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Vascular Access team asked to infuse EUA Bamlanivimab in nursing home with no RN

I work for a mobile vascular access team that has been asked to come and start pivs and then stay and infuse the monoclonal antibody treatment that has received EUA for use in covid patients- Bamlanivimab.  I don't work for the nursing home, don't know their policies. They say they have consent and emergency anaphylaxis kits on site. Any advice or opinions? Feel like I'm being set up for failure? Or am I being overly skeptical?

Thank you all for your input. 



IMHO, this is a perfect

IMHO, this is a perfect example of why and how we cannot separate vascular access from infusion therapy - they go hand in hand. I am certain this med is being infused at clinics. Will this insertion and infusion be done in a skilled nursing facility? I would not go by "they say" without having seen the consent process, all provider orders, and the anaphylaxis kit contents. Have a written protocol for an infusion reaction so you are ready to act if these reactions occur. I don't think you are being set up for failure. I think this SNF is asking you to step up and be the infusion/VA specialist you are so that patient needs can be met. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We have administered over 100

We have administered over 100 infusions of Bamlanivumab. We are a hospital and clinic team. we have opened a second outpatient clinic to infuse monoclonals to Covid + so we don't mix them with our other infusion patients. So far we have done a "road show" to infuse at 3 SNF's and 1 congregate housing facility for the cognitively challenged. None of the patients who have received the treatment have been admitted to the hospital or have died of Covid which is an immense help not only for the patients but to our ED, ICU and med-surg departments. 
Being that we are hospital based, we have brought our own pumps, poles, drug and rescue meds. The Department of Medicine and hospitalist program is assisting community physicians in screening and at times writing orders if the community provider does not have privileges. 
we have only seen 1 mild reaction in a patient who came to our new Covid infusion center. 
if you have other questions let me know.

It is an absolute MUST that

It is an absolute MUST that you are aware of the policies they possess.  First of all, this monoclonal antibody, depending on state regs, should only be given for mild to moderate Covid pt and must be given within the first 10 days of onset/diagnosis.  This medication is not given in a hospital, but rather LTC and Home settings for the specific purpose of keeping them out of the hospital.  It really wouln't be given in an infusion clinic, as you'd infect all the other pts, unless it was specifically a COVID infusion clinic.  Because it is made from WBC's some state regualtions, like mine, disallow LPN's to give any blood or blood product, so it must be administered by a RN in ths case.   Your organization must have a written policy on its administration including how to draw it up, give it, what and when to assess the pt (like vital signs).  These policies must follow the FDA/manufacturers EUA trial directives.  (Currently, it's a 250mL bag with the Bamlanivimab added to the bag and infused with a 0.22 micron filter followed by a chaser bag run at the same rate of 25mLs. )  And yes, a Anaphylaxis Ekit must be present in the facility and without expired drugs in it.  Sometimes, the most difficult part of this is getting a line in the pt as they are so dehydrated.  Could Hypodermoclysis help them before hand? Yes, it could and it helps.  In addition, the EUA has specific variables on what constitutes an appropriate patient to receive this medication. You must assess this before hand. 

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