Page 70 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Procedure
Administration and Monitoring Parameters
1. Prior to start of IVIG infusion, obtain baseline vital signs (blood pressure, pulse, respirations, and
temperature) and consider obtaining baseline immunoglobulin A (IgA), blood urea nitrogen
(BUN) and serum creatinine.
2. Assess patient’s volume status to ensure patient is not volume depleted. If patient appears
dehydrated, notify prescriber.
3. Begin with infusion rate no greater than 0.025 gram/kg/hour (0.5 mL/kg/hour for 10% solution).
Consider reduction in infusion rate for patients at increased risk for renal failure and/or
thromboembolic events.
 If tolerated, the infusion rate may be advanced every 15-30 minutes to maximum rate of
0.2 gram/kg/hour (2 mL/kg/hour for 10% solution)
 Maximum infusion rate for patients at increased risk for renal failure and/or
thromboembolic events is to be 0.1 gram/kg/hour (1 mL/kg/hour for 10% solution).
(Refer to Attachment B “Administration Protocols” for additional information)
 In the NICU, the provider may designate an IVIG infusion time.
4. Check patient and monitor vital signs ever 15-30 minutes (prior to advancing the infusion rate)
until the maximum infusion rate is reached. Check vital signs at least hourly after reaching the
maximum infusion rate and for at least 30-60 minutes after completing the infusion (Refer to
Attachment B “Administration Protocols” for additional rate information)
5. Obtain BUN and serum creatinine as needed to monitor renal function.
6. Monitor patient’s fluid intake and urine output during infusion and as needed
7. Immediately lower the infusion rate to the previous rate prior to onset of symptoms and notify
prescriber immediately if any of the following symptoms occur:
 Hypotension
 Headache
 Fever/chills
 Nausea/vomiting
 Chest tightness
 Diaphoresis
 Flushing
 Pruritus
 Urticaria
 Lightheadedness
 Myalgia
 Fatigue
 Hypertension
8. If patient symptoms persist, notify prescriber and lower the infusion rate further or stop
infusions as ordered until the symptoms resolve. (Refer to Attachment C “Monitoring Protocols”
for additional information.)
References

1. Dalakas MC. High-dose intravenous immunoglobulin in inflammatory myopathies: experience
based on controlled clinical trials. Neruol Sci. 2003 Oct;24 Suppl 4:S256-9.
2. Gammagard S/D Product Information Baxter Healthcare Corporation October 2009.
3. Gamunex Product Information. Talecris Biotherapeutics. Inc. October 2008.

Updated November 9, 2017 70