IVIG therapy sessions as needed. In addition, some clients will have IV ports that can be used for IVIG therapy. Clients do not self-administer IVIG therapy, but can administer subcutaneous (SQ) IG therapy, and possibly alternate between the two options depending on the clinical response. While clients in acute settings monitored by nurses and other health care professionals do not need to self-manage their responses to IVIG therapy, clients can be aware of possible IVIG therapy complications regardless of their setting. 

Clients can be aware of possible symptoms to alert for medical attention, such as trouble breathing, chest pain, facial pain, confusion, headache, numbness, redness around the IV insertion site, debris in the tubing, and fatigue. Caregivers or loved ones can be made aware of IVIG therapy administration, benefits, and risks as well. Common ways for clients receiving IVIG therapy to self-manage themselves include having access to medical care in the event of a delayed IVIG therapy reaction, having follow up appointments scheduled with their health care providers, and having a support system. Clients and caregivers can also be educated on infection reduction techniques, such as hand washing, mask wearing, disinfecting surfaces, and more (1,3,4,5,11,16).  

IVIG Alternatives 

Alternatives to being on IVIG therapy can greatly vary depending on the client response to IVIG therapy, health, and presentation. For most clients, the alternative to IVIG therapy is another medical intervention, such as another pharmacological drug, surgery, or procedure. Other options can also be considered with the aid of various medical consults from specialty providers (1,3,4).  

Limited Access to IVIG  

Depending on the nature of the client’s condition requiring IVIG therapy use, clients who do not receive adequate IVIG therapy might experience a decline in their health or progression of more health complications. Since IVIG therapy is rarely a first-line therapy option, clients who do not have access to IVIG therapy might have to continue using other interventions that might not be as effective for their desired health outcomes. As a result, it is important to educate clients on the importance of consistency in their treatment regime and the risks and benefits of being on IVIG therapy (1,3,7,8).  

IVIG Therapy Special Considerations for Specific Client Populations or Conditions  

Given the wide range of uses for IVIG therapy and use in various client populations, there are special considerations to be aware of for clients of certain age groups or with certain health conditions.  

Neonates 

IVIG therapy use is becoming increasingly more common in neonatal intensive care units (NICUs) across America. Neonates can receive IVIG therapy for multiple reasons, such as for sepsis management, for alloimmune hemolytic disease (AIHD) treatment, alloimmune thrombocytopenia, infection prevention and treatment, and neonatal autoimmune conditions like neonatal lupus. While there are several studies being conducted to determine the long-term safety and efficacy of IVIG therapy in neonate populations, IVIG therapy still lacks clear, consistent guidelines and evidence-based research on its usage and effectiveness in this population. For instance, some infants might not respond well to antibiotic therapy, so IVIG therapy can bolster their immune systems and reduce the risk of sepsis. Another infant might be receiving IVIG therapy to reduce the risk of hyperbilirubinemia in infants with AIHD. However, neonatal IVIG therapy use is far different than those in pediatric or geriatric populations.  

Educating parents, caregivers, and family members about IVIG therapy is essential, especially if the doses are repeat and continue after hospital discharge. In fact, more hospitals and pediatric and neonatal critical care units are exploring the long-term effects of IVIG therapy weeks after discharge to monitor for improvement and possibly delay or eliminate the need for surgery or more aggressive treatment options. IVIG therapy in neonates also needs to be monitored very carefully, as neonates use much smaller doses, concentrations, needle sizes, infusion pumps, and monitoring parameters. The exact prevalence of neonates on IVIG therapy is not known, but IVIG therapy is still not a first-line therapy for all NICU admissions, all deliveries, or neonatal complications. Neonates must be assessed prior to administration of IVIG therapy to determine the need, extent, duration, frequency, dosage, and strength. Neonatal condition and prognosis can also determine if a neonate receives IVIG therapy (1,4,17,18,19). 

Unlike adult populations, neonates are unable to verbalize their pain or comfort levels during medical interventions. Despite this, comfort measures and pain medication can be offered and administered to neonates receiving IVIG therapy. The use of blankets, pain medications, skin-to-skin care, breastmilk or formula, dim lighting, and other interventions can be used when neonates are receiving IVIG therapy. Taking the time to educate and inform parents about these interventions is essential. Assessing neonatal pain by examining for grimacing, excessive crying, skin changing, and other factors every hour is essential when giving IVIG therapy to neonate clients.  

For instance, the NICU might have a pre-term infant at 32 weeks receiving IVIG therapy to reduce their risk of thrombocytopenia complications for at least three days. Another NICU client might have been a 41-week full-term infant receiving IVIG therapy as a result of a severe enterovirus infection, and this IVIG therapy might last a week as the infant responds to this therapy and has their health monitored. Because of the various differences in lung development, infant development, critical care, and acute monitoring needing for neonates, neonate IVIG therapy is a special population that requires a good eye to detail, clear documentation, and excellent client care (1,4,17,18,19). 

Pediatrics 

IVIG therapy use is increasingly more common in pediatric acute care settings, long-term care settings, and even homes across America. Children receiving IVIG therapy can receive this therapy for many reasons, such as infection, autoimmune conditions, or to bolster their immune system. Some children receive a single IVIG therapy dose once in an acute setting and never again. Others can receive IVIG therapy monthly for Kawasaki disease management. Because there is such a growing demand for the role of IVIG therapy long-term and need for more long-term data in pediatric populations, IVIG therapy use and guidelines remain mixed and inconclusive. Some studies suggest that IVIG therapy can be a standard in childhood immune thrombocytopenia and for the management of multisystem inflammatory syndrome, but there are still many ways to manage these conditions without the use of IVIG therapy. Trial and error remain a part of treatment option for many pediatric clients, so that is something to keep in mind when administering IVIG therapy in pediatric populations (1,19,20,21,22,23).  

IVIG therapy in pediatric populations also need to be monitored very carefully, as children use much smaller doses, concentrations, needle sizes, infusion pumps, and monitoring parameters. For instance, a teenager receiving an IVIG therapy infusion is not going to have the same dosage or needle size as a 2-year-old client. The exact prevalence of pediatric clients on IVIG therapy is not known, and IVIG therapy is still not a first-line therapy for pediatric health concerns. Pediatric clients must be assessed prior to administration of IVIG therapy to determine the need, extent, duration, frequency, dosage, and strength. Pediatric client condition and prognosis can also determine if they are a good fit for IVIG therapy (1,19,20,21,22,23). 

Unlike adult populations, neonates are unable to verbalize their pain or comfort levels during medical interventions. Despite this, comfort measures and pain medication can be offered and administered to neonates receiving IVIG therapy. The use of blankets, pain medications, skin-to-skin care, breastmilk or formula, dim lighting, and other interventions can be used when neonates are receiving IVIG therapy. Taking the time to educate and inform parents about these interventions is essential. Assessing neonatal pain by examining for grimacing, excessive crying, skin changing, and other factors every hour is essential when giving IVIG therapy to neonate clients.  

For instance, the NICU might have a pre-term infant at 32 weeks receiving IVIG therapy to reduce their risk of thrombocytopenia complications for at least three days. Another NICU client might have been a 41-week full-term infant receiving IVIG therapy as a result of a severe enterovirus infection, and this IVIG therapy might last a week as the infant responds to this therapy and has their health monitored. Because of the various differences in lung development, infant development, critical care, and acute monitoring needing for neonates, neonate IVIG therapy is a special population that requires a good eye to detail, clear documentation, and excellent client care (1,19,20,21,22,23). 

Unlike adult populations, depending on the age of the pediatric client, they might not be able to verbalize their pain or comfort levels during medical interventions. Despite this, comfort measures and pain medication can be offered and administered to pediatric clients receiving IVIG therapy. The use of blankets, pain medications, quality time with loved ones, adequate nutrition, dim lighting, and other interventions can be used when pediatric clients are receiving IVIG therapy. It is also important to educate parents and caregivers about the use of IVIG therapy if they have a child receiving this care in the health care setting as well. Taking the time to educate and inform parents about these interventions is essential. Assessing pediatric pain by examining for grimacing, excessive crying, skin changing, and other factors every two hours is essential when giving IVIG therapy to pediatric clients.  

For instance, the pediatric post-surgical unit might have a 16-year-old client on a IVIG therapy as a result of a recent sepsis infection. Another example is a 3-year-old admitted to the local pediatric emergency room for a Kawasaki disease flare-up that has persisted for several days. The communication skills, IV infusion settings, parental involvement, client involvement, and vital sign monitoring for these clients will vary significantly because of the difference in the health parameters for a 3-year-old compared to a 16-year-old. Because of the various differences in pediatric populations, pediatric use with IVIG therapy is a special population that requires a good eye to detail and comfort with pediatric client care (1,19,20,21,22,23). 

Pregnant Populations 

IVIG therapy in pregnant people is a growing concern for many health care providers nationwide, as many people have used IVIG therapy prior to pregnancy or could benefit from IVIG therapy use initiated during pregnant. While there are some guidelines for IVIG therapy use during pregnancy or during the postpartum or breastfeeding time frame, much discussion remains about the use of IVIG therapy in pregnancy. Many people who receive IVIG therapy during pregnancy do so for a wide variety of reasons, such as to help with infections or manage pre-existing autoimmune conditions. That said, while there is some literature on IVIG therapy use in this population, data is limited on the long-term effects of IVIG therapy on the fetal outcomes or pregnant person’s health overall long-term and postpartum.  

IVIG therapy is not routinely considered in pregnant people because of the possible severe side effects and possible risks to the pregnancy, but it can be administered after discussing the risks and benefits. The exact prevalence of pregnant clients who have received IVIG therapy is not known. Like all other clients, clients must be assessed prior to IVIG therapy use to determine the need, extent, duration, frequency, dosage, and strength. Consultations with prenatal, maternal-fetal medicine, and genetic specialists are also recommended when using IVIG therapy in pregnant populations (1,19,24,25).  

IVIG Therapy Use and IV Management and Complications 

When thinking about IVIG therapy, it is important as a nurse to be aware of the basics of IV management and possible complications of both IV infusions and IVIG therapy. There are various IVIG therapy formulas, doses, concentrations, and frequencies to be aware of. Like any IV medication, it is important to confirm the correct medication for the correct client at the correct dosage and time. It is also important to ensure patent IV access prior to administration of any medication and to monitor the IV site for any infection, bruising, discomfort, or infiltration. It is important to know if the IVIG therapy needs to be given via an infusion pump or set to drip at a certain rate. It is also important to be aware of any client allergies, other medication use, and pre-existing health conditions as well. Ensuring that you have all your equipment set up and IV protocol in place is essential for IVIG therapy administration (1,2,25,26,27,28,29,30). 

Telemonitoring in Inpatient and Outpatient IVIG Therapy 

With the rise of at home client care, telehealth, and remote client monitoring, several clients receive IVIG therapy in health care settings and then transition to home use. In fact, some clients never use IVIG therapy in a clinical setting and receive IVIG therapy infusions under the guidance of a home health nurse at their own at home. While telemonitoring has expanded significantly in the past decade as a result of the rise of telehealth nursing, technological advances, and more widespread insurance and Internet coverage, making sure clients are aware of the risks and benefits of IVIG therapy and IV infusions are essential to nursing care.  

While clients receiving IVIG therapy at home should routinely seek advice and guidance from their medical care provider, many times, clients and caregivers can self-monitor their reactions to IVIG therapy for emergent complications or inadequate treatment resolution. Clients should be aware that if they suspect any complications with IVIG therapy, such as trouble breathing, increased pain or discomfort, or chest pain, that they should tell the nurse immediately. Even though there are many possible complications from IVIG therapy, many clients report high levels of satisfaction with remote monitoring, such as more independence in their daily activities and less time in transit to medical appointments (1,2,3,25,26,27,28,29,30).  

Nursing Considerations 

Nurses remain the most trusted profession for a reason, and nurses are often pillars of client care in several health care settings. Clients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses’ role in IVIG therapy client education, administration, and management, here are some suggestions to provide quality care for clients receiving IVIG therapy (1,3,4,11,12,13,15,25,26,27,28,29,30). 

Obtain a History and Physical 

Take a detailed health history of the client. Often times, vital signs and history taking can be complex, especially in acute settings. Many times, IVIG therapy is started in acute settings and then transitioned to home use or less-acute settings if needed. Correct, safe, and accurate use of IVIG therapy and IV access is essential for the client’s health. As nurses, it is important to be involved in the vital signs and history taking process to learn about noticing any abnormalities or medical concerns that warrant medical attention. As nurses, we are aware that complications from IV placements can lead to rapid fluctuations in vital signs, such as respiratory rate and oxygenation levels, and IV filtration. If a client is complaining of symptoms that could be related to their IVIG therapy, such as chest pain, trouble breathing, or headaches, inquire more about that complaint.  

Clearly ask the client if they have any allergies, especially to certain adhesives or medications. IVIG therapies can be derived from various sources, making them possible to trigger an allergic reaction. Monitor their skin integrity and breathing for any changes as well.  

Regardless of how long a client has been on IVIG therapy, if the client complains of any new symptom, ask about how long the symptoms have lasted, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. If you feel like a client’s complaint is not being taken seriously by other health care professionals, advocate for that client to the best of your abilities.  

Perform a Medication Review 

Review medication history at every encounter. Often times, in busy clinical settings, reviewing health records can be overwhelming, especially for clients with a complex medical history. Several clients using IVIG therapy have a complex medical history. Millions of people take medications for various reasons, and people’s medication histories can look similar over time. Ask each client about how they are feeling on the medication, how they are feeling with their central line, if their symptoms are improving, and if there are any changes to medication history.  

Be willing to answer questions about IVIG therapy. There are many people who do not know about the side effects, risk factors to be aware of, and lifestyle changes that can influence outpatient care. Be willing to be honest with yourself about your comfort level discussing topics and providing education on IVIG therapy administration. 

Provide Client Education 

Educate the client and caregivers on IVIG therapy administration. Educate the client to inform the nurse of any redness, pain, or swelling. Take time to answer any questions about IVIG therapy and to confirm the order as well. Educate the client on the importance of infection prevention, such as washing hands regularly, wearing a mask often, and other infection prevention measures. (more on client education later) 

Collaborate with Interdisciplinary Team Members 

Communicate the care plan to other staff involved for continuity of care. For several clients, especially for clients receiving IVIG therapy, care often involves a team of nurses, specialists, pharmacies, caregivers, and more. Ensure that clients’ records are up to date for ease in record sharing and continuity of care. 

Engage in Continuing Education 

Stay up to date on continuing education related to IVIG therapy, as evidence-based information is always evolving and changing. You can then present your new learnings and findings to other health care professionals and educate your clients with the latest information.   

Client Education  

Unfortunately, it is not possible to look at someone with the naked eye and determine if they are receiving IVIG therapy. While some people might have notable complications, such as trouble breathing or sharp headaches, the most common presentation for IVIG therapy complications vary widely. In addition, nurses can answer questions and concerns regarding IVIG therapy for both clients and their caregivers. Nurses can provide quality care by completing health history, listening to client’s concerns, addressing caregiver’s concerns, and performing IVIG therapy administration and post infusion care (1,25,26,27,28,29,30). 

• Tell the health care provider of any existing medical conditions or concerns (need to identify risk factors) 
• Tell the health care provider of any existing lifestyle concerns, such as alcohol use, other drug use, sleep habits, diet, surgical history, and allergies (need to identify lifestyle factors that can influence IVIG therapy and other medical interventions) 
• Tell the health care provider if you have any changes to your body, such as pain with breathing, trouble with movement, changes in sleep habits, or increased fatigue (potential systemic IVIG therapy complication symptoms) 
• Tell the nurse of health care provider if you experience any pain that increasingly becomes more severe or interferes with your quality of life, especially if pain or discomfort is near the IV placement site 
• Keep track of your health, medication use, machine function, and health concerns via an app, diary, or journal (self-monitoring for any changes) 
• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries 
• Tell the health care provider if you notice any changes while receiving IVIG therapy (potential worsening or improving health situation)  

Research Findings 

Available Research 

There is extensive publicly available literature on IVIG therapy via the National Institutes of Health (NIH) and other evidence-based journals.  

Clinical Trials 

If a client is interested in participating in clinical trial research, they can seek more information on clinical trials from local universities and health care organizations. 

Case Study 

Wendy is a single mom to 4-year-old Susan living in a major USA city. Wendy works as a teacher and her child is in pre-school. When Wendy picks up Susan from day care, she notices that Susan appears sick. After speaking with the day care staff, Wendy learns that Susan has a low-grade fever. She decides to keep Susan home from day-care for a few days. After three days, Susan is not getting better at home, and Wendy is concerned, so she goes to the local pediatric emergency room. Susan is in the emergency room with a fever, a rash, vomiting, and irritability. After some observation and testing for a few days, the health care team informs Wendy that Susan has Kawasaki disease.  

What are some specific questions you’d want to ask Wendy about Susan’s health? 

• What are some health history questions you’d want to highlight? 
• How would you perform an initial assessment on this client? 
• How does cost influence someone’s ability to access health care services? 

After speaking with Wendy, she wants to learn more about possible progression of Kawasaki disease. She wants to know about Susan’s treatment options and if there is anything she can do to make sure she is okay, as Wendy is a single mother and on a fixed income as a teacher. Wendy is tearful and emotional, and Susan is trying to rest. The doctor on site tells Wendy that IVIG therapy is a possible treatment option for Susan. Wendy says she would like more information about IVIG therapy and if this is a safe option for children. 

• How would a nurse educate a parent/guardian in the hospital about Kawasaki disease? 
• How would a nurse educate a parent/guardian on IVIG therapy in a 4-year-old child?  
• What are some contraindications for IVIG therapy use? 
• What are some ways to assess for IVIG therapy in children? 

Wendy expresses concern about Susan on the IVIG therapy since Susan has never received medications via IV before. Susan had a difficult time when the nurse was inserting the IV, but Wendy and the nurse were able to calm her down. Wendy is emotional about the infusion, but the nurse explained the risks and benefits of IVIG therapy in children. The nurse also calms Susan with a toy and tells her that everything will be OK. With Wendy’s permission and the correct order, the nurse begins to start the IVIG therapy for Susan.  

• What are some client education talking points you would discuss with Wendy about a child receiving IVIG therapy? 
• How would you monitor vital signs in a 4-year-old receiving IVIG therapy? 
• How would you monitor for an allergic reaction to IVIG therapy in this client? 

The initial IV infusion goes well without any immediate allergic reactions or side effects. Susan’s IV site also looks well presently. Wendy asks the nurse if Susan has to take this IV infusion often now. Wendy also asks if Susan can go back to day care while receiving this medication. The nurse discusses these concerns with Wendy. Susan is admitted to the hospital for an extra day to monitor for any delayed reactions and to observe her progression with Kawasaki disease. Susan says she is experiencing some pain at the IV site when the nurse does the end of shift assessment.   

• What are some pain management options for clients receiving IVIG therapy through a PICC port compared to an IV? 
• How would you further examine an IV site for infection or other possible complications? 
• How often can a child receive IVIG therapy? 
• What are some infection prevention measures that can be in place for a child on IVIG therapy? 
• What can happen if the IV is not patent? 
• What would be your next steps as a nurse with this client? 
• What would be your pharmacological and non-pharmacological recommendations presently? 
• What are some possible complications of suddenly stopping IVIG therapy? 

Conclusion

Use of IVIG therapy often requires extensive medical care and follow-up. While IVIG therapy can be life-saving for many clients, because of the risks, a serious overview of risks and benefits must be considered prior to starting IVIG therapy. Education and awareness of different IVIG therapy options can influence the lives of many people in a healthy way.  

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