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Janet Brown-Wise
Saline back-up for Remicade and IVIG

I was wondering if it is necessary to hang a back-up bag of NS with Remicade and IVIGG in an infusion center setting where NS is readily available in the event of a reaction.  What are your policies, opinions, etc.  We're always looking to run leaner and meaner, but not at the expense of patient safety.


Janet Brown-Wise, RN


INS journal article on this issue

Here's one journal article recommending that the saline bag is actually connected to the patient as the primary fluid.
Journal of Infusion Nursing. March/April 2006.
Management of the Patient Receiving Parenteral Biologic Therapy
by Cora Vizcarra

“…Ideally, biologic agents should be infused separately via a side port or low Y-site of a primary administration set so that in the event of an acute infusion reaction, the infusion of the biologic agent can be stopped and intravenous fluids can be initiated immediately…”

In one of her blog posts, the author of that INS journal article goes into more detail about why piggybacking a biological agent into primary normal saline is preferable to simply having the NS nearby if needed.

One other thing: The prescribing information for a few brands of IVIG state incompatibility with saline; but that it is acceptable to dilute with D5W. (Examples: Gammunex, Gammagard Liquid)

/Tess M. Hopkins


Saline back-up for Remicade and IVIG

As I have talked with others I have found the practice varies.

We do not do hydration (NSS or D5W based on compatability) with our IVIG patients (about 99% are done in the home and the remainder in our AIC.

We do run hydration (NSS 500 ml at about 100 ml/hr) with our Remicade patients in our AIC.  We hang the NSS when we start the IV and run for about 10 minutes after the Remicade is complete.

Does you facility protocol say you need to run hydration?  If you would like to change the practic/protocol I would look at your history.  As you look back at the last year were there many thime you needed the hydration as part of your hypersensitivity/anaphylaxis protocol when a patient experienced one or is it rare?  That may help to determine if you feel you need to continue the practice or it is ok to change the practice/protocol within your facility, provided the hydration and tubing are readily available in your infusion room.

Ann Marie


VITALine Infusion Pharmacy

Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

Saline back-up for Remicade and IVIG



Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

We do not spike the bag or

We do not spike the bag or prime the tubing but have both available at the chairside in the event we need it.

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