RHSC
Protocol 8.12
ADMINISTRATION OF INTRA-VENOUS
IMMUNOGLOBULINS
RHSC PROTOCOL 8.12
Yorkhill NHS Trust
Nursing and Midwifery Policy Committee
Protocol No:
Protocol Name:
STATEMENT:
RHSC PROTOCOL 8.12
ADMINISTRATION OF INTRA-VENOUS IMMUNOGLOBULIN
As a registered nurse, the nurse practitioner/designated nurse is personally
accountable for his/her own practice and in exercising accountability may
therefore enhance his/her practice by administering intravenous
immunoglobulins
Human Immunoglobulin is prepared from human plasma obtained from blood donors
out with the United Kingdom. The product contains antibodies against a wide range
of viruses, bacteria and toxins. Human Immunoglobulin is a sterile off-white
concentrate which when mixed with sterile water forms a slightly opaque solution for
intra-venous use. Clinical indications include replacement therapy in patients with
primary and secondary immunodeficiency i.e. hypogammaglobulinaemia,
prophylactic use in children with symptomatic HIV infection and for the prevention of
graft versus host disease and infections post bone marrow transplant.
1.0
Protocol
The nurse practitioner/designated nurse will work in partnership with medical staff
seeking their co-operation when necessary to ensure patient needs are met.
Characteristics of the nurse performing administration of intra-venous
immunoglobulins
The nurse practitioner/designated nurse must be deemed competent by:
 Having undertaken certificate in Intra-venous administration
 Completed Level 1 Safe Transfusion Practice
 Completed Intra-venous cannulation package
 Demonstrate capabilities with regards safe and competent practice
 Complete Paediatric Advanced Life Support (1 Day) Annually
The nurse practitioner/designated nurse must adhere to:
 Yorkhill Division ‘Cannulation’ Protocol;
 Yorkhill Division ‘Anaphylaxis’ Protocol;
 Yorkhill Division Nursing and Midwifery Medicine Policy
 NMC (2002) Code of Professional Conduct
 NMC (2002) Guidelines for Administration of Medicines
 Yorkhill Division PGD Supply and Administration of Emla Cream
 Yorkhill NHS Trust Laboratory Services Users Handbook
2.0
Conditions under which the Protocol can be used
1.0
The procedure must be explained to the child and parent (s) by the nurse
carrying out the procedure
1.1 Prior to the procedure the child’s health status must be checked, medical
advice must be sought if necessary
1.2 The immunoglobulin infusion must be prescribed by a Doctor (Dosage
chart overleaf) or by a Supplementary Prescriber utilising an agreed
Clinical Management Plan
1.3 The immunoglobulin must be prepared as directed by the product leaflet
1.4 Baseline bloods are taken prior to commencement of each infusion
1.5 The immunoglobulin must be administered at the prescribed rate
according to the child’s weight.
RHSC PROTOCOL 8.12
Dosage (as per Product Leaflet)
For patients with known Primary and Secondary Hypogammaglobulinaemia
Dose = 0.4g/Kg of body weight.
(see product leaflet for other indications and dosages)
New Patients
New patients require to be monitored closely their temperature, pulse, respirations
and blood pressure should be performed:
Every 15 minutes for the first hour
Every 30 minutes for two hours
Every hour until completion of the first immunoglobulin infusion



The initial infusion rate should be ultra-slow for 30 minutes, slow for 30
minutes, medium for 30 minutes and maximum till completion.
The second infusion rate should be slow for 15 minutes, medium for 30
minutes and maximum till completion
The third and subsequent infusion rates are at the maximum rate for the
duration of the infusion
The rate of administration of intra-venous immunoglobulin varies according to body
weight and previous experience of intra-venous immunoglobulin.
ULTRASLOW
SLOW
MEDIUM
MAXIMUM
Supporting Literature
3.0



4.
0.3ML/KG/HOUR
0.6ML/KG/HOUR
1.2ML/KG/HOUR
2.4ML/KG/HOUR
Technical Information Leaflet Scottish National Blood Transfusion Service
(2003)
Medicines for Children Royal College of Paediatrics and Child Health (2003)
British National Formulary (No 48, Sept 2004) Royal Pharmaceutical Society
of Great Britain
Authors
Maureen Lilley, Nurse Practitioner
Joan Marshall, Nurse Practitioner
Dr R Hague, Consultant in Infectious Diseases and Immunology
5.0
Ratification
Director of Nursing and Patient Services:
Signature: -------------------------------------
Date: -------------------------------------------
February 2005
Review February 2007