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Halle Utter
IVIG first dose at home

I posted this topic last week with no responses.  I would love ANY feedback about this topic.  I have been administering IVIG, various brands, in the home setting for years.  The first dose was always given at a hospital or infusion center.  Recently I have been ask to administer first doses at home.  I am uncomfortable with this.  I feel it is outside the Standard of Practice therefore if a reaction occurred I don't feel like any defense will "hold water".  The physician feels this is totally safe.  Am I just old and set in my ways, or is this a therapy that really should be administered in a controlled environment at least the first dose?  I am willing to look at the evidence and reconsider, but I really would like some feedback from other HomeCare Rns regarding whether they feel this is a safe and reasonable practice.  Thank you so much.  

Feel free to email me privately if that is your preference.  Thanks so much.


Hallene E Utter, RN, BSN

Intravenous Care, INC

[email protected]

I am not a home infusion

I am not a home infusion nurse, but I can tell you that the book, Intravenous Medications, states, "Hypersensitivity reactions have occurred; administer in a facility with a adequate equipment and supplies to monitor the patient and respond to any medical emergency." I know this drug is given in the home, and I am not sure of the emphasis that is placed on the first dose vs subsequent doses. I can tell you that the first dose is not always the risky dose. To have an allergic reaction, the patient must be exposed to the drug (antigen) so the body can create the antibody. The reaction will happen on the second or third dose. So whatever level of monitoring you decide is appropriate should be the same for all doses, not just the first dose. This book goes on to state that the incidence of anaphylaxis may be increased with repeated injections. I would suggest you do a literature search to see what has been reported with infusions of this drug in the home. I think there have been articles published about this in the Journal of Infusion Nursing. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

i have been doing ivig in

i have been doing ivig in home for 12 years. we have never given first dose at home. we do require epipen iin the home for ivig infusions.

Ann Marie
IVIG first dose at home

I work for a home infusion pharmacy and have worked at several home health agencies.  All of them had a policy the did not allow the first dose of IVIG in the home due to the risk of having a reaction to the medication.

If the patient is new on IVIG they must have 2 does in a controlled setting (hospital, MD office, clinic, AIC, etc) then they can have furhter dosing in the home.

If a patient is/hs been on IVIG and is being switched to a different product i.e Carrimune to Privigen or from IVIG to a sub q product like Vivaglobin we require a first dose of that product in a controlled setting.

Feel free to email me privately if you have further questions


Ann Marie

Ann Marie Parry RN CRNI

VITALine Infusion Pharmacy

[email protected]

I know that some of the

I know that some of the pharmacies that provide therapy for chronic pts. such as IVIG, factor, etc. will first dose IVIG at home.  Accredo is the one that comes to mind first.  If you have a local branch contact them or you could probably contact them nationally they may be able to help.  I'm sure they have certain criteria that must be met but I think they are doing it more and more often as they specialize in the therapy.

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